Transcription:
What Does it Mean When My Hands Go Numb

Scott Webb: There's a multitude of reasons why we might experience numbness in our hands. And sometimes it's temporary and sometimes it lingers on. And when it does, that's probably a good time to see a specialist. And I'm joined today by Dr. Gina Del Savio. She's a hand surgeon with Montefiore St. Luke's Cornwall.

This is Doc Talk presented by Montefiore St. Luke's Cornwall. I'm Scott Webb. So doctor, thanks so much for your time today. I know that you're a hand surgeon by trade, so great to have you on because we're going to talk about hand numbness and why someone's hands may be numb, when they may be numb and what an expert like yourself, you know, does about it.

And before we got rolling here, we were just kind of discussing what people say when they walk in the office and what they think it is versus maybe what it actually is. So this is going to be a good one today. As we get rolling here, what does it mean when our hands go numb?

Dr. Gina Del Salvio: Well, thank you so much for starting off with that, because that is really where you need to start, when you start thinking about why do I feel something that I feel. Most people don't realize that the nerves actually originate in the brain. And even if someone really pushed you on it, you might understand that, but you might not be able to articulate what does that really translate into meaning.

You've got your brain and your brain has a spinal cord. And what happens is that off of your spinal cord, which is this huge cable of every nerve to every part of your body, as your spinal cord goes down your back, along the way, branches come off of it. Now, up in your neck, that's where the branches come off that are going to eventually go down to the very tips of your fingers.

And so if you're feeling something down in your hands, whether that's numbness or pain, that can actually be starting all the way back up, even at your level of your brain, or at the spinal cord in your neck, or then at any point down your arm. What can't happen is if you have a bad back and someone's told you that you have a herniated disc in your lower back, that isn't going to give you hand numbness. I have many patients who think that because they have numbness in their leg because of a herniated disc in their lumbar spine, that can explain why they're getting numbness in their hands and the answer is no, because those branches off the spinal cord came off way up higher and way before that disc in their lower back.

Scott Webb: All right. So people come in the office and they think they know, and you helped to clarify and sometimes it is what they think it is and so on. So then, how do you really then begin to diagnose this specific cause of numbness in someone's hands?

Dr. Gina Del Salvio: Well, because nerves have patterns of sensation. And what do I mean by that? What I mean by that is all those nerves that started up a way back at the level of your neck, they all have a destination to go somewhere. And so if someone says, "My thumb is numb," well, that's going to be different problem than someone who says, "My pinky finger is numb," or someone who says, "I have numbness on the outside of my elbow."

So again, the first clue for any surgeon is to listen to somebody. Ask someone very specifically, if they say to me, "Well, my whole hand goes numb," I try to pin it down. I say, "Well, is it more on the thumb side of your hand? Is it more on the pinky side of your hand?" And sometimes people can give me clarity and sometimes they can't. But if they can, it's super duper helpful because in my own head, I'm starting to map out, "Hmm, if your pointer finger is numb, the possibilities are that it's coming from your neck at the level of C5, or maybe it's your carpal tunnel nerve," whereas if people tell me that their pinky finger gets numb, I think, "Hmm. Maybe that's a problem in your lower neck or maybe that's a problem with the funny bone at your elbow."

So again, the first thing to do is really, really listen to your patients. And I always ask my patients to really think about it and to be mindful about where they're feeling the numbness. And indeed, if I'm going to see them a second time, I send them away with the mission of "Next time your hand goes numb, don't just shake it out. Pay attention," right? Pay attention and see what fingers are going numb, because that's going to be helpful for me. So, one, always listening to your patients, right? So being able to articulate to your doctor exactly where you feel the numbness.

And then, of course, the next part is doing an examination. Why? Well, because if you have numbness, one, sometimes I can figure it out for myself by poking you with a little sharp item and asking you to tell me," Does it feel sharp or does it feel dull?" Sometimes I can figure it out by doing what we call provocative maneuvers. I'd have you bend your neck forward, "Does that make your hands feel more numb?" Well, it seems to be sort of self-explanatory, but if it does, maybe we're looking at a problem with your neck. But how about if you bend your elbow and that makes your hand go numb? Well, I need to start thinking about things that can go wrong at the level of your elbows. So listening to your patients, doing a good physical examination and also doing provocative tests to try and recreate the symptoms that people are complaining about are terrific ways for your doctor to figure out where exactly is that numbness coming from.

Scott Webb: Yeah, it just kind of makes me wonder, I'm going to go off script here just a little bit, but in this now new age of telemedicine and virtual visits, are you able to do any of this virtually with folks and you kind of go through these things? "Okay. Now what I want you to do is I want you to bend your neck forward." Can you do almost a virtual sort of physical exam and do a little diagnosis that way? Is that possible?

