Houston Methodist. Leading Medicine

Hand FAQ

Question:

I've been going through a series of tests trying to figure out why I have numbness and tingling in my hands at night. They don't think I have carpal tunnel syndrome, but they aren't sure what it is yet. Why is this so hard to nail down?

Answer:

Numbness and tingling in the fingers and hands from an unknown cause is often a signal that the sensory nerve to that area is being pinched or compressed. The condition is referred to as a compressive neuropathy. Nerve injury or damage of this type can occur as a result of trauma - the nerve gets pinched (compressed), crushed, cut, or stretched. Chronic nerve compression can also develop as a result of degenerative conditions or health problems like diabetes and chronic alcohol abuse that lead to nerve damage. Diagnosis and treatment of compressive neuropathies have presented quite a challenge to physicians. The best treatment is always one that provides a cure for the problem. But what we understand about how nerves function and what's happening biologically at the cellular level in these injuries is very limited right now. In fact, we only really have theories and models of what scientists think is going on to use when planning treatment. Part of the problem is that there are so many different parts to the nerve that could be affected. For example, there's the lining around the nerve and the connective tissue between the lining and the nerve. There are individual nerve cells that could be damaged. The nerve can be injured anywhere from where it connects to the spinal cord all the way down to where the nerve integrates with the skin or muscle it communicates with. Treatment and prognosis vary depending on which part of the nerve is damaged and how severe is the damage. But it's not like a cut on the finger that can be seen and a bandaid applied. You can't see the nerves. They can't be X-rayed. So how does the physician diagnose the problem? Well, first the patient's history and symptoms help identify which nerve is affected. Sensory or motor changes (or both) provide helpful information. Then a series of tests are applied. Some of these are simple nerve tests performed by the physician. Others are more technical involving nerve and muscle testing. The test results help point to which nerves are affected and the specific area of the nerve. It's really more of a process of elimination and deductive reasoning than a quick aha! Minal Tapadia, JD, MA, et al. Compressive Neuropathies of the Upper Extremity: Update on Pathophysiology, Classification, and Electrodiagnostic Findings. In Journal of Hand Surgery. April 2010. Vol. 35-A. No. 4. Pp. 668-677.

*Disclaimer:* The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.
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