Pain, tingling, and numbness in the hand is a problem. It can be merely annoying, or it can impair function at work, or it can ruin your day. A bunch of different things can bring on these sensations. What do you do when your hand hurts you?
I see many clients who've been putting up with some degree of discomfort in either or both hands. Because it's low grade, or it comes and goes, it's not the biggest problem in their lives. They don't want to go to the doctor at all, or yet. They've tried ignoring the problem, they've tried the ergonomic stretches for hands and wrists, and they've gotten comfortable with sundry painkillers. Now it's more intense, and maybe it's coming rather more often than going, and the question of seeing a doctor is more pressing.
I'm keen on doctors. I'm never delighted to field questions for which an MD is handy. I'm forever saying, "I know a smidgen about muscular anatomy, and I can get my mind around some of the ways muscle cells work. But there's way too much going on for me to answer that question. Do you have a primary care physician?"
When the problem is tingling in the little finger and the ring finger, that half of the hand, and up to the wrist, I have a slightly different answer. "There are lots of ways to get those symptoms, and I've got a good shot at clearing away one of them. After that, it's time to say hello to the doctor."
Here's what might be going on. In order of bones, muscles, and nerves...
Imagine the skeleton you see hanging in the biology classroom. There's the skull at the top. It sits on top of the vertebrae. The stack of vertebrae run down the back of the neck, along the ribcage, and enter into open space below the ribs. (We're not interested in the rest of the body, here.)
Zoom in on the vertebrae. They are hollow cylinders with some bits that jut out to the sides and out the back. Some are thicker than others, and the protrusions aren't uniform in size and shape. Focus on the vertebrae in the neck.
The ribs get in the way, don't they? Get rid of most of them. Keep, say, the top two ribs.
On the vertebrae in the neck, from the juts that come out either side, put some muscles. Imagine them like rubber bands a few inches long, and we glue them to those juts of bone and dangle them out to the side. Drag the loose ends down and forward, and glue the far ends to those two ribs we saved. Welcome to the scalenes.
There are three sets of scalenes: the rear, the middle, and the front. (Posterior, medius, and anterior scalenes are their proper names. Feel free to treat the naming of muscles like the naming of cats, for purposes of conversation.) What do they do? Well, imagine those rubber bands tightening up. They bring the top two ribs and the vertebrae in the neck closer together. If the ribs stay still, then the neck tilts to one side or the other. If the neck stays still, the ribs lift up.
Pay attention to the vertebrae again. Remember, they're hollow cylinders. Fit inside those cylinders is the spinal column. This is the bundle of nerves that connect the brain to the body.
Nerves are important to understand. In the bad old days of the telegraph and the telephone wire, we had an easy analogy. Now there's ubiquitous wi-fi, and who knows from telephone wires? Let's just say that the brain and the body are like seriously outdated pieces of hardware that lack wireless cards. On the desktop of your brain is a text file called "MyName.txt" and you want your hand to print it out. The only way for your hand to get the print command and the file is for a signal to travel by wire from the brain (which sits in the skull), down the hollow vertebrae in the neck, then out of those jutting bits of bone to either side. Once free of the vertebra, those wires...er, nerves...run the length of the arm to the hand. Hand gets the signal, hand prints MyName.txt in the sand.
So, we're looking at the vertebrae in the neck with rubber bands connecting them to the ribs. Our wires come out of the vertebrae at much the same spot where we've glued the rubber bands. Bad luck, eh? Well, it's easier to go forward than it is to go back. (Thanks, evolution!) Run those wires between the front two sets of rubber bands.
Not so bad, is it? That's the skull, the cervical vertebrae, and the first two ribs. That's three bands of scalenes. And that's the brachial plexus snaking its way between the scalenes. Nicely done!
Yeah, the brachial plexus. A/k/a the telegraph wires that carry important messages back and forth from the brain to the arm and hand. Let's imagine our skeleton has a full time job, works out, and suffers all the joys and stresses of human life. The scalenes get overworked, or maybe just stressed out, and they constrict. (It's one of the neat tricks pulled by the muscles.) They tighten up, and they wind up squeezing on the brachial plexus.
Nerves respond very well to pressure. The response of the brachial plexus to being squeezed by the scalenes is to scream pain at the brain. The brain interprets this screaming as coming from all the way down at the end of the arm. The brain says, "Huh. The hand out there is all numb, maybe a bit tingly. I wonder if it's time to do those ergonomic stretches?"
What do we do with the tightened scalenes? Gentle warming strokes. It's important to work through some other muscles in the area, and to avoid nearby arteries. Once we've gotten the area warmed and loosened, lengthening strokes for the scalenes work famously. It's simple, but not easy. It takes a bit of care and patience. And, I've learned, it helps to let folks know what we're doing and why -- because when somebody complains their hand hurts, it's not intuitively obvious why I start messing about with their neck.
For pretty pictures and more technical explanations of these structures, I recommend wikipedia's article.
Please remember that I'm a massage therapist, not a doctor. This information is not meant to take the place of qualified medical advice.
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