Numbness in the hands is a common
problem amongst those aged between 40 – 60 years. It can be mildly annoying or
disabling, and sometimes is accompanied by severe pain. It usually means a
nerve is constricted, and should never be ignored, as permanent nerve damage
with loss of sensation and strength may result if left untreated.
he most common conditions causing
numbness in the hands are carpal tunnel syndrome and cubital tunnel syndrome.
Carpal tunnel syndrome causes
numbness, tingling or burning pain in the thumb, index, middle or ring fingers.
The median nerve, which is the main nerve providing sensation to the hand, goes
through a narrow space in the wrist, called the carpal tunnel.
In some people, especially women,
this space is narrower, and any increase in the pressure within this space will
decrease blood flow to the median nerve, causing it to malfunction. Gripping an
object tightly, using a mobile phone or even holding up a newspaper can also
trigger these symptoms.
Shaking the hands vigorously
usually relieves the symptoms. Over time, the ability to feel becomes worse and
the thumb muscles may become weak and waste away, resulting in difficulty
performing simple tasks like doing up buttons or picking up coins. Out of every
1000 people, 3-5 will develop carpal tunnel syndrome.
People who do a lot of repetitive
work with their hands such as production line workers and homemakers, and those
who work long hours at the computer keyboard with poor posture are at greater
risk.
Pregnant women are also
susceptible due to water retention. It is also common among diabetics, those
with renal failure, hypothyroidism and rheumatoid arthritis.
Early or mild carpal tunnel
syndrome can be treated by keeping the wrist in a brace especially when
sleeping, and avoiding postures and activities that increase the pressure
around the nerve.
Non-steroidal anti-inflammatory
medication, high dose Vitamin B6 and steroid injections around the nerve may
also provide temporary relief. The best long-term solution is to permanently
decompress the nerve.
This involves a surgical
procedure to cut the bands of tissue constricting the nerve. It is commonly
done with a long, 3-5 cm incision in the palm. This takes about 2 weeks to
heal, and there is pain and weakness for 3-4 months, during which time use of
the hand is limited. This procedure can now be performed through minimally
invasive surgery (MIS), with a 1cm incision at the wrist, guided by a video camera.
Because the wound is miniscule and not in the palm, the hand can be used for
most daily activities the very next day after surgery. Pain and weakness are
less, lasting only 1-2 months.
Meanwhile, Cubital tunnel
syndrome is less common, but causes more disability. This condition affects
younger adults, especially those who do repetitive work with the elbows bent
most of the time. It may also affect older people with arthritis in the elbow.
The symptoms of this are numbness
in the small and ring fingers, along with clumsiness and difficulty
straightening these fingers. They are usually worse in the morning, and when
doing activities requiring prolonged elbow flexion.
Over time, sensation in these
fingers can be lost completely, and the small muscles of the hand can become
completely paralysed, weakening the whole hand and making it difficult to
manipulate small objects such as keys.
This is caused by constriction of
the ulnar nerve, which is the main nerve to the small muscles of the hand. It
goes through the cubital tunnel, a narrow space behind the elbow and under the
forearm muscles en route to the hand.
This is the “funny bone” that
causes tingling in the fingers when the inner part of the elbow is knocked
against a hard surface. Some people have a narrower space or thick bands of
tissue going across the nerve, making them more prone to constriction.
The treatment is similar to
carpal tunnel syndrome, except that the elbow instead of the wrist needs to be
rested and exercised. Surgery is recommended if symptoms do not resolve after 3
months of conservative treatment. A complete ulnar nerve release around the
elbow usually requires a 10cm long incision to do it safely. However, with MIS
techniques, the ulnar nerve can be safely released through a 2-3cm incision
hidden behind the elbow. Pain is much less, and the arm can be used for most
daily activities the very next day.
MIS nerve decompression, when
performed by a hand surgeon experienced in these techniques has proven to be as
safe as traditional open surgery, with much faster recovery of function, less
postoperative pain and a faster recovery. More than 90% of carpal tunnel
syndrome and 80% of cubital tunnel syndrome cases are cured if decompressed
within 6 months of noticing the symptoms.
Andrew Yam
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