Monday, December 18, 2017

I've Got This Feeling, Inside My Hands?

By Dr. R. Greg Lusk, DC

My recent DIY project of replacing the flooring on the main level of my house has made me keenly aware of the nerves that run down our arms. I'm well underway, nearly done in fact, but at some point after the demolition part of the project I began waking up in the morning with partial hand numbness. Looking down while pulling out thousands of staples that secured the quarter inch plywood sub-floor, beneath the vinyl I removed, may have had something to do with it. The numbness would go away easily at first with a change of position but then it became more persistent. Recently, it was accompanied by a burning sensation and a deep ache that drove me out of bed at 5 AM. That was the final straw that made me consult with a colleague for some treatment.
 
I've experienced these sort of symptoms previously, often preceded by increased, repetitive physical work. Some of you may be able to relate. Now, if they don't go away with some rest, treatment may be considered and paying attention to your symptoms can help your therapist identify the area(s) of your body that need treatment. For instance, location of symptoms is quite informative as three separate nerves provide sensation to your hand. Also, are symptoms felt above the wrist, elbow, or shoulder, or is there even neck discomfort? All nerves down the arms ultimately stem off the spinal cord at the level of the lower neck and upper back so that area could be the ultimate source of symptoms. Alternatively, a nerve can become irritated, or entrapped we call it, by soft tissues (i.e. muscles, fascia, ligaments, tendons) somewhere along its path as it makes its way down the arm. What's important to realize is that where you feel symptoms in the arm or hand may not be where your problems lie. Let's look at sensation of the hand to illustrate this.

As mentioned, three nerves supply the skin of the hand with feeling - the median, ulnar, and radial nerves. Looking at your hand with the palm up, the median nerve covers the palm side of your thumb, index, middle, and the half of your ring finger that is closest to your middle finger. This is the nerve that passes through the carpal tunnel so carpal tunnel syndrome involves pain or altered sensation in this area. However, this nerve also runs down the front of your arm and forearm and may become irritated by other soft tissues there (e.g. the biceps muscle/tendon). The ulnar nerve supplies the other half of the ring finger and the pinky, on both the palm side and back of the hand. It does not go through the carpal tunnel but runs down the inside of the forearm from the elbow, where it can commonly get compressed if you lean on your "funny bone". The last nerve is the radial, which runs down the back of the arm and forearm, providing back of the hand sensation to most of the thumb, index, middle, and the half of the ring finger closest to the middle finger. Clearly, these nerves all have different paths to the hand and different tissues to examine for possible involvement. This is in addition to their ultimate origin, the neck, as well as muscles around the neck (e.g. scalenes) and the chest (i.e. pec muscles) which they pass through or under en route to the hand.

So, if you have symptoms in your arm or hand that are not resolving on their own, pay attention to some of these specifics. The details will aid your therapist in providing an accurate diagnosis, intervention, and hopefully timely relief of your symptoms. This article is for general information purposes only and is not to be taken as professional medical advice.