Hand Numbness – Causes and Evaluation

So numbness in the hands is one of the vaguest symptoms you can have, and it can have a multitude of causes from anxiety to paraneoplastic syndromes (a side effect of certain cancers).  I of course assumed it was cancer, as that seemed like the worst thing it could be.  Surprisingly, I didn’t think it was a brain tumor, but multiple sclerosis did cross my mind.  I figured this was another good topic to explore as a result of my hypochondriasis.

First, to describe how the numbness presented in my case.  It came on relatively suddenly and affected both hands equally.  It seemed to affect my entire hands, not just the thumb and first few fingers like you’d see with carpal tunnel, and not just the pinky side of the hand as you might see in an ulnar nerve compression (the nerve that runs along your funny bone can get squished from different causes leading to numbness).  The class illness that causes “glove and stocking” numbness of the hands and feet is diabetes – that is how diabetic neuropathy presents.  But in my case, my feet weren’t involved, which is where it almost always will present first.  Also, I knew from my last physical that my blood sugar isn’t too far out of whack, so neuropathy shouldn’t be an issue for me any time soon.

I do use my computer a lot so carpal tunnel was still high on my list. I also recently got a new chair at work, so maybe the way my elbows sit on the arm rests were causing an ulnar neuropathy and together they were causing my entire hand to feel numbness.

The weirdest part about the numbness I had was the quality of it.  Not only did I have the tingling like when a limb falls asleep, but also everything felt strange.  Rather than having reduced sensation, it was like I had heightened sensation.  It was like everything I touched with a texture felt like someone was scraping their nails on a chalkboard.  Slightly rough surfaces would give me the chills almost.  I kind of thought this is what it must be like to be autistic where common sensations are very uncomfortable.  I didn’t have outright pain, but the discomfort maybe puts my symptoms in the category of dysathesia – uncomfortable sensations ranging from burning to all out pain.

The sensations would come and go and I never had outright weakness.  I did have on instance of having trouble buttoning my dress shirt.  I felt that was more due to the numbness than any sort of weakness though.  Initially, I chalked it up to maybe having slept funny combined with the new chair at work and the frequent typing I was doing.  After it persisted for two weeks, I went ahead and decided to see a doctor.  I had figured most likely they would say it sounded like a compression issue and maybe they would send me to a neurologist, but I wasn’t sure.  The doctor examined me, and at that time there were no finding on the exam.  She said it sounded like carpal tunnel to her, even though I said it involved my pinkies, which usually aren’t a part of carpal tunnel.  She insisted it could.  I’m still not convinced.  But she said she’d go ahead and do some basic blood work and that I should wear wrist braces at night.  She said I only need to wear them at night as getting several straight hours of protecting my median nerve should help it heal, if it were carpal tunnel.

So, I ran to Walgreens only to find they only had the braces for the left hand.  I then went to Osco pharmacy, and they only had braces for the right hand – but a different brand so they didn’t match what Walgreens had.  Just my crazy luck.  I wound up going to another Walgreens and found ones that can go on either hand – and based on what I saw on Amazon for similar braces, they were highly rated. Of course they were several dollars more expensive at Walgreens, but I wouldn’t have to wait even the two days that prime shipping would take (and I’m not a prime member any more).

A few days later I get a call from my doctor that my Vitamin B12 level is low.  It turns out it actually isn’t below the normal range, but it is lower than it should be.  The normal range was between 200 and 1000.  My level was 230.  While it seems unlikely I’d have symptoms with a level at 230, I’ve seen a few online discussions claim that it can happen.  My B12 is low because I’ve been taking antacids for a really long time.  If I don’t take my daily omeprazole (or similar), I have severe abdominal pain later that day.  At this point it is probably a reactive hypersecretion, but that is a discussion for another hypochondriacal post.  So the doctor recommends I start taking Vitamin B12 – 1000mcg per day.  She told me to take it 12 hours opposite from my omeprazole, so I can hopefully absorb it.

So I immediately started my b12 and using my hand braces at night.  Things seemed maybe better, but not really sure.  This went on for about a month longer.  Finally, I had one day with more significant tingling in my right hand.  I decided to tell my doctor I was worried and maybe I should see a neurologist.  The neurologist they recommended couldn’t get me in for quite a few weeks.  I’m of course thinking that whatever is causing my problems is either going to kill me or cause permanent nerve damage and paralysis, which clearly couldn’t wait.  I called another neurology office and they also had a long wait but said they had a cancellation later that day, so I could get in right away.  Nice.

