Do Your Hands Fall Asleep at Night

Many people complain about numbness in their fingers and hands especially while sleeping. Others complain about numbness in their hands and fingers while working. One reason for this could be Carpal Tunnel Syndrome. I know many of you have either heard of the term or know someone who has been diagnosed with it. There are different factors that could lead to these symptoms.

Anatomy

Let’s break down the anatomy of the arm and see what the possibilities are that could lead to the numbness and tingling in your fingers and hands. Pictured above are the musculature, arteries (red lines), and the nerves (yellow lines). As you can see, there are many nerves that run down your arm with a major bundle of them near the shoulder region. There are 3 major nerves in your arm that start at the brachial plexus and run down to your fingertips. The brachial plexus is a group of nerves that come from the spinal cord in the neck and travel down the arm. These nerves control the muscles of the shoulder, elbow, wrist and hand, as well as, provide feeling in your arm. The Radial nerve which lies on the thumb side of your arm, the ulnar nerve which runs down through your funny bone and along the pinky side of your arm, and then there is the median nerve which runs down the middle of your arm. The median nerve is the nerve responsible for the Carpal Tunnel symptoms. A typical Carpal Tunnel is where the median nerve is compressed or damaged at the wrist. However, that does not always have to be the case, as you can see the nerve is a long structure that passes through or alongside many muscles. This can cause entrapment at the forearm, elbow, and even biceps region. The Carpal Tunnel is a narrow passage at the wrist that allows nerves, arteries, and tendons to pass into the wrist. This passage has little room to move or stretch. If inflammation begins to accumulate at the wrist, it puts pressure on the Median nerve thus causing numbness/tingling. The nerve provides feeling in the thumb and index, middle, and ring fingers. The nerve also controls the muscles around the base of the thumb.

Cause

Most cases of carpal tunnel syndrome are caused by a combination of factors. Studies show that women and older people are more likely to develop the condition. Other risk factors for carpal tunnel syndrome include:

• Heredity. This is likely an important factor. The carpal tunnel may be smaller in some people or there may be anatomic differences that change the amount of space for the nerve—and these traits can run in families.

• Repetitive hand use. Repeating the same hand and wrist motions or activities over a prolonged period of time may aggravate the tendons in the wrist, causing swelling that puts pressure on the nerve.

• Hand and wrist position. Doing activities that involve extreme flexion or extension of the hand and wrist for a prolonged period of time can increase pressure on the nerve. Such as sitting at the computer for too long or gripping a motorcycle handle for too long.

• Pregnancy. Hormonal changes during pregnancy can cause swelling.

• Health conditions. Diabetes, rheumatoid arthritis, and thyroid gland imbalance are conditions that are associated with carpal tunnel syndrome.

Symptoms

Symptoms of carpal tunnel syndrome may include:

• Numbness, tingling, burning, and pain—primarily in the thumb and index, middle, and ring fingers

• Occasional shock-like sensations that radiate to the thumb and index, middle, and ring fingers

• Pain or tingling that may travel up the forearm toward the shoulder

• Weakness and clumsiness in the hand—this may make it difficult to perform fine movements such as buttoning your clothes

• Dropping things—due to weakness, numbness, or a loss of proprioception (awareness of where your hand is in space)

In my experience, a good percentage of patients that come in with the diagnosis of Carpal Tunnel Syndrome actually suffer from entrapment at either the elbow or neck. Limited spinal mobility at the neck can cause entrapment of the nerves as they exit the spinal cord. Muscular tightness in the biceps, pronator, supinator, and forearm musculature can entrap the Median nerve as well.

Here are two stretches to try out if you have symptoms that match Carpal Tunnel Syndrome.

Prayer Stretch – 3 for 30 seconds

Place the palms of your hands together and then slowly lower your hands down and bring your elbows up until you feel a good stretch in your forearms. This might increase your numbness while you are performing, however, it should decrease once you release the stretch.

Reverse Prayer Stretch – 3 for 30 seconds

Similar to the stretch above, but instead of putting your palms together put the backs of your hands together. Instead of your elbows going up, your elbows will be going down as seen in the picture below.

Stay tuned for Friday’s post on more ways to stretch and strengthen your upper extremity to decrease pain, numbness, and tingling in your hands and fingers. This does not have to be something you live with for the rest of your life. It can be easily treated and you can return to sleeping well and performing activities you once couldn’t. Disclaimer: I am in no way diagnosing anyone, if you have persistent pain you need to call your local physical therapist and schedule an appointment.