Pins and needles in arms at night

Numb hands are common at night. Numbness and tingling in the hands can wake you from sleep. These symptoms could be signs of carpal tunnel syndrome.

Carpal tunnel syndrome (CTS) is the most prevalent compression neuropathy in the hand and arm. This is basically a type of pinched nerve in the wrist. Patients feel tingling and “pins and needles” in the thumb, index, and middle fingers. Sometimes the whole hand can feel numb or asleep. The hand can also have burning or electric pain. Symptoms are often worse at night. Many patients wake up at night to shake out the hand for relief. Numbness and tingling are common while holding a phone, driving, typing, or gripping tools during the day.

As carpal tunnel syndrome gets worse, the symptoms become more frequent. The hand numbness and tingling can become constant. In severe cases, the muscles at the base of the thumb become weak and smaller. Constant numbness in the hand and thumb muscle atrophy are signs of nerve damage. 

Risk factors for CTS are: family history, diabetes, rheumatoid arthritis, thyroid disorders, pregnancy, and wrist fracture.

Hand surgeons treat patients with carpal tunnel syndrome every day. The diagnosis is usually obvious to most experienced hand surgeons, based on patient symptoms and physical examination. In some cases, a nerve study/EMG is ordered to confirm the diagnosis or rule-out other neurologic conditions. 

Many patients with mild to moderate CTS can improve with non-surgical treatments. Wearing a wrist brace at night is often helpful to prevent the nerve from being pinched in the wrist while sleeping. Stretching exercises and hand therapy may help some patients. Steroid injections often are helpful to relieve symptoms in mild to moderate cases of carpal tunnel syndrome. 

If the nerve compression is severe, or if non-surgical treatment has not been successful, carpal tunnel release surgery is usually recommended. Carpal tunnel surgery is the best way to prevent nerve damage in the hand. 

Carpal tunnel release surgery is the most common procedure performed on the hand in the United States. The majority of patients experience improvement in the numbness and tingling in the hands at night after surgery. Over 90% of patients are satisfied with the outcome of the surgery. Complications from carpal tunnel release surgery are unusual. The recurrence of carpal tunnel syndrome after surgery is rare.  

Seek consultation with a hand surgeon to discuss the best treatments for carpal tunnel syndrome. Dr. Erickson practices at the Raleigh Hand to Shoulder Center and he is an expert in the diagnosis and treatment of carpal tunnel syndrome.

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  Dr. John Erickson, Raleigh Hand to Shoulder Center