Tuesday, March 29, 2022

Hey! Read This If Your Hands Go Numb When You Look At Your Phone

We're a tech-heavy crowd here - by which I mean we're on our phones and computers a lot - so I bet some of you have your hands go numb while you're typing or looking down. Am I right?

My fingers started going numb probably 4-5 years ago, usually while I slept. I'd wake up and shake my hands around wildly to get the feeling back, not realizing the problem wasn't in my wrists, but my neck. Eventually I learned that a few neck twists looking over my shoulders would bring the feeling back, but even then I blamed it on tight shoulder muscles, and didn't think much of it.

Over the years the numbness got worse, though, so I finally did some Googling and found a name: Thoracic Outlet Syndrome. Even better, I found a diagram showing exactly where the problem is:


via Johns Hopkins


The culprits are the scalene muscles, which connect the neck to the clavicle. Things like "tech neck" and poor posture cause the muscles to tighten over time, pulling in the clavicle and constricting the nerves underneath against the top rib. The result is hand and arm numbness, tinging, pain, etc. (I'm not a doctor, of course, so hit that link to Johns Hopkins to learn more.)

The diagram was a revelation. Now when parts of my hand went numb I stopped simply twisting my neck - which was working less and less - and instead banged on my neck with my knuckles, all over the scalene area. This worked like a charm, but never lasted long. As soon as I lifted my arms or looked down at my phone again, the numbness would come back. It shifted around, too; sometimes my thumb and forefinger were out, other times the entire pinky side of my hand. My fingers would also ache from time to time, deep down.

I mentioned the numbness to our chiropractor many times, but nothing he did ever helped. So save your dollars if you're considering chiropractic; TOS is a muscle issue.


Over the years the numbness went from an occasional nuisance in the morning to an almost constant impediment. I was stopping over a dozen times a day to bang on my neck, and when we volunteered as painters a few months back my hands were so numb I couldn't hold the brush without stopping every few feet, for fear of dropping it. I knew that TOS doesn't cause permanent damage, so I wasn't worried, but it was so. dang. frustrating.

Now here's where we turn to the good news. Yayyyy.

If you've researched Thoracic Outlet Syndrome then you know the recommended treatment option of "physical therapy" is annoyingly vague. I couldn't find any recommended stretches or exercises, just repeated recommendations of "physical therapy." Harrumph. I'd been doing yoga almost every night since before Christmas, but that wasn't helping, no matter how many neck and shoulder stretches I did. So with the only other options being surgery or nerve blocks, I finally caved and asked John to find a physical therapist.

We were directed to an osteopath, which is a doctor who uses "physical manipulation" in addition to conventional medicine. Osteopaths aren't as common here in the U.S. as they are in Europe, but I'd heard good things. (It was an osteopath in the Netherlands who helped my mom recover full range of motion in her arm decades after a car accident, something no other doctor or chiropractor had been able to do.)

As soon as I sat on the table the osteopath and his assistant raised my arm, tilted my head back and to the side, and took my pulse. How's this for fascinating, y'all: because TOS constricts blood flow as well as nerves, they can diagnose TOS by a diminished pulse. They could even tell that my left arm was worse than my right, just by my pulse! So within two minutes I had an official diagnosis of "severe" TOS. Not the worst he'd ever seen, but definitely bad.

This is getting kinda long, so
as the TikTokkers say, let me skip to the good part.

I've had one 15-minute treatment a week for 6 weeks, and while I'm not fixed yet, I'm happy to report my hands only go numb a few times a day now. Considering it took most of my adult life to develop TOS, this much improvement in a month and half is incredible, and honestly more than I hoped for.  It's actually more frustrating now when my fingers go numb, because I'm not used to them being numb all the time anymore - and that's a wonderful feeling.

I also won't keep you in suspense; I'm going to tell you what the treatment is. Mostly because it is absolutely fascinating, and something I couldn't find online. Hopefully this will help if you're considering physical therapy yourself.

