Persistent Hand Numbness: Causes and Treatment Options

The issue of hand numbness has persisted for nearly a year without improvement?

Hello, doctor.
I work in the food service industry and frequently use my hands.
I often experience numbness in my hands when lifting heavy objects.
My dominant left hand often wakes me up at night due to numbness, making it difficult to sleep.
The numbness and pain extend to my entire arm and the inner side of my elbow.
My right hand also experiences numbness, but it's not as severe as my left hand.
I have seen various specialists, and X-rays showed no issues with my bones.
I was referred from orthopedics to rehabilitation, where they suggested electrical therapy, but it was ineffective.
Later, I visited a neurologist and underwent neurophysiological testing, which showed no signs of nerve compression.
I was told I have carpal tunnel syndrome and advised to wear a wrist brace and rest more, but that was a hasty conclusion.

I later discovered that I experience pain when tilting my head back; I can't tilt it very far due to soreness in the back of my neck.
When I slightly tilt my head back and move it side to side, I feel pain and hear a cracking sound.
I frequently have shoulder and neck pain, and many doctors have mentioned that my muscles are very tight.
I also experience pain in my shoulders, neck, upper back, lower back, and frequently in the area just behind my heels—not the soles, but directly behind them.

I would like to know what other methods I can use to determine the underlying cause of my hand numbness.
Could it be related to my neck? Which specialty should I consult, and what kind of tests should I undergo? The pain in my entire back and the pain behind my heels have been troubling me for 10 years.
Sometimes the symptoms are less noticeable, but when they flare up, I can't stand for long periods.
I have worn a lumbar support brace; how can I address the root cause of this issue?

Miss Jian, 20~29 year old female. Ask Date: 2022/06/09

Dr. Jiang Junyi reply Neurology

Dear Ms.
Chien,
You mentioned, "What other methods can be used to determine the underlying cause of my hand numbness? Could it be related to my neck?" Common symptoms of peripheral nerve compression include pain, numbness, and weakness.
Peripheral nerve examinations can typically utilize electrophysiological tests to assist in diagnosis.

Nerve conduction studies assess the conduction velocity and waveform of large fiber nerves.
Electromyography (EMG) evaluates the muscle response in the areas supplied by the nerves.
It is advisable to consult a neurologist specializing in peripheral nerves, as they have more experience with EMG diagnostics.
Additionally, your multiple pain complaints may warrant consideration of fibromyalgia, a complex clinical syndrome that may be related to an imbalance of neurotransmitters in the central nervous system.
The primary symptoms include chronic widespread pain and tenderness, along with other systemic symptoms and comorbidities such as fatigue, insomnia, headaches, gastrointestinal symptoms, depression, and anxiety.
These distressing symptoms often impact the quality of life for patients, leading to significant disability.
Thank you for your inquiry.
If you have further questions, please feel free to discuss them.
Wishing you good health and peace.
Sincerely,
Dr.
Chien-Yi Jiang
Neurology, Taoyuan Hospital

Reply Date: 2022/06/09

More Info

Persistent hand numbness can be a complex issue, especially when it is accompanied by pain and discomfort in other areas of the body, such as the neck, shoulders, and back. Given your history of working in the restaurant industry, where repetitive motions and heavy lifting are common, it is understandable that you might experience these symptoms.

Possible Causes
1. Nerve Compression: Even though your nerve conduction studies did not show signs of nerve compression, conditions like carpal tunnel syndrome or ulnar nerve entrapment can still occur. These conditions can cause numbness and tingling in the hands, especially if there is prolonged pressure on the nerves.

2. Cervical Spine Issues: Your description of neck pain and limited range of motion when looking up suggests that there may be issues with your cervical spine. Conditions such as cervical radiculopathy, where nerve roots are compressed or irritated in the neck, can lead to symptoms radiating down the arms.

3. Muscle Tension: Chronic muscle tension in the neck and shoulders can contribute to nerve irritation and pain. This is often exacerbated by poor posture, especially in jobs that require repetitive motions or prolonged periods of standing.

4. Repetitive Strain Injury (RSI): Given your occupation, it is possible that you are experiencing RSI, which can lead to inflammation and pain in the muscles and tendons of the hands, wrists, and forearms.

5. Systemic Conditions: Conditions like diabetes or thyroid disorders can also lead to peripheral neuropathy, which may cause numbness and tingling in the extremities.

Recommended Diagnostic Steps
To further investigate the root cause of your symptoms, consider the following steps:
1. Consult a Neurologist: Since you have already seen a neurologist, it may be beneficial to seek a second opinion or consult a specialist in neuromuscular disorders. They may recommend additional imaging studies, such as an MRI of the cervical spine, to check for any herniated discs or other abnormalities.

2. Physical Therapy: Engaging in physical therapy can help address muscle imbalances and improve posture. A physical therapist can provide exercises to strengthen the neck and shoulder muscles, which may alleviate some of the tension contributing to your symptoms.

3. Ergonomic Assessment: An ergonomic assessment of your workspace can help identify any adjustments that can be made to reduce strain on your body. This may include changes to your workstation setup or recommendations for lifting techniques.

4. Pain Management: If your pain is significant, a pain management specialist may offer options such as injections or medications to help manage your symptoms while you pursue other treatments.

5. Lifestyle Modifications: Incorporating regular breaks during work, stretching exercises, and proper body mechanics can help reduce the strain on your muscles and nerves.

Treatment Options
1. Physical Therapy: As mentioned, physical therapy can be invaluable in addressing muscle tension and improving overall function. Techniques such as manual therapy, ultrasound, and electrical stimulation may be used.

2. Medication: Non-steroidal anti-inflammatory drugs (NSAIDs) can help manage pain and inflammation. If nerve pain is significant, medications like gabapentin or pregabalin may be prescribed.

3. Cervical Support: If cervical spine issues are confirmed, a cervical collar or support may be recommended to help alleviate pressure on the nerves.

4. Surgery: In cases where conservative treatments fail and there is significant nerve compression, surgical options may be considered.

5. Alternative Therapies: Techniques such as acupuncture, massage therapy, or chiropractic care may provide relief for some individuals.

Conclusion
Persistent hand numbness and associated pain can stem from various underlying issues, including nerve compression, cervical spine problems, and muscle tension. A comprehensive approach involving proper diagnosis, physical therapy, ergonomic adjustments, and possibly medication can help manage your symptoms effectively. It is essential to communicate openly with your healthcare providers about your ongoing symptoms and any changes you experience, as this will guide them in providing the most appropriate care for your situation.

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