Dr Shams Amir

Hand Numbness

Get emergency help if numbness comes on suddenly

Call an ambulance or go to the nearest emergency department if numbness starts suddenly and comes with any of these:

These are signs of a possible stroke. Do not wait to see whether it settles.

Numbness after an injury needs prompt assessment

If a finger or part of the hand has gone numb after a cut, a fall or a blow, the nerve may have been injured directly. This is different from the gradual compression described below, and it should be seen quickly rather than watched. Nerve injuries generally do better when treated early.

The rest of this page is about numbness that has come on gradually, or that comes and goes.

Hand numbness often comes from a nerve problem

A numb hand does not automatically mean that blood is failing to reach it. A common cause is irritation or compression of a nerve somewhere between the neck and the fingertips.

Nerves carry sensation from the hand to the brain. Pressure on a nerve can disrupt these signals and affect the nerve’s own blood supply, producing numbness or tingling even when circulation to the hand is otherwise normal.

Circulation problems can also cause altered sensation, particularly when there are changes in finger colour or temperature. The pattern of symptoms and an examination help distinguish the causes.

It does not always feel like “numbness”

People describe this in very different ways, and not all of them sound like what you might expect:

That last one is easy to dismiss because it does not hurt. It is still a loss of sensation, and it still matters.

This distinction changes what helps. Rubbing the hand to “get the circulation going” may feel good briefly, but it does not address a compressed nerve.

Where do you feel it?

The pattern of numbness is the most useful clue to which nerve is involved. Notice two things: which fingers, and palm or back of the hand.

Which fingers are affected, and whether symptoms involve the palm or back of the hand, can help identify the nerve involved. Sensory territories overlap, and the pattern alone does not establish the diagnosis.

Thumb, index and middle finger — at the tips The most common pattern. Usually the median nerve compressed at the wrist (carpal tunnel).

Palm first, then spreading into the fingers Points higher up — the median nerve compressed in the forearm rather than at the wrist. The distinction matters, because the treatment is different.

Ring and little finger Usually the ulnar nerve. Most often compressed at the elbow, but it can also be compressed at the wrist, and it is not unusual for this to occur together with carpal tunnel in the same hand.

Back of the hand, on the thumb and index side This can suggest involvement of the superficial radial nerve, although other causes need to be considered. Classical radial tunnel syndrome mainly causes pain rather than numbness; the distinction is explained below.

The whole hand Often more than one nerve compressed at the same time, or a single nerve compressed severely.

Both hands This may be the same problem occurring on both sides, and in a hand surgery clinic that is the more common finding. But numbness in both hands always needs the neck considered as a possible source, and excluded — by examination, and sometimes by an MRI scan of the neck.

When does it happen?

Just as useful as where. Two patterns come up repeatedly, and they point to different problems.

Position-related. Numbness appears when the hand is held a certain way and settles when you change it. Holding a phone with the wrist bent forward is the one most people recognise. This suggests compression at the wrist.

Duration-related. Numbness or aching appears after a period of using the hand — cooking, typing, driving — rather than in any particular position. This suggests compression higher up, in the forearm.

What relieves it is another clue

If shaking the hand out relieves it, the problem is likely position-related. The shaking works because it brings the wrist back to a straight position, which takes pressure off the nerve.

If it eases with rest rather than with a change of position, that points more toward activity-related compression higher up the arm.

The threshold that shortens

Duration-related symptoms usually have a threshold — a certain amount of use before they start. That threshold tends to get shorter as the problem progresses. Someone might manage three or four hours of work before the ache begins. Months later it starts after one hour.

That change is worth paying attention to. A shortening threshold tells you more about whether things are progressing than how severe the numbness feels on any given day.

Other things worth noticing

These often matter more than the numbness itself:

Which direction does it travel?

If you have pain as well as numbness, notice which way it moves.

Symptoms that start at the wrist, forearm or elbow and travel upward usually come from a nerve compressed in the arm itself.

Symptoms that come from the neck or shoulder downward are more likely to be coming from the neck.

Common causes

Most hand numbness comes from a nerve compressed somewhere between the neck and the fingers. These are the ones seen most often in a hand surgery clinic.