It's, uh, also quite painful. The description may bother you a bit if you're squeamish.

As the doc explained it to me, the scalene muscles are too tight and need to be stretched, but there's no way we can stretch them ourselves. Instead we need a doctor to stretch the muscles for us.

To do this, the doc pulls my arm out at a right angle, applying constant pressure, and uses his other hand to dig his fingers in above my collar bone. He gets a grip around the collar bone with hooked fingers, and yanks. He uses all his strength, bracing his foot on the table below me and leaning back with his body weight. Then he stays like that, for several, excruciating minutes.

It hurts, y'all. And apparently it looks like this:


Heck yes I asked if we could take a picture, this is for posterity. I'm smiling under the mask, but only because he's stretching my less-severe right side. When he switches to the left I mostly keep my eyes closed and focus on breathing and not blubbering, because owieowieowie.  (Still not sure why my left side is worse, but I suspect it has to do with sleeping on that side.)

Over those few minutes both the osteopath and I can feel when the muscles start to loosen. I don't know how he can tell, but for me it starts to hurt less. However long it takes is how long he pulls, so sometimes it's only a minute, and others it feels like an eternity.

As much as this hurts, I can tell you the treatment has never triggered my panic. It's not a scary pain, just a muscle-pulling pain. I leave branded with angry red finger marks on my neck, but those fade in a few hours. I also leave feeling, as the doctor describes it, "like someone beat you with a baseball bat." Ha! It's not that bad, but definitely sore. I go home and apply a heat pack, then through the week I do my usual yoga stretches.

The yoga definitely helps the treatments work faster and "stick"; when I skipped several nights the numbness was noticeably worse, and my osteo treatment was surprisingly more painful, the only time I've fought tears on the table. That's motivation enough to keep up the yoga, but I'm also convinced it's speeding up the process. (Treatment can apparently take months and months, but at this rate I'm hoping to be done in under three.)

Again, I've been doing 45 minutes of yoga nightly since before Christmas, and none of it helped the numbness before the osteopath. So unfortunately you really do need professional intervention for Thoracic Outlet, or at least with severe cases like mine. Stretching at home on your own just won't cut it.

That said, after a month the doctor said my muscles had lengthened enough to add at least one specific stretch: a modified corner lean. I can't find the exact move online, but it's like this, only with your elbows higher and your fingers pointing into the corner:


So basically stick your elbows out high like you're about to do the Chicken Dance, open your palms facing the wall, and lean into a corner. Careful, though; even with my progress this stretch was too much for me the first week, and I gave myself some unpleasant muscle spasms in the boobage area that lasted for days. So, as the Dread Pirate Roberts would say, "gently!!"

Again, I am in no way a medical professional, so please get a diagnosis and do your own research before trying anything radical like Chicken Dance Leans or banging your knuckles into your neck, k? Y'all be smart out there.


I hope you found this as fascinating as I have, and take mine as a cautionary tale: if you're experiencing hand numbness, don't wait! Watch your posture, and start doing neck and shoulder stretches now to combat "tech neck" - aka forward head position - which can lead to TOS. Even with decent insurance these treatments are $60 each, so I'm looking at paying over $700 for my negligence in waiting this long. Don't be me. Save your neck and your bank account.


Right. Your turn! Do any of you have Thoracic Outlet Syndrome? If you've been treated, how long did it take? What do you find helps the most? Or if you're just learning about all this, do your hands go numb, too? And of course, let's talk ergonomics, baybeee. What's your favorite posture helper/tip/trick? I love my foot stool and Aeron chair, but I'll admit I'm still guilty of crossing my legs while I work. ::guilty grin::


*****

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45 comments:

  1. That particular exercise is what the doctor gave me to help stretch the fascia in my shoulder. I slouch, the fascia constrict, and it hurts. I also have an exercise where I pull my arms back and down and then hold it.