Dr. Gina Del Salvio: Interesting that you ask that, because I think that's a skillset that all of us have developed over the last couple of years with the pressures to move towards telemedicine. I would have said that five or ten years ago. I probably would've had a harder time doing that. But now, to your point, I've sort of figured out what are the things that I can solicit good information by just looking at someone or just speaking with someone or asking them to do tests on themselves.

So for instance, you can't really ask someone to poke themselves with sharp and dull stuff. That's cheating, right? They know when it's sharp and they know when dull. That's not going to work. But I can have patients put their hands up to a phone and I can see is there atrophy? Atrophy is muscle wasting, because muscle wasting in different patterns can also give me information as to, is there a nerve being compressed and if it's being compressed, where is it being compressed? So looking at someone's hand through a cell phone. And, then to your point, actually having them do actionable items and then simply asking them to articulate their response is absolutely doable using telemedicine. So yes, telemedicine, it can be a useful tool for this.

Scott Webb: Yeah, that's very cool. And, you know, silver linings, it's hard to find silver linings in light of COVID and how serious it is. But the medical system in general has really caught on and, you know, the virtual visits were just kind of inching along before, but we all sort of get it now and so great that even experts like yourself are like, "You know what? I've got to figure out a way to do this. I need to be able to do some of these things virtually over the phone or in a video visit." So, very cool. And I just love how the doctors and nurses, I always think are just sort of like great jazz musicians, you know? You know, they know how to improvise and they're just so, you know , creative and resilient and awesome. So, I got a few more questions for you here today. We've sort of established that sometimes people misdiagnosed their own issues before they come in and you help them with an accurate diagnosis, and you've explained how you do that. What are the most common causes of hand numbness that you experienced with your patients?

Dr. Gina Del Salvio: Well, by far by far, probably anybody can answer that question, which is carpal tunnel syndrome. And carpal tunnel syndrome is actually where the nerve that gives you sensation to your thumb, your index, your long, and your ring finger, that nerve is pinched in the palm of your hand, that electrical cable, as it comes down your arm and heads to your fingertips, it actually has to get to the tips of your fingers. And the only way it can get there is literally between the bones of your wrist, which are on the backside of your wrist and the muscles on the palm side of your wrist. So literally, the nerve has to pass between a rock and a hard place to get to your fingertips. And because it has to travel through that tight area, it's a really, really common spot for folks who do a lot of work with their wrist bent because why? When you bend your wrist, you make that spot even tighter. Or when you extend your wrist, you make the spot even tighter. Or you wiggle your fingers a lot in your job, like using a keyboard or using some handheld tools, well, that's rubbing your nerve as it travels through that spot. And that can create irritation in that tight spot.

So carpal tunnel for sure is the number one diagnosis, but not far behind is a pinched funny bone at your elbow, fancy dancy name for that would be cubital tunnel syndrome or ulnar nerve entrapment at the elbow.

Scott Webb: Yeah, and I think we can all identify with, you know, hitting our funny bone and, you know, pinching something in our funny bone. My wife has that sort of permanent pinch sort of thing in her elbow.

Dr. Gina Del Salvio: Yeah. And just imagine if you had that terrible feeling for a long, long, long time. That's why people come to see me as well.

Scott Webb: Yeah. Many good reasons to come see you. And so, yeah, you've identified the most common causes. Obviously there's a multitude of other things, but we don't have time to get into all of them. So let's just stay focused on the most common reasons or the common diagnoses. And so through that lens then, what are the treatment options? And when is surgery indicated?

Dr. Gina Del Salvio: So as with any pinched nerve, unless you had severe and acute, meaning that you just had some sort of trauma which started it, for the most part, these are things that came on slowly and, therefore, we can take a deep breath and we can try to manage your symptoms without jumping to surgery. So again, we just talked about how when you bend your wrist really sharply or extend your wrist really sharply, that can aggravate carpal tunnel.

So one of the treatments is to first off, start off by wearing a brace at night time. So when you sleep, you don't bend that wrist. So at night, you can rest your nerve. And during your day, when you're using your hand, making sure that you're doing your repetitive tasks without bending or straightening your wrist, but rather keeping it in a nice, neutral posture as you're doing activity.

For the nerve at your elbow, think about that nerve. It's behind your arm. So every time you bend, straighten, bend, straighten, bend, straighten your elbow, you're taking that nerve and you're torquing it and you're pulling on it. So for the elbow pinched nerves, we tell people, one, avoid leaning on your funny bone, which seems obvious, but you'd be surprised how many people say, "Well, it bothers me when I rest on my elbow." Well, don't do that.

