Do you feel numbness and tingling in your thumb, index, middle, or part of the fourth fingers? You may be suffering from a condition known as "Carpal Tunnel Syndrome".

Overuse and incorrect posture whilst busy typing away at your computer and mobile gadgets and phones could also put you at risk.

Dr Andrew Chin, Head and Senior Consultant from the Department of Hand Surgery at Singapore General Hospital, gives detailed answers to your questions.

Question by yinloke

Occasionally, I get an intense tingling sensation in the fleshy part of my right palm, where the thumb joins the hand. Usually, it happens when I grip an object tightly or am tugging at an object at an odd angle, though not all the time.

All this started when I noticed a weakness and dull ache in my wrist when I try to use my hands to push off a bed or chair. But only if entire body weight is placed on them.

Office doctor has prescribed Arcoxia but that doesn't work.

Is that carpal tunnel syndrome?

Answered by Dr Andrew Chin Head and Consultant Department of Hand Surgery Singapore General Hospital

Carpal Tunnel Syndrome is characterized by the feeling of tingling over the thumb, index, middle and adjacent half of the ring fingers.

Your symptoms do not suggest a typical presentation of Carpal Tunnel Syndrome. The nerve responsible for the sensation of your thenar eminence or as you have described, the fleshy part of the palm, is not the one that is affected in the Carpal Tunnel Syndrome.

You could have that nerve irritation that is situated superficially over the palmar aspect of the wrist. This is possible if you rest your body weight on that palmar aspect of the wrist and inadvertently irritated the nerve causing the symptoms that you have experienced.

If it is indeed due to irritation of the nerve, Arcoxia may not work. My advice is for you to avoid pressing your body with the wrist against the bed or chair and let the nerve heal naturally. However, if you do not get resolution of the symptoms over the course of 1 month after avoidance of the action, you should consult a Hand Surgeon.

Question by dave

I am a regular golfer. Quite a few years ago, I had trigger finger and had a jab by an ortho. This cured my problem for a few years. Then when it recurred, a GP did a jab for me, but the effect lasted only a few months.

My question is: how many times can a person do a jab like this and be effective? Are there any side effects in the long term? Also, what causes the diffference in effectiveness each time? Lastly, what can I do to prevent such occurence of trigger finger? Is this the same as CTS? thanks

Answered by Dr Andrew Chin Head and Consultant Department of Hand Surgery Singapore General Hospital

1. The injection concerned is a mixture of a local anaesthetic, commonly lignocaine and steroid compound or commonly known as H&L injection.

Personally, I do not give more than 2 injections each to the problematic fingers. This is because repeated injections with this mixture can result in the complication of tendon softening and its rupture, which is catastrophic. A fair majority of patients, about 60% to 75% do respond favourably after one injection. The remainder may need one more injection to achieve resolution but out of these, some may not respond favourably at all to the injections.

If one does not respond after 2 injections, it is unlikely that repeated injections will yield favourable outcome. Surgery will be the next option after 2 unsuccessful injections.

2. Each finger is different and even if it is the same finger, the degree of severity of the condition varies from finger to finger and at different times, which is why you get varied results.
3. Normally, it is difficult to avoid the occurrence as most of the time it is due to the nature of our work. Office based with lots of typing and computer related work, in the era of SMSing and mobile devices, the incidences will only increase.

What I do advise patients is that if they experience some degree of stiffness of their fingers and some pain over the base of their fingers, they should stretch their fingers backwards every now and then to try and minimize the progression of the condition. It may help to a certain extent but not all cases.

4. No, trigger finger is not the same as Carpal Tunnel Syndrome

Question by Wayang59

For the past 3 months, I have numbness feeling in my little pixie finger (the last finger) on my left hand. I do not spend alot of time on the computer or any gaming gadgets. I am male, 52 years old and wonder what caused this numbness and what medications are available to get rid of this discomfort. Is this numbness age-related syndrome? It just happened one morning when I woke up without any symptoms that usually occured with other illnesses.

Thank you.
Wayang59

Answered by Dr Andrew Chin Head and Consultant Department of Hand Surgery Singapore General Hospital

If you have numbness of the little finger, it could be the ulnar nerve that is subjected to compression and irritation and the common site of the nerve compression is at the inner side and behind the elbow, where we normally experience the “funny bone” phenomenon, the other common site will be at the base of the hand over the fleshy part opposite the base of the thumb or what we call the hypothenar eminence.

Although the symptoms are more common in the older age group, young person may be susceptible to the nerve compression depending on the postural habits developed over the years.

One common posture is to rest the palms of the hand at the back of the head and that inadvertently causes the elbow to bend and if this posture is adopted for a prolonged and frequent period of time, the nerve (ulnar nerve) at the elbow will be subjected to compression and may be irritated over the course of time giving rise to symptoms of numbness of the little and adjacent half of the ring fingers as well.

Question by victor

Firstly, pain and cannot bend in the middle finger on the left hand and doctor in polyclinic said it inflammation of muscle and steroid jab. one year later pain and cannot bend in the middle and fourth fingers on the right hand, again steroid jabs given to both fingers and now second finger is painful and cannot bend for five months. some pain also extend to the fourth finger and cannot bend also.

Should I go for steroid jab again or other method of curing this problem as I understand cannot have too many steroid jabs as it harmful for the body.

Please advise me as this pain and the finger cannot bend keep travelling from one to another finger.

Thanks

Answered by Dr Andrew Chin Head and Consultant Department of Hand Surgery Singapore General Hospital

You have trigger fingers and you certainly have been having multiple H& L injections. Please refer to Question 2 for a thorough explanation on the treatment of trigger finger. In this day and age, it is unlikely to avoid the problem.