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    1. Those stretches are *amazing* for posture & stiff everything after computer work. My go-to throughout the day is trying to touch my elbows behind my back; almost always gives me a relieving crack or two. Ahh.

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  2. I have never heard of Thoracic Outlet Syndrome and was convinced my hand numbness must be carpel tunnel. I'm planning to bring it up at my annual in a couple months. But I'll have to do some research now and see if it might be this instead!

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    1. I'd never heard of it, either, so I'm glad to be spreading the word! Next time your fingers go numb try poking around your lower side neck; if the feeling comes back, I'm willing to bet it's TOS.

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    2. My doctor tried to diagnosis me with carpal tunnel because of the finger numbness, however if your numbness/tingling goes higher than your wrist, then it may be TOS and not CT. Be as specific as you can with where you have your issues to get the best diagnosis - Good Luck!

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    3. Thanks both of you. I'll definitely try poking around my neck, and pay close attention the next time my hands go numb.

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  3. How interesting - I've never heard of that condition. So glad PT with an osteopath is helping you! Did the osteopath have to bone up on your condition first or did he know about it already? (And sorry for the unintential "bone/osteo" pun!)

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    1. Aww, I was hoping that pun was intentional! :p

      He already knew all about Thoracic Outlet; I only told him was my hands were going numb, since I know how doctors hate it when we self-diagnose. He immediately took my arm and did the test, so he knew what was up.

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  4. Oh, friend. I'm so sorry it took you this long to discover the source of your numbness. As soon as you started describing it, I had a feeling you were going to say that you got a TOS diagnosis. :(
    Massage therapy can also be a great treatment modality for TOS, BUT you need to find a practitioner who does therapeutic work and knows what they're doing in that area. The massage-based techniques aren't as intense as osteo work, and generally feel "nicer" but I've also had clients whimpering on the table because this crap is DEFINITELY not relaxing spa massage.
    Since you've been dealing with this for SO long, I would strongly suggest finding a massage therapist who can do some trigger point work on your anterior scalenes and SCM. This is more "not fun" work, but also not as intense as the osteo work. Perhaps check with the osteo for a referral to a therapist in your area, and ask a potential LMT about their experience and technique when dealing with TOS and anterior neck trigger points.
    Also, heat helps to relax and soften the muscles. Magnesium topically (lotion) on the area will also aid in getting those muscles moving more easily. Epsom salt baths are THE BOMB and should be taken as often as possible. Hope this helps!

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    1. When you mentioned trigger point work I immediately thought of how my chiro always pokes a spot in that area that hurts like heck, but kind of in a good way? So I'm guessing it's like that, ha.

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    2. Similar, yup. But also with a lot more work to the fascia and surrounding muscles than a chiro typically has time for. We get to kind of move slowly and let the body tell us how it wants to proceed because we've got 30/60/90/120 min, and chiros usually have 20 min or less. It generally feels easier when you don't have to force the body into compliance, but can ask it nicely.

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  5. Also! Scalene tension is not going to just show up on its own and not affect any other things; bodies don't work like that. So if they're tight, something on the other side (back of the neck) is going to be overworked/overstretched (ie: you get pain in the back of your neck/back of your shoulders). Other muscles are working hard to counteract this hyper-tense muscle group, so getting work on the entire cervical/thoracic area is going to be to your ultimate benefit and would potentially make your treatment process go faster, along the same lines that your yoga practice is keeping you moving forward. Just another plug for massage. :)

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    1. Excellent points, dang it. You're... you're going to make me try massage again, aren't you?

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    2. I mean... it's what I've been doing for the last 19 years, so I'm pretty biased. But it's also kind of amazing for stuff like this, so. :)
      Definitely ask loads of questions when you book your appointment, and you totally don't need to do full body work if that's not comfortable for you (for any reason whatsoever). There's a million modifications to suit every body's specific needs, and ways to work within your comfort zone to both get great results and feel pretty good during and after the process, too.

