Nerve pain (Neuralgia) is pain that is caused by damage or disease that affects the power cables of the body. These power cables control all of your body’s movement and communication, such as feeling to the skin and muscles. This includes touch, temperature and a variety of other feelings.
Nerves in the hand are like power cables, made up out of smaller strands of wire. These wires correspond to nerves running out of the spinal cord in your neck. There are 3 main cables of nerves in the hand:
- Median nerve – It is located on the bottom part of your forearm and leads to the wrist and palm of your hand to the thumb, index finger & middle finger. This is most commonly known as Carpal tunnel syndrome.
- Radial nerve – Located in the top part of your forearm through to all your fingers when your hand is placed flat on a table.
- Ulnar nerve – Located on the inside of your forearm and leads to the wrist, palm and fingers, up to your ring finger and pinky.
How does nerve pain feel?
Nerve pain feels very different to other types of pain. This can be a variety of abnormal feelings like: Pins & Needles, Numbness, Burning, Tingling, Weakness, Electrical Shock traveling from the palm of the hand to the finger. This type of pain from a nerve is also known as neuropathic pain or neuralgia.
Problems with a nerve
Neuropraxia – The protecting cover of the nerve gets damaged, but the strands inside are still intact. Like the plastic surrounding a power cable that gets stripped away exposing the wires on the inside. This causes a temporary interruption of the nerve impulses (This type of injury has a good chance of healing).
Compression – It’s like a watering hose that gets pinched close so the entire nerve stays intact, but the pressure at that point causes the signal to be diminished or lost.
Axonal injury – The nerve is still intact but the strands are stretched like an elastic that’s worn out and unable to recoil, the message traveling down the nerve gets interrupted (Neurotmesis).
Completely severed nerve: The nerve is cut, and the two ends separated completely, so no signal or message can be relayed along the path of the nerve.
Difference between a Neuropathy & Neurotmesis
Neuropathy is an injury or damage to the sensory ‘feeling’ side of the nerve.
With a Neuropraxia, there is still hope for the nerve to re-connect, regenerate and heal, but with a Neurotmesis there is no change of the nerve recovery and you would have to consider surgical procedures that bypass the original nerve, or tendon transfers where they use the nerves that are still working.
Most commonly occurs in the wrist and elbow,. The nerves that supply the hand can become irritated due to friction between the nerve, muscle, joint and ligament. This leads to swelling of the tissue surrounding the nerve. One of the first signs of irritation is that the discomfort progresses to pain, leading to pins & needles as it gets worse. Initially the nerve pain only comes on occasionally and relieves after a few minutes.
The irritation on the nerve may only be in your wrist, but the pain will travel along the nerve to the tips of your fingers. Usually it’s only brought on when moving into a specific movement or position. Generally it starts at the wrist or elbow and progressively moves upward towards the shoulder. You will notice that it develops slowly and starts off being worse at night or early in the morning.
Nerve Compression (Pinched nerve)
This is the result of a nerve irritation that gets worse. Constant irritation on the tissue surrounding the nerve can leave you with pain that does not ease, no matter what you do (Shake or stretch your hand).
When the nerve is totally compressed, it may cut off the signal from your fingers to your brain (Your fingers send the message, but it gets cut off at the point of compression). This will feel more like constant burning or sharp shooting pain. The pain will progress from pins & needles to numbness and eventually you won’t be able to control the movements in your fingers. This pain tends to hang around a lot longer and stays for hours until (if) the compression is relieved.
The more the compression, the more distorted the feeling will be, until the nerve is totally compressed and no message can go to the brain, then your skin goes numb. If the compression on the nerve is not relieved, there could be permanent damage to the nerves.
The compression on a nerve prevents feedback signals to your brain which causes clumsiness and weakness, which will make you feel like you have lost power. Muscle weakness is a very clear sign of nerve compression.
Symptoms of hand nerve pain
Not all of these needs to be present, only one is necessary to investigate nerve involvement.