Carpal tunnel syndrome — the median nerve at the wrist. Numbness at the fingertips of the thumb, index and middle finger. Classically wakes people at night, or is present on waking. Worse with the wrist bent, better with shaking.

Proximal median nerve compression — conditions such as pronator syndrome can cause forearm aching and altered sensation in the palm and fingers. Symptoms may become more noticeable with activity.

Radial nerve symptoms — classical radial tunnel syndrome mainly causes pain around the outer elbow and upper forearm. Tingling or numbness towards the back of the thumb and index finger may involve the superficial radial nerve or another cause and should not, by itself, be taken as evidence of radial tunnel syndrome.

Ulnar nerve compression — most often at the elbow (cubital tunnel), where numbness in the ring and little finger is worse with the elbow held bent. Long drives are a common trigger. It can also occur at the wrist, sometimes alongside carpal tunnel.

A trapped nerve in the neck — pain from the neck or shoulder travelling down the arm, in a band rather than confined to particular fingers. This needs a spine specialist rather than a hand surgeon.

Diabetic nerve damage — usually affects both hands and both feet, and is managed alongside diabetes care rather than surgically.

Thoracic outlet syndrome — compression where the nerves leave the neck and pass toward the arm. Less common, and needs to be excluded when symptoms affect the whole arm.

Pregnancy-related carpal tunnel — common in later pregnancy, caused by fluid retention. Treated with splinting and physiotherapy, sometimes with a steroid injection. In the great majority of cases symptoms resolve after delivery.

Some people have more than one of these at once. Compression at two points along the same nerve makes symptoms worse than either would alone.

What about symptoms over the back of the thumb and index finger?

Classical radial tunnel syndrome mainly causes pain around the outer elbow and upper forearm. Numbness is not a defining feature.

Occasionally, in my practice, patients with radial tunnel symptoms also describe tingling or numbness radiating towards the back of the thumb and index finger. In these patients, I suspect that the superficial radial nerve—the branch carrying sensation from this part of the hand—may also be compressed near the region of posterior interosseous nerve entrapment.

This is a possible explanation based on my clinical observations, rather than an established mechanism of classical radial tunnel syndrome. These symptoms warrant assessment of the radial nerve and other possible causes along the upper limb.

What about Thoracic Outlet Syndrome?

Thoracic outlet syndrome (TOS) is another possible cause of pain, numbness or tingling affecting the upper limb.

In neurogenic thoracic outlet syndrome, the nerves of the brachial plexus can become compressed or irritated as they travel from the neck towards the arm through the supraclavicular and infraclavicular region.

Because the brachial plexus contains nerve fibres that eventually form the major nerves of the arm and hand, the symptoms may not follow the distribution of just one peripheral nerve.

Patients can therefore experience symptoms that appear to involve multiple nerve territories.

This is important to distinguish from having multiple separate peripheral nerve entrapments around the elbow, proximal forearm or wrist.

In my clinical assessment of patients with widespread upper-limb numbness, I therefore consider not only individual peripheral nerve entrapments such as carpal tunnel syndrome, cubital tunnel syndrome, pronator syndrome and radial tunnel syndrome, but also more proximal causes involving the cervical spine or brachial plexus.

Why “urat” causes confusion

In Malay, urat can mean a nerve (urat saraf), a blood vessel (urat darah), a tendon (urat tendon), and it is also used for ligaments and muscles. One word, several completely different structures.

So when someone says “sakit urat”, it could mean any of them — and the treatment for each is entirely different. It is more useful to describe what you feel and where than to name the structure you think is at fault.

The aching pain that comes with nerve compression is particularly often put down to muscle strain, arthritis, or simply being overworked. That last assumption is worth questioning. People are familiar with the muscle soreness that follows hard exercise, and assume any ache after activity is the same thing. It is not.

This is why many people do not mention the ache at all. They come about the numbness or the weakness, and only when asked will say: yes, actually, I have had that ache for a long time — I always thought it was just from working too much.

Being tired from work does not mean you should be in pain.