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  6. Osteos really are worth their weight in gold! Wouldnt be without mine.

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  7. What keyboard you use makes a HUGE difference, too. I'm a professional writer and I was starting to get pins and needles and pain in my hands, and when I switched to a Kinesis Advantage ergonomic keyboard, it was incredible the difference. Pain went away completely after just a few weeks! And after a few months, my typing speed had increased from 92 WPM (where I had been steady for a decade or more) to 115 WPM without any added pain. As for the pins and needles, they're in my legs and back of my head too now, and they've decided it's not related and a complete mystery as to the source.

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    1. YESSSS to the ergonomic keyboard! I have the same story as you there; completely reversed the carpal tunnel pain. I can't type long at all without mine.

      My legs get pins and needles sometimes too, but I find my yoga back stretches help immensely. Since you're also a writer, I'm willing to bet your lower back is as stiff as mine, even if you can't feel it. The cow/cat yoga stretch is heaven for that, maybe give it a try sometime?

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  8. There are a lot more Osteopaths in the US than you would think! Any provider with DO after their name rather than MD is a Doctor of Osteopathy. Osteopaths can specialize just like other doctors. You find many of them in family practice. Keep your eyes open when you are looking at lists and you will be surprised by how many you find!

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  9. I will be forever grateful to my osteopath. I had gotten to the point where I was waking up in tears because of the intensity of the pins and needles. I couldn't wash my hair or brush my teeth without needing a rest or to 'do the Shaq shake' as my loving :P husband called it, trying to settle the nerves. The numbness, tingling or burning could be in my hands or stretch up to mid bicep, or anywhere in between. Chiropractor didn't know exactly what was wrong, but could provide temporary relief. Saw a PT for months, again temporary relief. Doctor prescribed nerve pain meds. I had XRays done, an MRI done...some one suggested that an option would be to remove the top rib to decompress the nerves. Yeah....no. Everyone I saw believed the issue was in my neck and just kept pulling on it. Finally, I was put in touch with an osteopath and within minutes, he figured out was was wrong and found a way to help me. At my last appointment, he did mention the shortening on the neck muscles as a contributor - sitting on the couch with one arm propped on the arm rest, or driving with one arm at the top of the wheel or even up on the window, sleeping positions, all encouraged those muscles to shorten. However, his initial diagnosis was that my ribs get stuck. okay, so, when you inhale, your ribs expand and lift and then settle back on the exhale. According to him, many of mine don't. So the top ribs stay elevated which pinches the nerves. A lot of our time together is him trying to gently pop them all back into place. I have tended to get muscle spasms several days afterwards, but found cold packs help with that. I should go more often, but like you said, it's not cheap. I would probably be more successful with it if I was more regular, but, yeah. I'm glad you found something that helps. I will try the version of the stretch you posted, it seems like it might help me too. Take care!

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  10. I have never heard of Thoracic Outlet Syndrome. THANKS for educating us. But more than that -- I'm s-o-o-o-o-o-o glad you are feeling better. Good on you for pushing until you found the diagnosis and then solution that works for you!
    Maureen S

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  11. Danielle HoffmeisterMarch 29, 2022 at 9:43 PM

    For self directed PT I watch Bob and Brad on YouTube.

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  12. I have been having my tips of my fingers go numb while holding my phone and the pinky and ring going completely numb when I rest my hands on my stomach while laying down. I have been trying to figure it out. I'm not sure if its the same deal, but it is definitely something to look into and maybe chat with you about more when I see you at Dragoncon!

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    1. This is my problem too! I’ve always thought it might be an elbow thing? But I definitely blame phone usage. I wonder if a pop socket would help me.

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  13. Osteopaths are magicians. Physical therapy is partially covered by public health insurance in Denmark, but osteopathy is NOT so it's hecka expensive (by Danish standards) so it took me forever to go, because I was afraid it would be a waste of money like so many other "treatments". Five minutes of looking at me and she had determined exactly what the problems with my back were and three 45 minute sessions later she'd worked through it and taught me some basic, gentle exercises and that was it. Ah. Friggin. Mazing.