I see the neurologist and he does some typical exam maneuvers checking strength and sensation.  He also did similar tapping on my medial nerve with his reflex hammer.  This is far more effective than just tapping with your fingers to see if there is a sensitive nerve there.  Unlike when my regular doctor tapped on my wrist, the reflex hammer replicated the increased tingling I’d had that day.  It was still a different sensation than the odd uncomfortable sensations I had most other times, but it at least supported the idea that some carpal tunnel issue was going on.  Phalen’s test didn’t replicate my symptoms (where you flex your wrist and hold it for a period of time to see if it will replicate the symptoms).  The neurologist said it could be a lot of things causing my whole hand to be involved, and that it involved both hands starting at the same time.  He suggested an EMG and nerve conduction study to try to see how much the nerve is affected.  I was able to get one scheduled within two weeks.  He suggested I have a neurologist do it, I guess as opposed to a technician.  I’m guessing he made the recommendation because the performance and interpretation apparently can be impacted quite a bit by whoever is doing it.

So the day before my EMG I decided to see if I need to get pre-certification from my insurance.  Based on my fun experience with insurance over an MRI years earlier, I figured it didn’t hurt to call.  No one seemed to know if it needed prior authorization at the insurance company.  They told me to have the clinic call them to check.  The clinic said that I should just ask the insurance company.  Such is the circle of life, at least for me.  Ultimately, the insurance company said that since the clinic I was going to was in network, I would not be responsible to pay if they failed to get needed pre-authorization, which is ultimately what happened with my MRI years ago.  This time I got the name of the representative who told me this, although I suppose she could always claim she never told me I wouldn’t be responsible to pay.

I also decided to try looking up online if pre-authorization is needed for an EMG.  As I’m typing into Google “EMG nerve conduction study” I notice one of the autocomplete search phrases includes “painful”.  How can I not take a look at that search?  Sure enough, there is a long catalog of people complaining online about how incredibly painful EMG nerve conduction studies are.  Most people equated it to medieval torture.  A few people said it wasn’t that bad.  I was sure hoping that by having a neurologist do the test, I wouldn’t have such a bad experience.

Of course, over the two weeks prior to the test my symptoms have gotten better.  I was debating canceling entirely, but decided I may as well go through with it, in case I have some horrible disease which could be picked up by the test.

I show up at the clinic a bit more anxious than usual, which is quite a bit by most people’s standards.  A technician has set-up the room to assist the neurologist with the procedure.  The technician is a tall lanky guy with a heavy accent.  I can’t help but think he would make a perfect character who tortures secrets out of people.  Perhaps that is what he had done earlier in his career.

Ultimately, the test wasn’t as bad as I had expected.  As the neurologist told me, it isn’t horrible, but most people wouldn’t volunteer to have another one the next day.  The test had two part.  The first part involves electric shocks at various locations along nerve paths, and measuring the signal conduction across the nerves.  Each series of shocks starts with a very slight tingle, and they escalate to painful shocks.  Most locations weren’t that bad, but a few spots hurt quite a bit.  The second part of the test involved sticking small needles into various muscles and then I assume the measured current somehow.  Most of the locations were not painful at all, but when they stick a needle in the pad of the thumb – that does hurt a bit.

Overall, it seems I had a mostly normal test.  He said it is good that my symptoms are better (duh) and that they may not ever figure out what caused my problems.

Given my history of hypochondriasis, I suppose it could be psychosomatic.  I doubt it, but then most people with hypochondriasis don’t realize when their symptoms are psychological as opposed to organic. In the mean time, I’m continuing to take my vitamin b12 pills and wearing my wrist braces at night.

So, I’ve learned about bit more about parasthesias, dysasthesias, vitamin B12, and electromyelograms, and my hand numbness is mostly better (but not completely gone).  If I had to guess what is going on, I’d say that there was some inflammation affecting my median and ulnar nerves which has since settled down.  I’m not sure why I would get that kind of inflammation, but I do have some allergies and mild autoimmune type stuff. Hopefully it won’t come back like how it was. Time will tell.