My
recent DIY project of replacing the flooring on the main level of my house has
made me keenly aware of the nerves that run down our arms. I'm well underway,
nearly done in fact, but at some point after the demolition part of the project
I began waking up in the morning with partial hand numbness. Looking down while
pulling out thousands of staples that secured the quarter inch plywood sub-floor,
beneath the vinyl I removed, may have had something to do with it. The numbness
would go away easily at first with a change of position but then it became more
persistent. Recently, it was accompanied by a burning sensation and a deep ache
that drove me out of bed at 5 AM. That was the final straw that made me consult
with a colleague for some treatment.
I've
experienced these sort of symptoms previously, often preceded by increased,
repetitive physical work. Some of you may be able to relate. Now, if they don't
go away with some rest, treatment may be considered and paying attention to
your symptoms can help your therapist identify the area(s) of your body that
need treatment. For instance, location of symptoms is quite informative as
three separate nerves provide sensation to your hand. Also, are symptoms felt
above the wrist, elbow, or shoulder, or is there even neck discomfort? All
nerves down the arms ultimately stem off the spinal cord at the level of the
lower neck and upper back so that area could be the ultimate source of
symptoms. Alternatively, a nerve can become irritated, or entrapped we call it,
by soft tissues (i.e. muscles, fascia, ligaments, tendons) somewhere along its
path as it makes its way down the arm. What's important to realize is that
where you feel symptoms in the arm or hand may not be where your problems lie.
Let's look at sensation of the hand to illustrate this.
As
mentioned, three nerves supply the skin of the hand with feeling - the median,
ulnar, and radial nerves. Looking at your hand with the palm up, the median
nerve covers the palm side of your thumb, index, middle, and the half of your
ring finger that is closest to your middle finger. This is the nerve that
passes through the carpal tunnel so carpal tunnel syndrome involves pain or
altered sensation in this area. However, this nerve also runs down the front of
your arm and forearm and may become irritated by other soft tissues there (e.g.
the biceps muscle/tendon). The ulnar nerve supplies the other half of the ring
finger and the pinky, on both the palm side and back of the hand. It does not
go through the carpal tunnel but runs down the inside of the forearm from the
elbow, where it can commonly get compressed if you lean on your "funny
bone". The last nerve is the radial, which runs down the back of the arm
and forearm, providing back of the hand sensation to most of the thumb, index,
middle, and the half of the ring finger closest to the middle finger. Clearly,
these nerves all have different paths to the hand and different tissues to
examine for possible involvement. This is in addition to their ultimate origin,
the neck, as well as muscles around the neck (e.g. scalenes) and the chest
(i.e. pec muscles) which they pass through or under en route to the hand.
So,
if you have symptoms in your arm or hand that are not resolving on their own,
pay attention to some of these specifics. The details will aid your therapist
in providing an accurate diagnosis, intervention, and hopefully timely relief
of your symptoms. This article is for
general information purposes only and is not to be taken as professional
medical advice.