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  14. Thank you so so much for talking about this. I’ve been dealing with numb hands for months, especially when I wake up in the morning. I’ve assumed it was carpal tunnel and didn’t want to deal because it might involve surgery and I work with my hands and can’t afford time off. I’m hopeful there may be a non-surgical solution ❤️

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  15. I had C6/C7 rupture in my sleep due to "Tech Neck" that I had ignored. It was the most intense pain and it took Forever to get it under control. Sadly I had to have steroid injections to get the pain in my right arm and the numbness to stop. I have been heavy for almost 20 years and I had lost 70lbs before the injury. The steroids combined with intense pain for 6 months brought back all the weight and then some. I was in Therapy with a Chiro who also did Nearly all muscle work instead of just cracking and he was my saving grace. My Doctor who was treating my neck at first wanted to fuse my neck since the disc ruptured inward and displaced my spinal cord I went to an osteopath and he referred me to the Chiro that I went to because my insurance would cover his treatments fully vs only covering 12 weeks of PT. Tech neck is no joke and TOS is a miserable and long treatment process! I'm glad you are getting help and I hope you are able to heal completely soon!
    You asked for ideas. Ask your Osteopath if the Posture Pump would be helpful for you. I'm no doctor so take his advice but I have found that the PP helps me when I sleep wrong and flair things up.

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  16. OH. MY. GOD.

    Jen, are you me???

    I have been dealing with numbness/pins-and-needles in my right arm and hand in bed for quite a while now, but it became intense (and sleep-disruptive) just in the last couple of weeks. I knew it was stemming from somewhere in my neck, because I could induce or avoid it depending on the angle of my neck and positioning with pillows, so I've been summoning up my courage (and, ahem, cash) to go visit my physio for an anticipated expensive few weeks of treatment.

    He's amazing and always figures out just what the problem is and how to tackle it, but Imma surprise him this time with my new-found knowledge and big words like Thoracic Outlet Syndrome and Anterior Scalene, lol. I'm pretty sure he's shown me the Chicken Dance Lean and similar kinds of stretches using doorways before, but I've been a bit lazy about actually doing them lately. Oops...

    Things I have found that help: The problem always happens in my right hand, so if I'm sleeping on my left side, I need to have a pillow in front of me to keep my right arm slightly raised (but not pointing too high - more stretched out in front than towards my head). If I'm lying on my right, I have to experiment a bit with head and neck placement on my (sculpted, memory foam) pillow so the pressure points are okay - I know straight away if I've got the wrong position (tingly fingers!) or the right position (uh, nothing, yay).

    Lots of trial and error has gone on the last few weeks, but things are improving a bit. Can't wait to get OWIEOWIEOWIED soon when I finally get to the physio...

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    1. I do the same at night except I use one of those animal shaped/plush heat up therapy packs. I heat it up as I get very cold (or in the summer you can put it in the freezer for some coolness on hot nights). But I find if I forget to use it, my hands will start going numb. Just enough to elevate my shoulder area slightly seems to work great. :)

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  17. I've been having numb hands on and off when I wake up for a few months now, so this post came just in time. I'd been assuming it was something in my hands or my elbow, though, not my neck! Gonna go look up some stretches now so I hopefully DON'T have to go find an osteopath later. Thanks, Jen, and I'm glad you're feeling better!

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  18. Yay yay yay I'm so glad this is making a difference for you!!

    I'm a long-time follower and trained as an osteopath, though I practice generally 'standard'/allopathic Western medicine at this point, and *so* many of the health things that you've been vulnerable in sharing over the years -- gut issues, anxiety/panic, etc -- can ALSO ea place for osteopathic medicine to help, not just with muscular pain! Not every DO will specialize in the craniosacral treatments, or treating viscera (guts, organs) or autonomic nervous system (fight-flight-or-freeze), but those that do -- it can make a HUGE difference. So keep in mind for yourself, and your followers! I go regular for dental/orthodontic issues, migraines, pregnancy (both managing back pain, and preparing for labor, and putting everything back together after birth), and I bring my children for gut issues, falls, dental issues, and nervous system regulation.

