Signs and Symptoms
Symptoms depend on which nerve is affected and how badly it is hurt:
- Numbness, tingling or a pins-and-needles feeling in part of the hand or fingers
- Burning or electric-shock pain along the path of the nerve
- Weakness, clumsiness or trouble pinching and gripping
- Loss of feeling right after a cut to the hand, wrist or forearm
- Wrist drop, meaning you cannot lift your wrist or fingers, which can be a sign of a radial nerve injury
- Over time, shrinking of the small muscles in the hand
What Causes It?
Three main nerves run to the hand: the median nerve, the ulnar nerve and the radial nerve. They can be injured in two ways.
Nerve compression means a nerve is squeezed over time. Carpal tunnel syndrome is pressure on the median nerve at the wrist and has its own page on our site. Cubital tunnel syndrome is pressure on the ulnar nerve at the inside of the elbow, the "funny bone" area, and often causes numbness in the ring and small fingers.
Traumatic nerve injuries happen suddenly:
- Cuts and lacerations from glass, knives or tools, which can partly or fully divide a nerve
- Stretch injuries from a fall, a dislocation or a forceful pull on the arm
- Crush injuries, where the nerve is bruised or pinched by a heavy object or swelling
- Radial nerve palsy, a loss of radial nerve function often linked to a fracture of the upper arm bone or prolonged pressure on the back of the arm
How We Diagnose It at POPB
Dr. Tucker will ask how and when the problem started, then map where you have lost feeling and which muscles are weak. Sensation testing checks how well your fingertips feel light touch. She will also examine your neck and elbow, because a pinched nerve higher up can cause similar symptoms.
X-rays in our office can show a fracture or other bone problem near the nerve, and diagnostic ultrasound or MRI can help show the nerve and the tissues around it. Nerve conduction studies and EMG (electrical tests of nerve and muscle function) can show where a nerve is injured and how severe the damage is. When needed, these tests may be arranged with an outside testing provider.
Non-Surgical Treatment Options
Many compression problems and some stretch or crush injuries improve without surgery:
- A custom splint to rest the nerve or support a weak hand or wrist. Elise Burger, OTR, our occupational and hand therapist, makes custom splints in our office.
- Hand therapy with Elise Burger to keep joints flexible, protect numb skin, retrain feeling and rebuild strength as the nerve recovers
- Activity changes, such as avoiding long periods with the elbow bent or leaning on it
- Repeat exams over time, since a stretched or bruised nerve can recover on its own
Surgical Options
A nerve that has been cut usually needs surgery, and so may compression that does not improve with other care. Dr. Tucker studied microvascular techniques during her training and uses microsurgical methods, done under magnification, to work on small nerves.
- Nerve repair: the cut ends of the nerve are carefully lined up and stitched together so the nerve can begin to regrow.
- Nerve decompression: tissue pressing on the nerve is released to give it more room, as in carpal tunnel release or cubital tunnel surgery.
- Nerve or tendon transfers: in some cases, when a nerve is not expected to recover, a working nerve or tendon is moved to restore an important movement.
Your surgeon will explain which approach fits your injury and the benefits and risks of each.
Recovery
Nerve recovery is slow. After a nerve is repaired, it regrows gradually from the injury toward the hand, and this can take many months. Some people do not regain full feeling. Recovery after decompression is usually faster, but long-standing compression may leave some numbness.
Hand therapy with Elise Burger in our office is an important part of recovery. She shares your chart with Dr. Tucker so splinting and exercises match each stage of healing.
Insurance and Cost
Medicare and most commercial PPO plans generally cover office visits, imaging, splints, hand therapy and medically necessary surgery, subject to your co-pay, co-insurance and deductible. Surgery often requires prior authorization from your plan. HMO and managed-care plans require a referral from your primary care physician before your visit.
If you were hurt at work, we coordinate care under workers' compensation and handle the required documentation with your employer and carrier.
When to Be Seen
Call our office if numbness, tingling or weakness in your hand or arm lasts more than a few weeks, wakes you at night, or makes you drop things. Be seen promptly for any new weakness or numbness after an injury.
If you have a deep cut with numbness beyond it, a finger that is cold or pale, or heavy bleeding, go to the emergency room or call 911. For other questions after hours, call our main office number to reach the answering service.
