Tingling in Your Fingers? It Could Be One of These Syndromes

If you’ve been feeling a tingling, numbness or shooting pain in your fingers after bending your elbows or wrists for a sustained period, don’t shrug it off.  

You might have a compressed or irritated nerve that’s causing carpal tunnel or cubital tunnel syndrome. I see a lot of patients with this condition in my practice at UW Medicine. Early diagnosis is important — delaying medical care can lead to permanent nerve damage. 

The good news is that you can expect a successful recovery as long as you get an accurate diagnosis and expert treatment. Let’s take a look at carpal tunnel syndrome first. 

What is carpal tunnel syndrome? 

The carpal tunnel is a narrow passageway surrounded by bones and ligaments on the palm side of the hand. The median nerve passes through the carpal tunnel, which provides sensation to the thumb, index finger, middle finger and half of the ring finger, as well as motor function to the thumb. 

Anything that squeezes or irritates the median nerve within the carpal tunnel may lead to carpal tunnel syndrome. The condition can have several causes:  

• A wrist fracture that causes swelling or narrows the carpal tunnel 
• Nerve-damaging conditions, such as diabetes 
• Swelling and inflammation caused by gout, rheumatoid arthritis or other diseases 
• Workplace factors, such as working with vibrating tools or doing tasks with repetitive wrist movements 
• Your wrist anatomy  

Many people believe working at a computer and using a computer mouse causes carpal tunnel syndrome. But research doesn’t bear that out. However, those activities could worsen existing symptoms.

Carpal tunnel syndrome is three times more likely in women than men. This may be because the carpal tunnel area is relatively smaller in women than in men. Also, hormonal changes during pregnancy can cause swelling, leading to increased pressure in the carpal tunnel. 

Common symptoms of carpal tunnel  

Symptoms of carpal tunnel syndrome appear gradually. Here’s what they can look like: 

• Dexterity issues that can cause you to drop things like coffee cups and car keys 
• Lack of sensation or hyper-sensitivity in the affected thumb and fingers 
• Pain in the forearm on the palm side of the wrist 
• Pain, numbness and tingling in the thumb, index and middle finger, and half of the ring finger 

Pain symptoms tend to worsen at night. When you are asleep, tissue fluid in the arms redistributes, leading to increased pressure in the carpal tunnel area. In addition, people often sleep with their wrists flexed, which increases compression on the median nerves. 

When is it time to see a doctor? 

It’s better to be safe than sorry with carpal tunnel symptoms. If they interfere with your sleep or daily activities, make an appointment with an orthopedic hand specialist. Permanent nerve and muscle damage can occur without treatment. 

In the meantime, you can try reducing your symptoms at home by doing the following:  

• Avoid certain activities: If driving or typing worsens your symptoms, change how you position your wrists when you do them. Keeping your wrists in a neutral position and proper ergonomics are helpful. 
• Wrist splinting: Wrist splints are available without a prescription at most drugstores. You can wear one while you sleep to help relieve nighttime symptoms of tingling and numbness.  
• Nonsteroidal anti-inflammatory drugs (NSAIDs): Over-the-counter medicine, such as ibuprofen (Advil and Motrin IB), may help decrease inflammation and relieve pain. 

These therapies won’t cure carpal tunnel syndrome, but they may make you more comfortable while you wait to see the orthopedic hand specialist. 

During your appointment, the orthopedic surgeon will discuss your symptoms and perform a comprehensive exam of your hands. To confirm the diagnosis, you might need additional testing, such as a nerve conduction study or an ultrasound. 

If you have carpal tunnel syndrome and experience mild symptoms that come and go, you might be able to manage them by wearing a wrist brace, taking NSAIDs and modifying certain activities. But if your symptoms are moderate to severe, a hand specialist will likely recommend carpal tunnel release surgery. 

When is it time for surgery? 

Carpal tunnel release surgery is the treatment of choice for people with moderate to severe symptoms. The procedure relieves pressure by cutting the ligament that is pressing on the median nerve. 

Surgeons traditionally use an open technique for this procedure. They make a small incision in the palm over the carpal tunnel and cut through the ligament to free the nerve. 

Many doctors, including me, do the surgery endoscopically, which is less invasive than open surgery. First, I make a small incision in the wrist. Then, I insert a telescope-like device with a tiny camera into the carpal tunnel to show me the ligament on a video screen before I cut it.  

Compared to an open surgery, the endoscopic approach, which requires a smaller incision, means less pain and faster recovery. Longer-term outcomes are the same for both surgeries, although the endoscopic approach allows people to return to work and their usual activities a few days sooner.  

