Persistent Hand Numbness and Muscle Atrophy: Which Specialist to See? - Family Medicine

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Numbness in the hands during sleep + muscle atrophy?


I have been experiencing numbness in both hands while sleeping for the past year.
Three months ago, I visited a neurologist and underwent nerve conduction studies, which showed normal results.
I also had a cervical X-ray, and the doctor mentioned that my cervical spine is slightly straightened, but it should not be compressing any nerves.
Recently, I noticed muscle atrophy in both the palms and the backs of my hands.
I went back to the neurologist, who suggested I see a rehabilitation specialist.
However, the rehabilitation doctor could not identify a specific issue.
I would like to ask which specialty I should consult for this situation.

Jie, 40~49 year old female. Ask Date: 2022/06/28

Dr. Lin Zhebin reply Family Medicine


Hello: Based on your description of numbness in both hands and muscle atrophy, and having ruled out cervical nerve compression, it is possible that you have carpal tunnel syndrome.
If you consult a neurologist, they can arrange for relevant nerve and muscle tests to assist in the diagnosis.
If you see a rehabilitation specialist, they can provide non-invasive treatments and assistive devices.
If surgical intervention is necessary, you may consider consulting a neurosurgeon or an orthopedic surgeon.

Reply Date: 2022/06/28

More Info


Persistent hand numbness and muscle atrophy can be concerning symptoms that significantly impact daily life. Given your situation, it’s essential to approach this issue methodically to identify the underlying cause and receive appropriate treatment.

Firstly, it’s important to understand that persistent numbness in the hands, especially when accompanied by muscle atrophy, can stem from various conditions. These may include nerve compression syndromes (like carpal tunnel syndrome), peripheral neuropathy, cervical spine issues, or even systemic conditions affecting muscle and nerve function. Since you have already undergone nerve conduction studies and cervical X-rays, and the results were normal, it suggests that the issue may not be straightforward.

Given the complexity of your symptoms, here are some recommendations on which specialists to consult next:
1. Neurologist: Since you have already seen a neurologist, it might be beneficial to return for a follow-up. A neurologist can conduct a more comprehensive evaluation, including advanced imaging studies like MRI of the cervical spine or brain, if necessary. They can also assess for other neurological conditions that may not have been considered initially.

2. Physical Medicine and Rehabilitation (PM&R) Specialist: Also known as physiatrists, these specialists focus on rehabilitation and physical therapy. They can help develop a tailored rehabilitation program to improve muscle strength and function. They may also provide insights into whether your symptoms could be related to musculoskeletal issues or require specific therapeutic interventions.

3. Orthopedic Surgeon: If there is a suspicion of structural issues in the cervical spine or if there are concerns about joint or muscle problems, an orthopedic surgeon specializing in the upper extremities or spine might be appropriate. They can evaluate for any potential surgical interventions if conservative treatments do not yield results.

4. Rheumatologist: If there is a possibility of an autoimmune condition or systemic disease affecting your muscles and nerves, a rheumatologist could be consulted. They specialize in conditions like rheumatoid arthritis, lupus, and other inflammatory diseases that can cause muscle weakness and atrophy.

5. Occupational Therapist: An occupational therapist can help you with strategies to manage daily activities and improve hand function. They can also provide exercises tailored to your specific needs and help with adaptive techniques to cope with muscle weakness.

6. Pain Management Specialist: If your symptoms are accompanied by pain, a pain management specialist may help address this aspect, providing treatments such as injections, medications, or alternative therapies.

In addition to consulting these specialists, consider the following steps to manage your symptoms:
- Physical Therapy: Engaging in a structured physical therapy program can help strengthen the muscles in your hands and arms, improve coordination, and reduce the risk of further atrophy.

- Ergonomic Adjustments: Evaluate your daily activities and workspace for ergonomic improvements. Proper posture and hand positioning can alleviate strain on your muscles and nerves.

- Regular Monitoring: Keep a detailed record of your symptoms, including any changes in numbness, strength, or function. This information can be invaluable for your healthcare providers in diagnosing and treating your condition.

- Lifestyle Modifications: Ensure you are maintaining a balanced diet rich in vitamins and minerals that support nerve and muscle health, such as B vitamins, vitamin D, and omega-3 fatty acids. Regular, low-impact exercise can also promote circulation and overall well-being.

In conclusion, your persistent hand numbness and muscle atrophy warrant a thorough evaluation by a specialist who can address the multifaceted nature of your symptoms. By consulting with the appropriate healthcare providers and engaging in a comprehensive treatment plan, you can work towards improving your condition and enhancing your quality of life.

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