Nighttime hand numbness

Male, 53 years old. Complaints of nighttime numbness in right hand (hand and especially fingers), left hand too, but much less. Numbness is provoked by uncomfortable body position. It seems to bother me the most at night. This problem started about a year ago. Numbness had been developing gradually and he could not connect it to any particular reason.

Objective examination: patient is not symmetrical (right shoulder, first rib higher from the left one). There is noticeable swelling of supraclavicular areas. On palpation of the scalene muscles, there is sharp soreness with reflected pain in the shoulder. The first rib on the left: mobility is limited, palpation is sharply painful, on the right: no mobility, elevated, sharply painful. Tension symptoms of the peripheral nerves of the hand were positive (especially the median nerve, more on the right), at the same time, the provocation test for radicular symptomatology was negative. Adson's test is positive. Mobility of the neck is limited. Breathing was difficult, shallow, painfulness of places of attachment of the diaphragm, functional blocks of ribs (1,2,5 on the right, 1,6 on the left). Posture: upper crossed syndrome, head and shoulders forward, stooping.

Diagnosis: scalene muscle syndrome. Compression of the neurovascular bundle in the area exiting the thorax (between the tensed anterior, middle scalene muscles and the first rib). Functional joint blocks of ribs, vertebrae, diaphragm dysfunction, upper crossed syndrome.

Treatment: mobilization and muscle-energetic techniques for joint blocks, postisometric relaxation of scalene muscles, myofascial release techniques for thoracic diaphragm, thoracic outlet, neck, nerve tissue mobilization (neurodynamics).
☛  Proven effects of neurodynamic therapy

Results: after three sessions there was a significant reduction in the frequency and intensity of numbness. The patient was trained in independent joint mobilization exercises, PIR of the scalene muscle, exercises to optimize breathing and improve posture.

Night time pins and needles in hands. Conclusions.

In my experience of seeing patients already examined, nerve or vascular compression in the area of the scalene, small pectoral muscles is very rarely identified in the diagnosis. Usually the diagnoses are quite different (osteochondrosis, radicular syndrome, sometimes many at once). Although the nighttime hand numbness is quite common. And the sooner adequate care is provided, the better the recovery. Let me remind you that this is a functional disorder, which means that a complete cure is possible (until irreversible tissue changes develop).
But what is the cause of this condition? To the question: "Did you have any respiratory tract diseases?", the answer was: "Yes. I suffered from bronchitis with a very bad cough for six months, which became less, but I still have it now and again. That was about six months ago."
The most probable mechanism of dysfunction development is overloading of the respiratory muscles by shallow breathing and heavy coughing, appearance of rib blockages. Compensatory activation of the scalene muscle, their overloading, violation of the function of the first rib by them, compression of the neurovascular bundle by them, appearance of nighttime pins and needles in hands. All this was superimposed on the patient's existing problems with posture. The case illustrates how everything in the body is interconnected and, accordingly, the treatment should also be holistic.

Grigori Tafi
Osteopath, sports medicine doctor
15 years of experience in osteopathy and manual therapy. Read more...

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