Persistent numbness can persist after surgery, and patients may need up to three months to experience the full benefit of surgery. However, most people eventually make a full recovery. Only in severe cases is a complete recovery less likely. 

Now, let’s take a look at cubital tunnel syndrome. 

What is cubital tunnel syndrome? 

The cubital tunnel is on the inside of the elbow and is made up of muscles, ligament and bone. The ulnar nerve passes through the cubital tunnel and provides sensation and motor function to your little finger (pinkie) and half of your ring finger.  

When the ulnar nerve gets squeezed or irritated, it can cause numbness, tingling and pain in the hand, ring finger or pinkie, especially when your elbow is bent. The pain is similar to when you hit your “funny bone,” but it can be constant. 

You may also experience symptoms like:  

• Aching pain on the inside of the elbow 
• Hand pain 
• Weakness and clumsiness in the affected arm and hand 

What causes cubital tunnel syndrome? 

Though it isn’t always possible to tell what causes cubital tunnel syndrome, some possible reasons include:  

• Frequently bending your elbow with physical activities that involve pulling and lifting 
• Long periods on the computer or phone with the elbow bent past 90 degrees 
• Leaning on your elbow a lot 
• Blunt trauma to the inside of the elbow   

Arthritis, bone spurs, and elbow fracture or dislocation can also cause this condition.  

If you think you may have cubital tunnel syndrome, make an appointment with an orthopedic hand specialist sooner rather than later. In the meantime, be sure to give your elbow a break. Rest it and stop doing anything that makes your symptoms worse.    

How is cubital tunnel syndrome treated? 

Doctors diagnose cubital tunnel syndrome the same way they diagnose carpal tunnel syndrome. But the treatment course often differs. If you have mild cubital tunnel syndrome symptoms, your doctor will recommend one or more nonsurgical therapies first:  

• Foam elbow braces or splints: These devices, often worn at night, limit elbow flexion and reduce irritation. 
• Gel elbow pads: Soft cushions protect your elbow when it rests on a hard surface. 
• NSAIDs: Over-the-counter medicine, such as ibuprofen, may help relieve your pain.  
• Physical therapy exercises: Specific movement can improve nerve gliding and decrease pressure on the ulnar nerve.   

If these treatments don’t work or your symptoms are moderate to severe, surgery may be the next step. 

What are the surgical options? 

Orthopedic surgeons perform two different types of surgery for cubital tunnel syndrome. The simplest is called ulnar nerve release. During this procedure, they make an incision on the inner side of the elbow and cut the tight tissue that is compressing the nerve. Ulnar nerve decompression can be performed as an open procedure or an endoscopic procedure. After the nerve is freed up, the surgeon moves the elbow into flexion and extension to ensure the nerve is in a good position. If everything looks good, they’ll close up the incision. 

If the ulnar nerve appears unstable, the surgeon will perform an ulnar nerve transposition. During this procedure, the surgeon moves the nerve to the front of the elbow so it’s in a more stable position. They may relocate the nerve directly under the skin or underneath the muscles. Transposition surgery is typically more involved and requires a longer recovery time.    

As with surgery for carpal tunnel syndrome, people who have cubital tunnel syndrome surgery tend to do very well. However, the recovery time is longer with cubital tunnel surgery since it is a larger operation, and the ulnar nerve has to heal from the elbow down to the fingertips. Although patients recover from the surgery in four to six weeks and can return to full activities, it may take about six months before patients notice improvements in sensation and muscle function. In severe cases of cubital tunnel, nerve and muscle recovery will likely be incomplete.   

The last word: Don’t wait 

I’ll conclude this article the same way I started — with a caution not to wait to see a doctor for symptoms of carpal and cubital tunnel syndromes. Too many patients decide to live with the pain, tingling and numbness. They decide it’s “not that bad,” and before they know it, their symptoms are a lot worse. Don’t let it happen to you! With proper diagnosis and care, you can feel good again and use your arm as you did before. 

Dr. Jerry Huang is a professor in the Department of Orthopaedics and Sports Medicine at UW Medicine and program director of the UW Hand Fellowship. He evaluates patients with elbow, wrist and hand problems and provides nonoperative and surgical treatment options. Dr. Huang works closely with patients to help them achieve pain relief and return to their work and recreational activities. Dr. Huang has an active lifestyle and encourages his patients to do the same. Some of his favorite activities are hiking, snowboarding, kayaking and playing basketball.