Tingling hands, or numbness in the hand is a common source of patient discomfort. There are two major causes – carpal tunnel syndrome and cervical nerve compression.
Yet the crossover in symptoms can make it hard to make the correct diagnosis.
Up to 30% of patients sent to me with an initial diagnosis of cervical nerve root compression reveal, upon deeper examination, it is carpal tunnel.
This is a simple summary to help you diagnose the cause, though as always if in doubt do refer. Especially as patients often endure the symptoms for many months before visiting their GP. Nerve compression can eventually become irreversible if untreated for an extended period.
Carpal Tunnel Syndrome
Patient history: typical symptoms
- Tingling in the palm of the hands and often wakes them up at night. They might shake their wrist to relieve their symptoms.
- During the day it can be brought on by repetitive holding actions. For example a steering wheel on longer drives, or a computer mouse.
Cervical Root Compression
Patient history: typical symptoms
- Pain starts in the shoulder and runs down to the hand. The patient should be able to identify tingling in specific fingers.
- Any tingling on the back of the hand is more likely from the neck.
- The symptoms are more likely to be triggered by movements of the head or neck. Looking over the shoulder is a classic.
- Sometimes symptoms are relieved by raising the affected hand above the head.
- Can also wake them up at night but shaking the hand will not relieve symptoms.
A mixed picture
Often the histories overlap, with patients presenting with a mixture of symptoms.
Cervical nerve root damage could be both back of the hand or the palm. Carpal Tunnel syndrome is only palm side.
Weakness of elbow or wrist could well be cervical root damage, but it will not be carpal tunnel syndrome.
Localised pain to the shoulder or behind the shoulder blade is cervical root damage. But pain up the arm to shoulder could be both.
Tests to confirm
A pressure test on the carpal ligament should confirm the syndrome.
If still not sure the following can help:
- Nerve conduction study of the hand
- An MRI of the neck to see if there is nerve damage. Though be mindful that older patients will naturally have some decay of the spinal bones. It could still be carpal tunnel syndrome.
Treatment
For carpal tunnel syndrome simple things are recommended first. A cock-up wrist splint worn at night usually provides pain relief for carpal tunnel. Other non-surgical treatments include cortisone injection to the wrist.
If still no improvement, refer to a hand surgeon.
If cervical nerve damage is likely then refer to a spinal surgeon for a more extensive diagnosis.
You can view the recording of my webinar on Tingling Hands here.
And as always if you have any questions about a patient, please feel free to call me on 02 9650 4893. I will return your call and discuss how we can help.
You can also reach me via ralphstanford@powspine.com.au.
Further Resources for Referrers include:
- Spinal Fusion surgery
- Foot Drop
- Why I only operate when it makes a difference to my patient's quality of life
- The limited role of cortisone injections for spinal conditions
- Cervical myelopathy – a disease of the spinal cord that may pass unnoticed
- Cervical Radiculopathy – shooting pains from the neck
- Back pain and how to manage it
Dr Ralph Stanford is a spinal surgeon with over 20 years’ experience. He is adept in all surgical approaches to successfully treat his patients.
As a teacher Dr Ralph Stanford is Conjoint Senior Lecturer at the UNSW; Supervisor of Training for Orthopaedic Trainees, Prince of Wales Hospital; and Education Secretary for the Spine Society of Australia.
As a researcher and scientist, he is a well-published author and Honorary Senior Scientist at Neuroscience Research Australia (NeuRA). He is also a current member of Spinal PFET.
Posted 10 January 2022
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