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  19. Wow, I've been having issues with my right arm going numb for a while. I wonder if it might be connected. I'll mention it my next visit!

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  20. Wow. I had never heard of TOS, but this is definitely what my massage therapist works on. I had been seeing her for headache relief and she asked me if I experienced numbing based on what she was feeling as she worked different areas. It isn't a relaxing spa massage, but it has made a world of difference to incorporate that specific focus.

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  21. This is so interesting. I am mentioning this with my doctor at my next check up in April. This sounds exactly like what I am stuggling with. Thank you!! Glad you are getting some relief.

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  22. I had not heard of this but it's good to know and I'm glad you have found a way to improve your condition so markedly!

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  23. What yoga do you do and like?

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    1. I tried a little of everyone's teaching I could find on YouTube, following a different video every night for a month, and from there I made up my own routine that I do while watching TV, so I don't get bored.

      My favorite teacher on YT is Rodney Yee, so I'd recommend him to fellow beginners: not too advanced, no excessive talking, and great stretches. I would do the combo of his neck video & his hip opener video to make one 20+minute workout.

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  24. If you follow Orlando Magic basketball at all, TOS was what Markelle Fultz had when he was with Philly before being traded here. It completely ruined his shot, and he spent a long time in therapy and relearning how to shoot. He has a shooting form that is very different from both his previous one and from other NBA players. Glad you finally got it diagnosed and are getting help.

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  25. My friend and former colleague Amy Zhong made the medical illustration you shared! I'm also a medical illustrator, and one of our biggest thrills is when our illustrations help someone to understand their body. So, yay! And I'm so glad you're feeling better.

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    1. That's amazing! I love it when the internet is such a small world.

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  26. I have an appointment this afternoon with my GP to figure out which specialist to see you get my ring and pinky fingers back to feeling something other than tingles on my right hand.

    Thank you so much for this!!!

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  27. Awesome!
    I have also been trying to figure out night time hand pain, but my cause is different. It's amazing how many different forms nerve pain can take. Brachial plexus nerve pinching can make hands numb or painful too, and there are wonderful nerve gliding exercises for that with a simple Google sesrch. Mine seems to be stemming from both brachial plexus (very roughly, neck through armpits, branching out) in combination with tight muscles around my elbows. I have no elbow pain at all. It definitely pays off to check in with someone who knows what they're doing!

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  28. I was misdiagnosed with Thoracic Outlet Syndrome and as a result what was actually carpal tunnel syndrome in both hands went untreated for years (with resulting muscle atrophy). After the carpal tunnel surgery, my hands are completely cured, so just be sure you have the right diagnosis!

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  29. LynnT here. I've had intermittent/recurring neck pain and hand numbness for years; Kaiser gave me a wrist brace to wear at night, which helps but does not eliminate the problem. I sent them this blog entry; they say that TOS normally presents as pinky/ring finger pain & numbness, where thumb/index problems tend to be carpal tunnel -- but they are setting me up with an orthopedist to do nerve transmission testing to see where the issue is in my case. Thanks for helping me get them moving!

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    1. Hi Lynn! That's wonderful, glad to share more options for you to test - though a "nerve transmission test" does sound more expensive than having someone tilt your head and take your pulse. So if you're looking at a hefty bill for that, maybe see if you have the option of an osteopath instead.

      For my own case I can tell you I frequently had my thumb & index finger go numb with TOS, about as often as the pinky finger side of my hand. Both resolve when I bang on my neck where those muscles are. I'm only one person, of course, but TOS definitely makes both sides of my hands go numb.

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