Hand pain, numbness and tingling is a common symptom of both carpal tunnel syndrome and cervical spine issues. It can be hard to tell the difference between the two problems. Sometimes a careful exam and assessment is required by a hand and/or spine specialist. This article will discuss the cause, symptoms and treatment of each diagnosis. It will also review some ways to tell the difference between them.
CARPAL TUNNEL SYNDROME
Carpal tunnel syndrome occurs when the median nerve is compressed. The median nerve travels through the wrist. It controls feeling and sensation in the thumb, index finger, middle finger and part of the ring finger. Compression of this nerve can cause numbness, tingling, pain and sometimes weakness in these areas (green shaded area in picture). The pinky and remaining part of the ring finger are usually spared. Pain can occasionally occur in the forearm and even up into the shoulder. Some patients may complain of clumsiness. Symptoms of carpal tunnel syndrome are usually worse at night or with repetitive activity with that hand and wrist.
Cervical radiculopathy occurs when a cervical nerve in the spine is compressed. The cervical nerves travel through the spine. There are eight cervical nerves. Each cervical nerve controls sensation and motor activity in different areas of the face, neck, arms, and hands. Compression of one of these nerves can cause radiating pain, numbness or weakness in the area that nerve controls. Neck pain is not always present. Patients often complain of electric, shooting pain down their arm(s). They may also feel numbness or tingling in specific parts of their arm(s) or hand(s). Weakness can also occur anywhere from shoulder to fingers. As you can see from the figure to the right, multiple cervical nerves (C6: lime green, C7: orange, and C8:brown) can all cause these symptoms in the hand when compressed. Cervical radiculopathy can be due to a disc herniation or degeneration of the spine.
It is very important to figure out which is the cause of a patient’s hand pain/numbness/tingling. To do this, a physical exam is performed to assess the median nerve (to look for carpal tunnel syndrome) and the cervical nerves (to look for cervical radiculopathy). Sometimes it is obvious which condition the patient has. In these cases, the diagnosis can be made clinically. Other times, it is hard to tell the difference with just a history and physical exam alone. If this is the case, a test called an electromyogram (EMG) can be very helpful in making the correct diagnosis. An EMG helps to identify the location of the compressed nerve causing the symptoms in the hand. If the EMG indicates an issue with the median nerve, no further testing is required. If the EMG indicates an issue with a cervical nerve, a Magnetic Resonance Imaging (MRI) is usually performed next. The MRI helps to assess the extent of compression. It also helps to evaluate exactly where in the spine the problem is occurring. This information can be important for determining the best treatment or surgery options.
The treatment for carpal tunnel syndrome and cervical radiculopathy follow a similar course but it is important to make sure you are treating the correct condition. Conservative treatment is tried first for both diagnoses. For carpal tunnel syndrome, a night splint that keeps your wrist still while sleeping can be helpful to reduce symptoms. NSAIDS (i.e. Ibuprofen, Naprosyn) or steroid injections can be used to reduce inflammation around the nerve. If these do not improve a patient’s symptoms, surgical intervention may be required. For cervical radiculopathy, steroids taken by mouth, physical therapy, NSAIDS or steroid injections can be used to reduce inflammation around the nerve. If appropriate conservative treatment options do not improve a patient’s symptoms for either of these diagnoses, surgical intervention may be required.
If you are experiencing any of the above symptoms, call Three Rivers Orthopedics at 412-782-3990. Our team of orthopedic surgeons would be happy to help you alleviate your pain.
By Bethany Wink PA-C