However, Diabetes Mellitus is associated with this problem and do affect multiple fingers. If you have diabetes, it is imperative that you control your diabetes as this may help in reducing the occurrence of this problem.

Question by healthblur

Recently I sometimes feel some pain in one or two of my fingers ( usually the fourth finger, and mainly my right hand), both in the lower joint and the straight part of the finger. I will rub it with my other fingers for a few minutes to make it feel better.

Is this a symptom of carpal tunnel syndrome? Or is just temporary overuse on the computer and handphone sms and blackberry, all of which I use a lot for my work and personal communication as well.

Is there any cream or other home/ self remedy that will help heal this? How do I know when it is time to see a specialist and what will likely happen (i.e. treatment)? I do hope to avoid the need for any surgery.

Btw, when would surgery be required and is surgery safe? Will I get back full use of my fingers back or just 70-80% kind of thing?

Look forward to your reply. Thank you.

Answered by Dr Andrew Chin Head and Consultant Department of Hand Surgery Singapore General Hospital

1. It is unlikely to be Carpal Tunnel Syndrome as the symptoms do not quite fit into the typical presentation of numbness as I have described in the answer to the 1st question. In view of your job nature, it could very well be symptoms of overuse or of early trigger finger where there is pain at the base of your fingers with some stiffness of the finger joint.
2. For early Carpal Tunnel Syndrome, where the symptoms are infrequent and come on usually on prolonged gripping and/or posture of bending the wrist, the treatment is usually with avoidance of the aggravating factors, modification of the workstation ergonomics and medications like pain killers for occasional pain and Vitamin B6 supplements. Splinting of the wrist to keep the wrist straight has also been used. Topical creams have not been shown to be effective treatment for CTS.

Surgery is indicated if there is persistence of symptoms such as numbness and/or pain to the extent that it affects the person’s lifestyle and activities of daily living and disturbed sleep. When there is weakness of grip, pinch and the fleshy part of the palm just below the base of the thumb shrinks in size compared to the opposite hand (Thenar muscle wasting).

If surgery is performed at earlier stages when there is only symptoms of sensation abnormalities then there is a likelihood of almost full recovery but if there is already very chronic symptoms for many years and in particular, there is weakness and loss of the muscle bulk over the base of the thumb, then the recovery at best will only be partial as some of the nerves have already been damaged beyond recovery.

Question by laychoo

I have numbness and tingling feeling in my fourth finger after I've rested my head on my left palm for about 10mins. That happened a few years back and GP said nothing much can be done and advised me to take Vitamin B complex. Sometime the tingling feeling can stretch from the arm to the back of the shoulder. I have also tried massage but still the feeling can come and go. My right tumb also have the numbness feeling since yesterday. Not sure what have I done that trigger it. Is this due to poor blood circulation/old age? Do I need to consult a specialist?

Answered by Dr Andrew Chin Head and Consultant Department of Hand Surgery Singapore General Hospital

Your problem is likely to be Cubital Tunnel Syndrome. You did mention that it comes on after resting the palm of your left hand over the head. This is because in that position, you are subjecting the ulnar nerve, the one responsible for relaying sensation of the 4th and 5th fingers, which runs across the back and inner aspect of your elbow to being compressed.

This will lead to nerve irritation and thus giving rise to the symptoms that you are experiencing. The best treatment is to avoid that posture altogether so that the nerve is not unduly compressed for prolonged periods. I understand that this can be quite difficult as some have been doing that all their lives and it has become a habit. Medications and massages may not be effective.

The numbness of the right thumb could suggest that you may be starting to develop symptomatic Carpal Tunnel Syndrome. I do suggest that you make an appointment to see a Hand Surgeon to get it investigated.

Question by yoonratiaung

I had my operation in 2003 for removal of extra bone from neck. After that operation until now I feel numbness of my 4th and 5th fingers. Is that related to "Carpal Tunnel Syndrome"?

Answered by Dr Andrew Chin Head and Consultant Department of Hand Surgery Singapore General Hospital

Based on your short description given, it does suggest that you had Thoracic Outlet Syndrome from the “extra bone” in your neck, called cervical rib.

This “extra bone” that you have mentioned could have caused you to develop symptoms of nerve compression and pain to your upper limb at the same side as the cervical rib.

As the cervical rib is intimately related to the nerves involved in relaying sensation from the ring and little fingers, it may have an influence on the numbness that you have been experiencing.

It is not Carpal Tunnel Syndrome as in this condition; the numbness is usually over the thumb, index, middle and adjacent half of the ring fingers. May I suggest that you see a Hand Surgeon to get your problem re-evaluated and investigated further.

Question by pigsyz

My left thumb banged onto some objects and I heard a cracking sound, followed by sharp pain in my thumb.

After the incident, I occasionally felt tingling pain & usually felt the aching sensation and trembling in my thumb. These symptoms appear more frequently during cold weather.

I went to a few GP to check on this, they either say it's sms finger (due to using too much of thumb in sms-ing or typing the keyboard, which I don't really do much of these activities) or it's relating to the tendon in my thumb. Is it advisable to put on a thumb support/stabilizer for my case?

Answered by Dr Andrew Chin Head and Consultant Department of Hand Surgery Singapore General Hospital

Your thumb has been subjected to trauma and you may have inadvertently injured and bruised the nerves to the thumb as well as the other surrounding tissues of the thumb.

The nerves are responsible for relaying sensation from the thumb surface. This is why you are getting some tingling and aching symptoms.

You may benefit from a splint to support the thumb for a couple of weeks till the bruising and swelling subsides, together with some painkillers/anti inflammatory medications and let nature tackle the healing process. Your nerve should also recover in due course but in some situations, it may take up to a few months.

However, should you not experience improvement or resolution of symptoms by then, you should consult a Hand Surgeon.

Ref: U11