Category Archives: Pinched nerve tingling hand

common symptom complex due to nerve entrapment


OA is the most common form of arthritis and affects more than 20 million adults.  It’s been estimated that by the age of 70 almost all people have OA to some extent.

OA is a disease of articular cartilage, the gristle that caps the ends of long bones.  Cartilage is a complex substance consisting of two basic materials: collagen and proteoglycans and one type of cell- the chondrocyte.  Cartilage provides shock absorption as well gliding functions.

With OA, there is premature wear and tear that occurs as a result of a metabolic abnormality that causes the chondrocyte to produce destructive enzymes.  There is a complex interplay of the cartilage, the synovium (lining of the joint), and the subchondral bone (the bone that lies underneath the cartilage. The result is premature wear and tear as well as local inflammation.

While OA is primarily a condition that affects weight-bearing joints such as the neck, low back, hips, and knees, it also affects other areas such as the hands and feet, particularly in women.

Risk factors for the development of OA include genetics, trauma (injury to the joint), and weight in the case of weight-bearing areas such as the low back and knees.  There is less evidence that weight plays a role in inducing OA of the hips.  However, once OA in the hips is present, weight plays a key role in making the symptoms worse.

Symptoms of OA include morning stiffness lasting less than one-half an hour, stiffness during the days with prolonged sitting, crepitus (crunching sounds that accompany joint movement), pain, and joint swelling. Joint fluid, called an “effusion” can develop.

As osteoarthritis progresses, it becomes harder for patients to limber up and to move without pain.

Diagnosis is usually suspected by history and physical examination.  While confirmation can be obtained by x-rays, unfortunately, by the time x-ray changes occur in OA, it is late in the course of disease.

While magnetic resonance imaging is much more sensitive for making the diagnosis, because of expense, it is often not used.

Laboratory tests are usually negative or normal.

Current forms of treatment for this condition are inadequate.

While advising a patient who is heavy to lose weight and exercise is admirable and necessary, it is an admonition that is usually ignored.

In addition, other measures such as analgesic medications (pain killers), non-steroidal anti-inflammatory drugs, physical therapy, bracers, and injections of glucocorticoids and viscosupplements provide only temporary and palliative relief.

Ultimately, patients will go on to get knee replacements.

In a recent report, Madonna Behan writing for Healthday reported, “The number of new-knee procedures doubled over the last decade, reached more than 620,000 in 2009, and the researchers said younger patients — those 45 to 64 — accounted for a disproportionate amount of that growth. In addition, researchers “estimate that nearly 53 percent of men and 52 percent of women diagnosed with symptomatic knee [osteoarthritis] will receive a total knee replacement in their lifetimes.”

Knee replacement surgery is not an innocuous procedure with the potential for complications such as infection, excessive bleeding, blood clots, worsening pain after the procedure, nerve damage, and death.

So what else can be done?  Attempts to find a pharmacologic solution, so-called disease modifying anti-osteoarthritis drugs (DMOADS) have been disappointing at best.

The most promising new development is the use of autologous mesenchymal stem cells.  These are adult stem cells found within many areas of the body including the bone marrow, fat, deciduous teeth, and periosteum of bone.

Anecdotal reports and small uncontrolled studies in both animal models as well as humans appear promising as a method for slowing down the rate of cartilage loss in knee OA and possibly even allowing for cartilage regeneration.

(Wei N, Beard S, Delauter S, Bitner C, Gillis R, Rau L, Miller C, Clark T. Guided Mesenchymal Stem Cell Layering Technique for Treatment of Osteoarthritis of the Knee. J Applied Res. 2011; 11: 44-48)

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Pinched nerve tingling hand

Nerves are the roadways that lead from the brain and spinal cord to the rest of the body.  They carry electrical impulses that allow both the capacity to feel things as well as the ability to move body parts.

A pinched nerve refers to a nerve that becomes compressed.  In the neck that pressure can be due to a bulging or herniated disc or arthritis.

However, nerves that travel out to the rest of the body, often referred to as the “periphery”, get pressure as a result of other reasons.

There are three major nerves that travel into the hand, They are the median nerve, the ulnar nerve, and the radial nerve.

Pressure on the radial nerve causes burning and numbness in the top of the hand and involves the thumb and first two fingers.

Pressure on the ulnar nerve leads to numbness and tingling of the fourth and fifth fingers.

Probably the most common cause of this problem- the technical term is “entrapment neuropathy”- is carpal tunnel syndrome (CTS).

The carpal tunnel is located on the palm side of the wrist.  The floor and sides of the carpal tunnel are formed by the eight wrist bones and the roof of the tunnel is a tough piece of fibrous tissue, called the transverse carpal ligament.

carpal-tunnelThrough this tunnel pass the flexor tendons to the fingers (these tendons are responsible for helping bend the fingers) as well as the median nerve.

CTS occurs when there is undue pressure on the median nerve.  This may occur as a result of many conditions including repetitive stress, trauma (such as fractures), arthritis (rheumatoid arthritis, psoriatic arthritis, gout, and pseudogout are among the more common ones), thyroid disease, growth hormone excess, obesity, diabetes, and pregnancy.  Most of these conditions cause swelling within the carpal tunnel which leads to pressure on the median nerve.

When the median nerve becomes compressed, there is slowing or blocking of nerve impulses traveling down the nerve.  This leads to loss of both sensory function (being able to feel things) as well as motor function (weakness in the muscles innervated by the median nerve).

Symptoms include numbness, burning, and tingling in the fingers, with gradual weakness in the hand.

Patients will often try to “shake” the numbness out of their fingers.  Since symptoms are present often at night, patients will also say they drape their hands over the side of the bed to get relief. Daily activities may be affected.  For example, buttoning can become difficult.  Patients may drops things. There may also be a sensation of swelling in the fingers, even though swelling is not present on exam.

Other activities that seem to bring on the symptoms include driving, holding a book, or any other activities requiring prolonged bending of the wrist or prolonged grasping.

Symptoms are pronounced in the fingers innervated by the median nerve.  These are the thumb, index, middle, and thumb side of the fourth finger.

Symptoms from CTS can also radiate up the arm as high up as the shoulder.  This causes difficulty in establishing the diagnosis.

As the condition progresses, atrophy of muscles innervated by the median nerve occurs. This can lead to permanent nerve and muscle damage.

The diagnosis can be made clinically.  However, it should be confirmed using electrical nerve conduction tests.  There is a small percentage of people who have CTS but who have normal electrical studies.

Diagnostic ultrasound and magnetic resonance imaging (MRI) can also be used for diagnostic purposes.

Early treatment consists of splinting, vitamin B6, and rest.carpal-tunnel-splint

Glucocorticoid (“cortisone”) injections can also be used.

Surgery, either endoscopic or open, has been the usual procedure of choice, with carpal-tunnel-surgery-healedall the attendant risks of surgery.carpal-tunnel-surgery

However, recently, there is a new technique that has been used with much success- ultrasound guided needle release.  With this procedure, a small needle is introduced using ultrasound guidance.  Fluid is injected to disrupt the fibers of the transverse carpal ligament. The cutting edge of the needle is then used to gently cut through the fibers. This weakens the transverse carpal ligament rather than cuts it open entirely.  One of the problems associated with regular surgery is that the integrity of the transverse carpal ligament is lost when completely severed.  That does not occur with the needle technique. Recovery takes one day.

For more information about this procedure, go to or call 301 694 5800.

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