Scott Webb: Don't do that. Right.

Dr. Gina Del Salvio: Now, the one thing that most people don't think about though is that repetitive bending and straightening, bending and straightening. So avoiding positions where you have to hyperflex your elbow repeatedly, how to do things with your arms more out in front of you to try and rest the nerve. From time to time, therapy can be helpful for the elbow, but it really doesn't help carpal tunnel. So modification of activities and bracing or the nonsurgical treatment.

And of course, if those don't work, I am a surgeon after all. That means my toolbox does include not only time and braces, but also physically mechanically going to where the nerve is pressed and making it unpressed. So going in and taking away those structures that are pinching or rubbing on your nerve so that your symptoms go away.

Scott Webb: Yeah, that's perfect. And I just love your language choices, you know. And unpress it. You know, it's pressed, so I'm going to, unpress it. You know, you've made this really easy, even for me to understand today, doctor. And I do appreciate. I'm sure listeners do as well.

And you know, my son had a surgery on his thumb. Baseball injury, the thumb, the tendon, and they had a pin in there and all that. And the reason I bring that up is, because he went for physical therapy afterwards and it was super helpful, like it really helped him and it helped him to recover much faster. So just wondering, when surgery is indicated and you've performed surgery, what's the recovery time like, the process like, whether it's rehab, PT, however you want to frame it? How quickly can folks get back to work or tennis or whatever it is that they weren't able to do because of the pinching?

Dr. Gina Del Salvio: So after we do an operation, I always tell people there's two stages of healing. There's the inside healing and there's the outside healing. The outside healing is where I had to make an incision since I can't do surgery using a magic wand. So you have to heal on the outside first. So skin healing takes about two weeks. So for about two weeks, you got to keep your incisions clean and dry. Don't get sweaty, don't get dirty. You can't get on the treadmill, even though it's your elbow, because you'll get sweaty and you'll give yourself an infection. But that's the outside healing.

After about two weeks, when your wounds are healed, now you're just healing up on the inside. Most people will say that after this procedure at four weeks, you can be released to full activities, meaning that you can do full activities without injuring yourself. But I will tell you, I always warn my patients because I don't want to set unrealistic expectations. And that is this, "I will let you do everything at four weeks, but you may find yourself restricting yourself for up to three months as you regain your strength and your full functionality."

Scott Webb: As we wrap up here, doctor, what would be your parting words, your takeaways for folks who are dealing with hand numbness or finger numbness, or, you know, any kind of pinching like that? How are we going to get them to come in to see you?

Dr. Gina Del Salvio: Well, I think what you have to remember is that. As with any illness and I'll include this as an illness, left untreated, it's going to get worse. And then even when you do pursue treatment, your outcome won't be as good. So I would say too, as a physician, not just as a hand surgeon, this has been a trying time for all of us all through COVID.

And unfortunately, as physicians, we are seeing the results of that. We're seeing folks presenting to us as physicians with more exacerbated or more aggravated conditions or more advanced conditions. And we as physicians then can't always give them optimal outcomes. And we think to ourselves, "If only you would've come sooner, then I might've been able to get you back to 99% normal. But now, because we're dealing with something that's been going on for so long, it's going to compromise my ability to get you back to where you want to and you need to be."

So, again, it's not the worst thing in the world to go to the doctor and have them say, "Hey, it's still mild. It's still early. Here are some tools to help you manage your symptoms. And here for you, particularly as an individual, when you get to this point, then you really need to come back to me." It's much better to get that message than to have a physician sit across from you and say, "Boy, I wish I'd seen this three months ago, six months ago," or "I wish I'd seen you when your symptoms were only this, because then I could have done so much for you, but now I don't have as much I can do for you."

So again, whether it's hand numbness, whether it's a cardiac issue, whether it's a breathing issue, whether it's a skin lesion, whether it's a lumpy bumpy thing, please do not allow the fear of COVID to stop you from seeking appropriate and timely medical care and keeping yourself well and healthy.

Scott Webb: That's perfect. What a perfect way to end. And as we know, doctor, and you know all too well, most of these things, they don't fix themselves, they don't cure themselves, which is why we have doctors and hospitals and so on. So, great advice from an expert today. I really appreciate your time, and you stay well.

Dr. Gina Del Salvio: You as well. Thank you.

Scott Webb: That's Dr. Gina Del Savio. She's a hand surgeon with Montefiore St. Luke's Cornwall. And if you found this podcast helpful, please share it on your social channels and be sure to check out all the other Doc Talk episodes.

This has been Doc Talk, the podcast for Montefiore St. Luke's Cornwall Hospital. I'm Scott Webb. Stay well.