Persistent Hand Pain: Causes and Next Steps for Diagnosis

Numbness and pain in the hands?

My mother, who is 52 years old, has been experiencing chronic numbness and pain in both hands.
Last year, she underwent carpal tunnel surgery on her right hand (she was afraid to have both hands done at once, so only one was operated on), but the numbness and pain have not improved.
The discomfort extends from her shoulders to her fingers, and she often wakes up at night due to the pain and cannot fall back asleep while lying flat.
Her fingers (the middle and ring fingers) tend to curl and cannot be straightened, and her palms feel tight and shiny.
She experiences pain in her shoulder joints during certain elevated movements of her hands.
Recently, she has also noticed weakness in her hands, making it difficult for her to make a fist or even pull the covers at night.
What kind of examinations should she undergo to determine the cause of her symptoms?

Xiao Lu, 30~39 year old female. Ask Date: 2007/02/09

Dr. Ye Boshou reply Neurology

First, determine whether the condition is caused by shoulder arthritis or cervical nerve compression; neurological examination and nerve conduction studies will be helpful.

Reply Date: 2007/02/09

More Info

Understanding persistent hand pain, especially after a surgical intervention like carpal tunnel release, can be quite complex. Your mother’s symptoms, including persistent pain, numbness, and weakness in both hands, suggest that there may be underlying issues that were not fully addressed by the initial surgery. Here’s a detailed exploration of potential causes and recommended next steps for diagnosis.

Potential Causes of Persistent Hand Pain
1. Residual Carpal Tunnel Syndrome: Even after surgery, some patients may continue to experience symptoms due to incomplete decompression of the median nerve or the presence of scar tissue that can irritate the nerve.

2. Cervical Radiculopathy: Pain and numbness that radiates from the neck down to the arms can be caused by nerve compression in the cervical spine. This can lead to symptoms similar to carpal tunnel syndrome, including weakness and pain in the hands.

3. Thoracic Outlet Syndrome: This condition occurs when blood vessels or nerves in the space between your collarbone and your first rib are compressed. Symptoms can include pain, numbness, and weakness in the arms and hands.

4. Complex Regional Pain Syndrome (CRPS): This is a chronic pain condition that can develop after an injury or surgery. It is characterized by prolonged or excessive pain and changes in skin color, temperature, and swelling in the affected area.

5. Tendonitis or Tenosynovitis: Inflammation of the tendons in the wrist or hand can lead to pain and stiffness, particularly with movement.

6. Rheumatoid Arthritis or Other Autoimmune Conditions: These conditions can cause joint pain and stiffness, particularly in the hands and fingers. Given your mother’s age, it may be worth considering these diagnoses.

Recommended Next Steps for Diagnosis
1. Consultation with a Specialist: Given the complexity of her symptoms, it would be beneficial for your mother to see a hand specialist or an orthopedic surgeon who focuses on upper extremity issues. They can provide a comprehensive evaluation and determine if further intervention is necessary.

2. Neurological Examination: A thorough neurological examination can help assess the function of the nerves in the arms and hands. This may include tests for sensation, strength, and reflexes.

3. Electromyography (EMG) and Nerve Conduction Studies (NCS): These tests can help determine if there is ongoing nerve damage or compression. They measure the electrical activity of muscles and the speed of nerve conduction.

4. Imaging Studies: An MRI of the cervical spine may be warranted to check for any nerve compression at the neck level. Additionally, an MRI of the wrist can help visualize any soft tissue issues, such as scar tissue or tendon problems.

5. Physical Therapy: Engaging in a structured physical therapy program may help improve her symptoms. A physical therapist can provide exercises to strengthen the muscles and improve flexibility, which may alleviate some of the pain.

6. Pain Management Consultation: If the pain is severe and persistent, a consultation with a pain management specialist may be beneficial. They can offer various treatment options, including medications, nerve blocks, or other interventions.

Conclusion
Persistent hand pain after surgery can be frustrating and debilitating. It’s essential to approach this issue comprehensively, considering both neurological and orthopedic evaluations. By following the recommended steps, you can help ensure that your mother receives the appropriate care and treatment to address her ongoing symptoms. Early intervention and a multidisciplinary approach are key to improving her quality of life and functionality.

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