- Burning pain
- Pins & Needles
- Sharp stabbing, shooting pain
- Electrical shock pain
- Difficult to control movement
- Dead feeling over skin
Test for nerve damage:
If you suffer from any of these you should give us a call:
- Unable to distinguish between light touch (cotton wool stroked over the skin) and deep touch (compressing the skin in the area)
- Difficult to distinguish between sharp touch (skin pierced with a toothpick) and blunt touch (press with the back of a pencil)
- Temperature: Difficult to distinguish between hot and cold temperatures.
- Pins & needles when touching something
- Numbness (“Dead” feeling over skin)
Nerve injury in your hand (Nerve fallout)
- Usually as a complication after another injury to the upper arm, forearm
- Scar tissue
- Loss of functional movement (Myotomes) rather than pain
- Trauma – cut, gunshot, fall
- Systemic conditions
- Bacterial & Viral infection
- MS, Guillain Barre Syndrome, Parkinson’s disease
Diagnosis of hand nerve pain
This is a test where needles are inserted into the muscles that the nerve supplies to. It measures the electrical activity produced by these muscles. The electrical activity of the nerve will be tested when you contract and relax your muscles. This test can determine if there is any nerve damage.
This test is performed by a Neurologist and is often referred to as ‘Nerve conduction studies’. It examines both the sensory (feeling) and the motor (ability to contract or relax muscles) function of the nerve. A ENMG is able to show the weakening of the impulse traveling through the nerve. It is considered abnormal when the impulse travels slower, and weakens between 2 points (conduction velocity), mainly between the elbow, wrist, the palm of the hand & fingers.
An ultrasound can visualize the structures and the space around the nerve as well as swelling of the tendons, muscles, joints etc. We will compare the uninjured side to the side experiencing pain.
Problems we see with patients suffering from nerve pain in their hands:
After a patient has had surgery there is scar tissue formation on the wound that forms into a scar. Scar tissue is a dense tissue that looks like a spider web. It helps to close a wound very well, but in some cases, it can restrict the normal slide of the nerve. Seeing a therapist is very important to ensure that scar tissue is guided to prevent any restriction on the nerve tissue.
Waiting too long
When you wait too long before getting treatment the nerve damage can progress too far making it very difficult to regain full use of the hand. Research has shown that if moderate symptoms occur for longer than 6 months the effects of conservative treatment is poor. If your pain does not relieve in 2 weeks you might want to consider asking our advice.
Braces can make it worse:
There is a wide variety of generic braces, sleeves and splints on the market. The problem we see with these braces are that they most often do not fit well and can end up causing more pressure on the nerve. Make sure you know what you are dealing with before you buy something that can make it worse.
Be careful what you buy:
Generic products sold to help the position of the hand, for example an ergonomic mouse pad. These products can increases pressure on the Carpal Tunnel and therefore increase the pressure on the nerves running in your wrist. Rather ask for advice before you buy certain products.
Treatment of hand nerve pain:
We are experts at treating injuries coming from your nerves, we will guide you through the process to test, diagnose and treat your nerve pain. Treatment of nerve pain can be complex and it takes time to monitor all the changes.
We use all kinds of treatment techniques to act on the nerve directly or treat the surrounding structures to have a indirect effect on the nerve.
Splinting – We protect the nerve by offloading the pressure from the nerve using a custom splint. The splint is made on the hand or elbow and will fit perfectly.
Exercises – We focus on getting the muscles stronger by guiding your through a gradual progression as you get stronger.
Nerve Gliding – Getting the nerve free from the obstruction and restoring its normal slide through the area.
Sensory retraining – To restore the normal feeling in your hand and fingers.
Oedema management – Reduce swelling in and around the wrist or elbow
Ergonomics – Changing or adapting activities, tasks or the environment to reduce the pressure on the nerve
What else could your nerve pain be?
- Scar Tissue
- Referred pain from the Neck (Cervical Radiculopathy)
What needs to be tested to determine the source of your hand pain
Range of Movement
Nerve tension test
Tendon gliding test