Most of us have woken up in the morning, or even in the middle of the night with our hand or arm asleep. What does it mean? Numbness and tingling (sensation of pins and needles) usually means some kind of a nerve problem.
Many of us sleep in a fetal position, with our wrists flexed (bent) for prolonged periods of time.
In the middle of the wrists lies the median nerve, which supplies sensation to the thumb, index, middle, and half of the ring finger. When it is compressed, then we feel numbness and tingling in that distribution. The compression is usually very temporary; the nerve is not receiving blood supply.
When the wrist is straightened, and shaken, the blood flow returns, and the feeling usually resolves after a few seconds. If, however, the feeling takes a long time to resolve, there may be a condition called Carpal Tunnel Syndrome. This is the most common compression neuropathy, and it initially presents with numbness and tingling in those 3 and half fingers.
As the condition progresses, pain and hand weakness develop.
A different nerve, called the ulnar nerve, supplies the pinky, and the other half of the ring finger. When an elbow is bent for a long time, symptoms of numbness and tingling will be felt there. Once the elbow is straightened, the blood flow returns, and the sensation resolves.
Again, if the symptoms take a long time to resolve, or not at all, then a condition called Cubital Tunnel Syndrome may be present. The ulnar nerve at the elbow (funny bone) is affected.
Both of these nerves can also be squeezed at other parts of the arm, from the shoulder down to the wrist. Also, there are some less common compression neuropathies, that will cause symptoms in other parts of the extremity. The radial nerve at mid-arm can be compressed if there is prolonged pressure. This is called “Saturday Night Palsy”.
The best diagnostic test is electromyography (EMG), and nerve conduction studies.
A trained and experienced physician will be able to find the problem, figure out the extent, and discuss treatment options. The compression neuropathies can be mild, moderate or severe.
Treatments can range from conservative management such as therapy and bracing, to injections, to surgical correction.
The best recommendation is not to wait too long if the numbness and tingling keep recurring.
The earlier the diagnosis is made, the better the prognosis and outcome will be.
