Presented by: Amy Ladd, MD
Professor, Orthopaedic Surgery
Stanford University Medical Center
April 29, 2010
- Numbness in hands is usually caused by irritation or compression of a nerve in the arms, hands, or fingers.
- Repetitive movements can put pressure on the nerves of the wrist and elbow, causing numbness, tingling, or pain.
- Certain movements can inflame the tendons, which also can put pressure on the nerves.
- Most conditions are treated initially with simple measures, such as a splint or brace.
The hand is composed of many different bones, muscles, and ligaments that enable a large amount of movement and dexterity. Most of the time its movements do not cause problems, but symptoms do arise from everyday wear and tear, certain medical conditions, or overuse.
“The hand is an amazing feat of nature. From everyday tasks to complex maneuvers, the hand demonstrates exquisite capabilities,” said Amy Ladd, MD, a professor of orthopaedic surgery who specializes in treating the hands and upper limbs, at a presentation sponsored by the Stanford Health Library. “And when it doesn’t work, life is hard.”
There are several common causes of hand numbness and pain. Some of the conditions are so common that Ladd said that sometimes she only needs to ask about the basic symptoms to have a good idea of the problem.
The carpal tunnel is a narrow, rigid passageway of ligament and bones at the base of the hand that houses the median nerve and tendons. Carpal tunnel syndrome occurs when the median nerve becomes pressed or squeezed at the wrist, causing numbness, weakness, tingling, or pain, particularly in the thumb and first three fingers. Swollen hands are a common sign of carpal tunnel syndrome.
“Think of the median nerve as a rubber hose or a piece of pasta,” said Ladd. “When you pinch it or stretch it, it becomes compressed.”
People who use their hands repeatedly and forcefully, such as laborers, assembly line workers, or meatpackers, often develop the syndrome because of injury to the wrist. Women are more likely to develop carpal tunnel syndrome, perhaps because of fluid retention due to hormones or because the carpal tunnel itself may be smaller than men’s.
Contrary to popular belief, carpal tunnel syndrome is not caused by computer use, although it can be the result of poor posture at the workstation or by resting the wrists on the computer pad, which causes constant pressure on the wrists.
Numbness and swelling in the hands can also be caused by inflamed tendons, a condition called tendonitis. Tendons are bands of connective tissue that attach muscle to bone that can expand and push into the median nerve when they become overused. The tendons are tightly packed, so tendonitis and nerve compression are usually closely associated.
Pain is subjective, so if the symptoms bother you it’s time to see a doctor, advised Ladd. A hand specialist will assess the visible signs and arrange for additional nerve tests if necessary. The goal is to reduce the swelling and pressure on the median nerve, which usually restores normal function of the wrist and hand. Initial treatment usually involves the use of a splint or brace, and steroids or anti-inflammatory drugs may be used to reduce inflammation.
“Exercise and physical therapy do not often work because the nerve is already compressed,” she said. “If it doesn’t get better after using a splint, it’s better to do the surgery sooner than later.”
Cubital tunnel syndrome symptoms usually include pain, numbness, and tingling in the ring finger and little finger caused by increased pressure on the ulnar nerve at the elbow, commonly known as the “funny bone.” The nerve lies directly next to the bone, so pressure on the elbow also puts pressure on the nerve. The syndrome occurs when the pressure on the nerve is significant and sustained.
“Cubital tunnel syndrome is often caused by leaning on your elbows,” said Ladd. “Your mother was right about keeping your elbows off the table.”
It also arises in musclebound athletes, bicyclists who exert pressure on the ulnar nerve at the wrists, and in people who sleep in positions with a bent elbow that pinch or stretch the nerve. Like carpal tunnel syndrome, the condition is usually first treated by using a brace to break the habit of constantly bending and putting pressure on the elbows. Surgery to shift the location of the nerve or to pad the elbow with more fatty tissue may help relieve the pressure on the nerve.
Another condition caused by damage to the tendons is called trigger finger, in which a finger or thumb gets stuck in a bent position and then straightens-like a trigger being pulled and released. Trigger finger is caused by a narrowing of the sheath that surrounds the tendon in the affected finger. It affects people over age 50 who work with their hands (like crafts or sewing) and is also provoked by using plastic bags to carry heavy loads.
The condition is treated with a splint to extend the finger and may respond to steroid injections, although Ladd warned against multiple injections, which can weaken tendons. Surgery is recommended when other tactics do not work or the finger remains stiff, she said, and is often the best chance of getting a positive result.
“Most people get more than one trigger finger,” Ladd said. “If you get one, you tend to get another.”
De Quervain’s tenosynovitis causes pain and swelling near the base of the thumb. Also called New Mom Syndrome, it is caused by an inflammation of the tendons from overuse (such as lifting a newborn baby). This condition is treated by immobilizing the wrist with a splint, taking medications, or surgery in more serious cases. More than 90 percent of cases improve after treatment with a splint and injections, said Ladd
Tennis elbow is an overuse injury caused by repeated contraction of the forearm muscles used to straighten and raise the hand and wrist. A poor tennis backhand, repetitive lifting of luggage or a briefcase, or painting can result in inflammation in the tendons that attach the forearm muscles to the bone at the outside of the elbow.
Tennis elbow is usually treated with a splint or physical therapy, since injections tend to be less successful in reducing pain symptoms.
“When someone has trouble lifting a coffee cup, it’s almost always tennis elbow,” said Ladd. “The best treatment is to stretch, strengthen, and re-educate.”
About the Speaker
Amy Ladd, MD, is a professor of orthopaedic surgery (hand surgery) and, by courtesy, of medicine (immunology & rheumatology) and of surgery at Stanford University Medical Center. She is chief of the Robert A. Chase Hand Center at Stanford and chief of the Pediatric Hand and Upper Limb Clinic at Lucile Packard Children’s Hospital. A renowned hand surgeon, Ladd also studies and treats congenital hand anomalies in children. Ladd received her MD from State University of New York and did her orthopaedic residency at the University of Rochester School of Medicine. She completed a hand fellowship at Brigham and Women’s Hospital and Boston Children’s Hospital.
For More Information:
About Dr. Ladd
Orthopaedic Surgery and Sports Medicine Clinic
Stanford Department of Orthopaedic Surgery
National Institutes of Health / Hand injuries