Question for docs - numb hand?

[Hetmann]

Went to see my doc today. Got his answer, but what say you?

My right hand goes numb sometimes when I'm sleeping or riding my bicycle. What causes this? Is it lack of circulation or a pinched nerve? Happens fairly frequently. Is this something to worry about and what would you do?

Always my right hand. Oh, and keep it scientific fellas.

[legion]

No stranger?

[cgarr]

too much keyboard and mouse fella!

[Noah930]

Carpal tunnel syndrome? Could be a couple other possibilities, but this is at the top of the differential.

[dentist90]

What do you do for a living (repetitive strain scenario?)
Is there any discoloration of your hand/fingers when this happens? (clue that it would be vascular)

[BlueSkyJaunte]

You gotta give Mother Thumb and her four daughters a little rest once in a while.

[GWN7]

I've stayed at a Holiday Inn.............. The nerve between c6 and c7, if pinched, can cause tingling, numbness, or even severe pain all the way down your right shoulder, upper arm, elbow, forearm, and hand.

I was talking to my buddy the bone cruncher when I read your post and asked him.

[Shuie]

Carpal/Radial tunnel syndrome.

[Tobra]

I would say more likely spine than wrist if it is after sleeping and riding the bike.

[Eric Coffey]

Dunno, but if you got your answer from your PC doc, I'd probably request a neuro referral and get a NCV/EMG test to confirm.

[sc_rufctr]

Most likely a pinched nerve.

But because it's your right hand only it's probably not in your spine.

Shoulder/Elbow/Wrist/ injury?

[IROC]

I had a similar problem about a year ago - my pinky and ring fingers on my right hand would go numb on occasion. In my case, the cause was obvious as it was accompanied by the horrific pain of a pinched nerve in my neck. C6 and C7 sounds about right.

[sammyg2]

The bicycle thing is prolly caused by pressure on a nerve, but the sleeping thing reminds me of something that happened years ago when I had back surgery.

I'd wake up from the demmoral induced sleep and half my hand would be numb.
This went on for several days. They did MRI's and all kinds of diagnostics trying to discover if somehow the nerves to my hand were damaged by the surgery or if i had a spinal infection or whatever.

Turns out the drugs were knocking me out so well that I'd fall asleep on my back with my hands folded on my chest and wouldn't budge until the drugs wore off several hours later.
With my elbow cocked like that it reduced the blood flow to my hand and basically put it to sleep.

The doctor told the nurse to change my sleeping position if she observed me sleeping on my back like that, problem went away.

Figure out of you are sleeping with your elbow contracted past 90 degrees, that should be an easy possibility easy to rule out.

[Noah930]

Exactly sammy: not enough information to tell. Could be carpal tunnel, or cubital tunnel (like you had), or cervical radiculopathy. Those would be the most likely culprits. Which is why the OP should go with what his doctor says, instead of fishing for guesses on the internet.

[Superman]

In Abnormal Psychology, we were told that the nerves serve portions of the hand, but that no nerve serves the whole hand. Numbness in the heel of the hand, extending through the two smallest fingers suggests a nerve problem. Or maybe a numb thumb. But if someone reports numbness from the wrist down, nerve problems will not explain that.

[Hetmann]

Thanks for your replies. My doc suspects carpal or cubital tunnel. I always thought extremities went to sleep from lack of circulation. Being past 50 I've had my share of bumps and bruises, so who knows maybe something is damaged as well. This condition is not particularly painful, more annoying than anything.

[notmytarga]

Lots of docs helping out here!

sammyg - the situation you describe sounds like your ulnar nerve was being compressed at the elbow while you were in the hospital bed - happens more often with non-obese males because of the lack of padding, the elbow's 'carrying angle' and that men assume the position you described. Getting up and around and/or elbow pads do the trick. But you got the $5000 workup to address something that an anesthesiologist would just know.

Carpal tunnel syndrome affects the median nerve at the wrist and thus will affect the index, middle and 1/2 of the ring finger. There are exam tests (tapping on the ligament that covers the nerve) that can pin it down but Electromyography and Nerve conduction studies help pin point the level of compression. Other situations mentioned above such as cubital tunnel syndrome, Reynauds syndrome etc could be the cause - but your depth of symptoms was rather limited. Which fingers? Any symptoms above the wrist?

Prior to jumping to surgery (simple and effective) see an occupational therapist - there are exercises and stretches that can help alot. Wearing a wrist brace may help but I would go for surgery before becomeing dependent on a brace 24/7.

The stretches are of the wrists and fingers. All tendons that flex(grab) your fingers go through the same space with the nerve. Do a search.

[Noah930]

Originally Posted by Superman

But if someone reports numbness from the wrist down, nerve problems will not explain that.

Yes and no. The median nerve (involved in carpal tunnel syndrome) innervates the thumb, index finger, middle finger, and radial half of the ring finger. The ulnar nerve (involved in cubital tunnel syndrome) innervates the ulnar half of the ring finger and the small finger. So purely anatomically, you're correct that glove-like paresthesia is anatomically unlikely. (Of course, that doesn't take into account the 15% of people that have Martin-Gruber anastamoses between the median and ulnar nerves in the hand. Maybe those people don't follow the perfect dermatomal distributions expected from textbooks.)

But (here's the "no" part of my response) patients are often not savvy enough to present with a complaint of which fingers, specifically, go numb. They just know their hand(s) goes numb. Now, upon questioning and examining the patient they may then realize that some fingers seem to bother them more than the others. But that's not always present, whether it's because the diseases didn't read the textbook and present in typical fashion, or because the patient isn't discriminatory enough to realize that only part of the hand is actually symptomatic.

The history sometimes helps. Carpal tunnel very typically presents itself at night, for example. Exam helps. Which fingers go numb? Is there a Tinel's sign at the wrist? Or at the elbow? Is there a Phalen's sign, Durkan's sign, or flexed elbow sign on exam? Is there any dryness to the skin of the fingers? Is there any hand atrophy? Are there any symptoms when the neck is placed through a range of motion? And usually electrodiagnostic studies (EMG/NCV) of the upper extremities are obtained to help confirm the diagnosis.

[sammyg2]

Originally Posted by notmytarga

Lots of docs helping out here!

sammyg - the situation you describe sounds like your ulnar nerve was being compressed at the elbow while you were in the hospital bed - happens more often with non-obese males because of the lack of padding, the elbow's 'carrying angle' and that men assume the position you described. Getting up and around and/or elbow pads do the trick. But you got the $5000 workup to address something that an anesthesiologist would just know.

.

LOL seemed really simple now but it took a few days and lots O'spensive stuff to figure out. Prolly needed a better ana .... anastese... uh sleep doc.
I didn't know if it was a nerve or blood flow thing so I just guessed.

At the time I was 25 years old, 6'2" 195# and was a total gym rat lifting almost every day with a BFI of single digits, so the non-obese thing was right on.
Back then at least

[sammyg2]

BTW do they call it the funny bone because it's the humorous?
ba da bump.