Hand Numbness and Stiffness: Possible Neurological Issues

Numbness and stiffness in the middle three fingers of the left and right wrists?

I have been experiencing a sensation of swelling (though there is no actual swelling) and stiffness (with a feeling of hardness) in my left and right palms, particularly in the muscles of the middle three fingers, for the past six months.
The condition began approximately six months ago, initially with numbness in my middle and ring fingers, which gradually extended to the palm area.
The sensation of stiffness and swelling is especially pronounced at night while sleeping, and at times, my palms feel as if they are numb from lack of blood.
I previously consulted two neurologists who performed an EMG test, which indicated no signs of carpal tunnel syndrome.
One of the doctors later suggested that I undergo an MRI of the brain and cervical spine to check for any signs of a stroke.
I have not yet had the MRI done, but I am very concerned about my health.
Please help with a diagnosis and provide recommendations.
I have also followed one of the doctors' advice to have tests for diabetes and thyroid function, and the results were normal.
Wishing you a Happy New Year.

Xinji Ren, 40~49 year old female. Ask Date: 2002/02/17

Dr. Huang Yingzhe reply Neurology

If both NCV/EMG indicate that it is not carpal tunnel syndrome, although the symptoms are quite similar, other conditions should still be considered.
I do not believe it is a brain-related disorder, as the symptoms are too symmetrical.
However, cervical spine disorders should be considered (although NCV/EMG should provide some clues), so cervical MRI and SSEP could be considered.
Additionally, another condition called CRPS (Complex Regional Pain Syndrome) may also be worth considering, although it would likely involve more pain.
Furthermore, it is essential to clarify whether there is any vascular obstruction in the arm.

Reply Date: 2002/02/17

More Info

Hello! It sounds like you've been experiencing some concerning symptoms with your hands, particularly numbness and stiffness, especially in the middle three fingers. Given the duration and nature of your symptoms, it's understandable that you're feeling anxious about your health. Let's break down some potential causes and considerations based on your description.

Possible Neurological Issues
1. Peripheral Neuropathy: This condition can lead to numbness, tingling, and weakness in the hands and feet. It can be caused by various factors, including diabetes, vitamin deficiencies, and certain medications. Since you've already ruled out diabetes, it might be worth considering other potential causes, such as vitamin B12 deficiency or exposure to toxins.

2. Cervical Radiculopathy: This occurs when a nerve in the neck is compressed or irritated, often due to a herniated disc or bone spurs. Symptoms can include pain, numbness, or weakness radiating down the arm into the fingers. An MRI of the cervical spine could help identify any structural issues that might be affecting the nerves.

3. Multiple Sclerosis (MS): Although you mentioned that you had EMG testing that did not indicate carpal tunnel syndrome, MS is another condition that can cause numbness and stiffness in the limbs. It’s characterized by a range of neurological symptoms due to the demyelination of nerves in the central nervous system. If you have other neurological symptoms, such as vision changes or coordination issues, this might be worth discussing with your doctor.

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

5. Anxiety and Stress: Psychological factors can also contribute to physical symptoms. Anxiety can lead to muscle tension, which might explain some of the stiffness and discomfort you're feeling. It’s important to consider the role of stress in your overall health.

Recommendations
1. Follow Up with MRI: Since one of your doctors recommended an MRI of the brain and neck, it would be prudent to follow through with this imaging. It can provide valuable information about any potential neurological issues.

2. Physical Therapy: Engaging in physical therapy might help improve your symptoms. A physical therapist can work with you on exercises to enhance mobility and reduce stiffness.

3. Lifestyle Modifications: Ensure you are maintaining a healthy lifestyle, including a balanced diet rich in vitamins and minerals, regular exercise, and good sleep hygiene. These factors can significantly impact your overall health and may help alleviate some of your symptoms.

4. Stress Management: Consider incorporating stress-reducing techniques into your routine, such as mindfulness, meditation, or yoga. These practices can help manage anxiety and may improve your physical symptoms.

5. Regular Monitoring: Keep a close watch on your symptoms. If they worsen or new symptoms arise, seek medical attention promptly.
6. Consult a Neurologist: If your symptoms persist or worsen, it may be beneficial to seek a second opinion from another neurologist, especially one who specializes in peripheral nerve disorders.

Conclusion
Your symptoms warrant further investigation, and it’s good that you are being proactive about your health. While it’s easy to become anxious about potential diagnoses, focusing on the steps you can take to understand and address your symptoms will be beneficial. Remember to communicate openly with your healthcare providers about your concerns and any changes in your symptoms. Wishing you a happy and healthy New Year!

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