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.
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.
Glucocorticoid (“cortisone”) injections can also be used.
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 www.arthritistreatmentcenter.com or call 301 694 5800.
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