Related to numbness in hands: Tingling in Hands | Hand Numbness and Tingling | What Is Carpal Tunnel Syndrome? | Numbness in Feet

Numbness in hands: the wrist gets blamed, but it isn't always the wrist

Numbness in hands can start at the wrist, at the elbow, in the neck, or from something bothering nerves all over the body at once. Which one it is changes the treatment completely. Knowing how the common patterns differ, what an exam with our team involves, how the treatment choices compare, and which warning signs shouldn't wait will save you a lot of guessing.

Most people describe it the same way at first. A hand that feels asleep, buzzing, thick, or like it belongs to someone else. Maybe you shake it out at 3 a.m. and it fades. Or you've started dropping your keys and you're not sure why.

Your story, plus a map of which fingers are involved, usually points us to the right nerve and the right spot along it.

The short version on numb, tingling hands

What You Should Know:

Why a squeezed nerve tingles before it goes numb

Think of a nerve as a bundle of tiny wires wrapped in insulation, with its own small blood supply. Pressure on that bundle slows the traffic inside it.

Early on, the wires misfire. That's the pins and needles, the buzzing, the electric feeling when you tap the wrong spot. As pressure keeps up, signals start to drop instead of misfire, and the fingers feel dull or dead.

Weakness is the symptom we take most seriously. Many people recover sensation well once the pressure is relieved, though a nerve squeezed hard for a long time may not come all the way back.

Comparing the usual sources of numbness in hands

No two of these patterns feel quite the same, and that's useful. Before your visit, pay attention to which fingers are involved, whether the back of your hand is affected, what time of day it's worst, and what position sets it off. Here's how the most common sources tend to line up, and where they overlap.

Patterns blur, of course. Someone can have a cranky neck and a tight carpal tunnel at the same time, and that mix is one reason we'd rather examine you than sort it out over the phone.

The second wrist tunnel most people have never heard of

The ulnar nerve can also get pinched at the wrist, on the small finger side of your hand. Steady pressure on the heel of the palm can squeeze it there.

Cyclists know this one well. After long rides, the small and ring fingers can feel numb or clumsy, which is why it picked up the nickname handlebar palsy. It also shows up in people who lean on a cane or a walker, use vibrating tools, or rest their palms on a hard desk edge all day.

Telling a wrist pinch from an elbow pinch is something we sort out in the exam.

Padded gloves, a change in grip and hand position, and breaks during long rides can help, and we can tell you whether a splint makes sense. If symptoms stick around or the hand feels weak, come in.

When the hand is numb but the problem is in your neck

The nerves that run your arm and hand start as roots leaving the spine in your neck. When a disc bulges or arthritis narrows the opening a root travels through, the hand can go numb even though the neck itself barely hurts.

Several clues push us to look higher up, at the neck, instead of stopping at the wrist. None of them settles the question alone, but when two or three of them show up together in the same arm, the neck moves to the top of our list. Watch for these:

• Numbness that runs as a band from the neck or shoulder blade down the arm
• Symptoms that change when you turn, tip or extend your neck
• Aching in the shoulder or upper back alongside the hand symptoms
• Weakness in the shoulder, elbow or wrist, not only in the hand
• Numbness in both hands along with clumsiness, trouble with buttons or handwriting, or a change in balance and walking

That last one matters most. Clumsy hands paired with balance trouble can mean pressure on the spinal cord itself, and it deserves a prompt evaluation rather than a wait-and-see month. Nerves can also be irritated in more than one spot at once. That muddies the picture, and it's another reason an exam beats guesswork.

Causes that have nothing to do with a pinched nerve

Not all numbness in hands is mechanical. Diabetes is a well known reason nerves misbehave, and low vitamin B12 or an underactive thyroid can do it too. These tend to build gradually and show up in both hands and both feet, in that glove and sock pattern, often with burning at night.

An underactive thyroid is interesting because it works both ways. Fluid changes from a thyroid problem can crowd the carpal tunnel, so it's worth checking.

A few things make a tight carpal tunnel more likely in the first place. Pregnancy and other fluid shifts can crowd the space. An old wrist fracture or dislocation can change the shape of the joint. Rheumatoid arthritis and other inflammatory types of arthritis, and higher body weight, can play a part too. Plenty of people with numb hands have none of these, though, and carpal tunnel can show up in anyone.

Blood flow is a separate story. When small vessels in the fingers clamp down in response to cold or stress, the fingertips can turn pale or dusky, feel numb, then throb and tingle as they warm back up. That color change is the tell. Sores that don't heal, or fingers that stay discolored, need medical attention promptly. And if a hand or a set of fingers suddenly turns cold, white or blue and becomes painful, weak or numb, that can mean a blocked artery. Go to an emergency department right away instead of booking a routine visit.

These causes often need lab work and care alongside your primary doctor. We're glad to help figure out which lane you're in.

What actually happens when you come in

We start with your story, because it carries more weight than most people expect. Which fingers, what time of night, which activities, how long it's been going on, and whether anything has gotten weaker.

Then we examine you. We check feeling finger by finger, test the small muscles of the hand, look at the muscle pad below your thumb, and press or tap along the nerve at the wrist and the elbow to see what brings on your symptoms. We'll look at your neck too.

Carpal tunnel can often be diagnosed from the history and exam, and we'll tell you if nerve testing would add anything. It tends to help most when the picture isn't clear. Bring a list of your medications and any lab work you've had recently.

If surgery is on the table, here's the recovery picture

Carpal tunnel release gives the nerve room, and we'll walk you through how we'd do it in your case.

Recovery varies from person to person and depends on the kind of work you do. We'll go over what to expect for your situation before anything is scheduled.

After surgery, we'll tell you whether a splint or therapy makes sense for you.

Things worth trying while you wait for your appointment

None of this replaces an exam, and none of it treats a cause we haven't found yet. Still, these small adjustments are low risk, and some people notice a difference once they stick with them. Pick the ones that match your pattern.

• If you already have a wrist splint, wearing it at night with the wrist straight may help; bring it to your visit so we can check the fit
• Stop sleeping with your elbows fully folded; a soft sleeve or a loosely wrapped towel around the elbow can break the habit
• Quit resting your inner elbow on the car door, the desk edge or a hard armrest
• Set your keyboard and mouse so your wrists stay level, and drop your shoulders while you type
• Use padded gloves or thicker grips on bikes and tools, and shift hand positions often on long rides
• Take short breaks from vibrating equipment instead of powering through
• Keep your hands warm if cold sets off color changes and numbness
• Keep blood sugar and thyroid care on track with your primary care doctor

Let's find out what your hands are telling you

Feeling that's been off for a while often improves once the pressure comes off the nerve, and earlier is generally better than later. If your hands have been waking you up, or the small finger side has gone quiet, or you're just tired of guessing, our hand and upper extremity team is here for you.

Schedule Exam with Princeton Orthopaedic Associates and let's get you answers.

The information here is general education, not medical advice for your specific situation.

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This blog post is meant to be informative and should not act as a self-diagnosis tool. If you’d like to see one of our doctors, please contact us here.