Managing Hand Numbness in Fibromyalgia: Seeking the Right Specialist

Fibromyalgia and hand numbness?

Hello, doctor.
I have been suffering from hand pain and numbness for about three years.
Initially, I was examined at two major hospitals in central Taiwan, and they both indicated issues related to autoimmune rheumatic arthritis.
I was on medication for nearly a year without any improvement.
Earlier this year, they told me it was neither autoimmune arthritis nor seronegative arthritis.
I am currently being treated at a medical center in central Taiwan, where the doctor diagnosed me with fibromyalgia, based on my medical records from 2019.
There have been no new blood tests or examinations since the diagnosis.
I experience pain in my fingers that makes it difficult to grip a toothbrush or wring out a towel.
While the medication has alleviated some pain, the numbness in my hands has not improved at all.
I have also been referred to a neurologist and consulted with an orthopedic specialist, both of whom suspect carpal tunnel syndrome.
However, the medications prescribed have had no effect.
The orthopedic doctor mentioned there might be an issue with my neck, but I am unsure what to do next.
The numbness in my hands is making it nearly impossible for me to work.
Could you please advise me on which specialty I should consult for my hand numbness issue? Thank you.

Miss Zhong, 50~59 year old female. Ask Date: 2022/04/24

Dr. Gao Jiankai reply Internal Medicine

Hello, thank you for your question.
The numbness you are experiencing is likely not related to fibromyalgia; it seems more probable that it is due to carpal tunnel syndrome.
Carpal tunnel syndrome can be confirmed through neurological examinations while ruling out cervical spine issues.
I recommend that you consult a neurologist for a final confirmation.

Numbness can be a challenging issue to resolve; however, once carpal tunnel syndrome is confirmed, wearing a wrist brace can help alleviate the symptoms.
I suggest that after confirming carpal tunnel syndrome, you visit a rehabilitation specialist to have a brace fitted.
You should wear it at night and remove it during the day while working.
Additionally, combining this with medication should help reduce your symptoms.

Best regards from the Allergy, Immunology, and Rheumatology Department of Changhua Hospital, Ministry of Health and Welfare.

Reply Date: 2022/04/24

More Info

Managing hand numbness, especially in the context of fibromyalgia, can be quite challenging due to the multifaceted nature of the condition. Fibromyalgia is characterized by widespread musculoskeletal pain accompanied by fatigue, sleep disturbances, and cognitive difficulties. Patients often report symptoms such as hand numbness and pain, which can be exacerbated by stress, physical activity, or even changes in weather. Given your history of consultations with various specialists, it’s crucial to approach this issue systematically.

First, it’s important to understand that while fibromyalgia itself does not cause nerve damage, it can lead to symptoms that mimic neuropathy, such as numbness and tingling. This can sometimes confuse the diagnostic process. Since you have already seen rheumatologists, neurologists, and orthopedic specialists, it may be beneficial to revisit the neurologist, particularly one who specializes in pain management or fibromyalgia. They can conduct a thorough neurological examination and possibly recommend nerve conduction studies or electromyography (EMG) to assess for any underlying nerve issues, such as carpal tunnel syndrome, which is common in patients with fibromyalgia.

In addition to seeking further neurological evaluation, consider consulting a pain management specialist. These professionals are trained to address chronic pain conditions and can offer a multidisciplinary approach, which may include physical therapy, occupational therapy, and possibly cognitive behavioral therapy (CBT). Physical therapy can help improve strength and flexibility in your hands and arms, while occupational therapy can provide strategies to manage daily activities without exacerbating your symptoms.

Moreover, since you mentioned that medications have provided some relief for pain but not for numbness, it may be worth discussing with your healthcare provider the possibility of adjusting your medication regimen. Some patients with fibromyalgia benefit from medications such as gabapentin or pregabalin, which are often used to treat nerve pain. Additionally, antidepressants like duloxetine or milnacipran have been shown to help with both pain and fatigue in fibromyalgia patients.

Lifestyle modifications can also play a significant role in managing symptoms. Regular low-impact exercise, such as swimming or walking, can help improve overall function and reduce pain. Stress management techniques, including mindfulness, yoga, or tai chi, can also be beneficial in managing fibromyalgia symptoms.

Lastly, consider the importance of a supportive healthcare team. Since fibromyalgia is a complex condition, having a team that communicates effectively and collaborates on your care can lead to better outcomes. Don’t hesitate to advocate for yourself and express your concerns about the numbness and its impact on your daily life and work.

In summary, I recommend the following steps:
1. Revisit a neurologist, preferably one with experience in fibromyalgia.

2. Consider consulting a pain management specialist for a multidisciplinary approach.

3. Discuss potential adjustments to your medication regimen.

4. Engage in physical and occupational therapy.

5. Implement lifestyle modifications to manage symptoms.

By taking these steps, you can work towards finding the right specialist and treatment plan that addresses your hand numbness and overall fibromyalgia management.

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