What you can do now

Nerve stretches (regangan saraf)

These stretch the nerve along its path through the arm.

Move gently into each stretch. You may feel a mild to moderate pulling discomfort, but it should never feel strong or painful. Slight tingling or numbness can occur, but keep it mild—do not push further to increase the sensation.

Any tingling or numbness brought on by the exercise should settle when you release the stretch, either immediately or within a few minutes.

Stop the exercise if it becomes painful, the numbness increases, or symptoms do not settle promptly afterwards. Seek advice from your doctor or hand therapist before trying that exercise again.

These exercises may help some people with nerve-related hand symptoms, but they are not suitable for every cause of numbness. If you are unsure whether they are appropriate for you, ask your doctor or hand therapist.

Exercise safety advice informed by NHS hand-therapy patient information: Frimley Health and Leeds Community Healthcare.

Exercise 1 — arm out in front, elbow straight

Wrist and fingers back. Extend the arm with the elbow straight. Gently pull the hand and fingers backward. Include the index and middle fingers in the pull — most people grip only the outer fingers and leave these two free, which makes the stretch much less effective. Hold to a count of ten. Repeat five times.

Wrist and fingers down. Same arm position. Gently push the wrist down and bend the fingers. You should feel a mild to moderate pull over the wrist or forearm. Hold to a count of ten. Repeat three to five times.

Exercise 2 — arm at your side, elbow straight

Palm facing up. Bend the wrist back and move the arm backward, keeping the body still. Hold to a count of ten. If the stretch stays within the limits above, you can gently tilt the head away from that arm.

Palm facing down. Drop the wrist and move the arm backward in the same way. This stretches the other side. Hold to a count of ten. Repeat five times.

How often. At least three or four times a day at set times. Also do them before any activity you know brings on numbness or aching — that is often more useful than doing them afterwards.

Night splinting

If numbness wakes you at night, or is there when you wake in the morning, a wrist splint worn overnight often helps.

The reason it works is worth understanding. During the day, if your wrist stays bent long enough to become uncomfortable, you notice and change position — usually before symptoms get severe. Asleep, you do not. The wrist can stay bent for hours, and what would have been mild numbness during the day becomes severe numbness or pain by morning.

A splint holds the wrist straight while you sleep, so the nerve is not compressed for hours at a time.

Changing how you hold things

Two habits come up constantly:

Holding a phone lying down. Elbow straight, wrist bent, forearm muscles working to hold the position. Sustained long enough, this reliably produces numbness.

Long drives with the elbow bent. Straighten the elbow periodically.

When to wait, and when to get it checked

Hand numbness is common and often settles on its own. As a rough guide:

You can usually give it a week or two

You can try the gentle exercises above during this time, following the stop rules described there.

Numbness after sleeping awkwardly — falling asleep in a chair, or in an unusual position — that happens once and never returns is generally nothing to worry about. Numbness that happens most nights, in your own bed and on your usual pillow, is worth looking into.

See your doctor

Start with your GP. If it is still there a week or two after seeing them, ask about referral to a hand specialist.

Do not wait — see a specialist

If numbness comes with weakness, or you are dropping things, or you notice the muscle at the base of your thumb looks thinner than on the other side, do not wait for it to settle.

Weakness and muscle thinning mean the nerve is more seriously affected. Nerves recover slowly, and sometimes incompletely. The earlier this is treated, the better the result.

How it is diagnosed

Most of the diagnosis comes from the history and examination — what you describe, which fingers are affected, when symptoms happen, and what is found on testing sensation and strength. Specific tests during the examination can reproduce your symptoms and help identify where the nerve is compressed. In many cases this is enough.

Where further information is needed:

Nerve conduction studies measure how well signals travel along the nerve, and can show where a nerve is compressed and how severely. Useful in planning treatment and where the picture is unclear. Not needed for everyone, and a normal result does not always rule out a problem.

Dynamic ultrasound looks at the nerve while the arm is moved, which can show compression that only appears in certain positions or during activity — something a static test may miss.

MRI of the neck is used when the symptoms suggest the problem may be coming from the cervical spine rather than the arm.