My Wife Needs a Hand

November 23, 2005 7:58 AM

What could be causing my wife's hands to become numb and painful at night??

Within the last few months, my 43 y/o wife has been complaining of (mostly) night time pain, tingling, and numbness in both her hands. Last night it was so bad that she was up almost crying at 4am and had to pace around until it finally stopped. It's only when she is laying down that it becomes that bad. Otherwise, she is ok but complains at time that it is difficult to use her hands for prolonged periods during the day.

She quit smoking last January and has gained a lot of weight since. She has a family history of arthritis (her mom has it). It just does not seem like arthritis...at least, if it is, I didn't realize it could do this at night...or could it be something else (cardiac)? No other symptoms like shortness of breath, dizziness, etc. Anyone else who might have arthritis go through this? What helps?

She is calling the doctor today but, since it's the day before Thanksgiving here in the States, we probably won't be seeing a doctor for a few days, if not next week.

posted by SparkyPine to health & fitness (35 comments total)

Could it be carpal tunnel? Read the symptoms in the green box.
posted by iconomy at 8:03 AM on November 23, 2005

I hit post too soon. I meant to add that these comments might help her as far as things to mention to the doctor.
posted by iconomy at 8:05 AM on November 23, 2005

Does she lay on them?

They may be 'going to sleep' (cut off from blood) depending upon the way she is laying on them - it's somewhat common with obese people.

If they are asleep for an extended period, they would probably hurt mightly when the blood starts flowing again. This would explain the numbness and tingling. The 4 a.m. just-awoke mood state would tend to amplify the pain response, I would think.

Have her sleep on her back.
posted by unixrat at 8:06 AM on November 23, 2005

Also the fact that it goes away when she gets up and starts pacing points towards the 'going to sleep' theory.

And, uh, don't mention to her that I called her obese. I was just going by the weight gain comment. Best to leave that out. :)
posted by unixrat at 8:09 AM on November 23, 2005

As a sufferer of carpal tunnel syndrome myself, I concur with iconomy that that is the most likely cause. It certainly doesn't sound like arthritis--the tingling and numbness would tend to indicate a neural problem, and arthritis is by definition joint inflammation.
posted by cerebus19 at 8:09 AM on November 23, 2005

The doctor will know best, but I would not rule out Multiple Sclerosis. The tingling/burning sensation certainly sounds like MS. I haven't heard of MS symptoms being exacerbated by laying down, but it's theoretically possible that could happen because of changes in blood flow / blood pressure to the brain.
posted by alms at 8:20 AM on November 23, 2005

The doctor will know best, but I would not rule out Multiple Sclerosis.

That's what I was going to say. I don't mean to be alarmist, and hopefully this isn't it, but definitely go to a doctor. I've heard of similar symptoms in MS sufferers, especially in the early, undiagnosed stages.
posted by loquax at 8:23 AM on November 23, 2005

I have a similar problem (although it doesn't wake me up at night) and asked this question about it a few months ago. ikkyu2's answer was close - I have a problem with my C8 disc, and some ulnar nerve problems as well (not surprising, as I have a history of hand/arm repetitive motion issues).

Tell her not to worry, its not going to be this way forever. One trick I do have that works for me is to dangle the affected arm over the side of the bed as I'm falling asleep. For whatever reason, that helps.
posted by anastasiav at 8:26 AM on November 23, 2005

I've had numbess and tingling in my hands before, though not as bad as your wife's, and it was exacerbated by laying down. Turned out it was a spine and nerve-related issue, and fixed by my chiropractor in a few visits. Considering the stress involved in quitting smoking, the physical stress of weight gain and the holidays, I wouldn't get too worked up about it being MS.

Go see your doctor ASAP, and remember that until you know something you know nothing, which means she should try as much as she can to simply relax - stressing out will only make it worse, whatever it is. Best of luck.
posted by gregariousrecluse at 8:39 AM on November 23, 2005

could be advanced diabetes. I'm not a doctor, but's definitely something that should be checked ASAP because it's very common.
posted by CrazyJoel at 8:54 AM on November 23, 2005

She needs to visit a neurologist. The symptoms are those of bilateral median sensorimotor neuropathy. Whether this is caused by compression in the carpal tunnel or other problems is for a doctor to figure out, not the internet.

Do not delay too long. After a while, the changes can be irreversible.
posted by ikkyu2 at 8:55 AM on November 23, 2005

A friend who recenly died of ALS had symptoms like this at the start. That said, There are so many answers to this question. It could be the first symptom of a major degenerative nerve disorder, or a minor circulation problem. A doctor and a few days of tests can tell you more than any of us can.
posted by Megafly at 9:03 AM on November 23, 2005

Definitely listen to ikkyu2. Unlike the rest of us, he's a real doctor.
posted by solid-one-love at 9:03 AM on November 23, 2005

I had this problem when I had untreated sleep apnea--not because of the apnea--but because I had to sleep sitting up. I would zonk out and stay in one position all night. Prying my hands open in the morning was no fun.

I mentioned this to my doctor, who said that my sleep position wasn't the problem, but rather that my position didn't change.

Now that I can sleep more normally, I move around a bit, and I haven't had the problem since.
posted by frykitty at 9:06 AM on November 23, 2005

I had these exact symptoms last year and am probably a twin to your wife in statistics: 43, a little overweight, very stressed.

I couldn't figure it out - it can't be carpal tunnel because it was exactly even in both hands - not in just my "working" computer-mouse hand. It did kind of mimic pain I had from a previous bout w/carpal tunnel. I was stumped - nerves or circulation, nerves or circulation?? I thought I was going to have a stroke.

I had a lot of relief by wearing wrist braces on both hands while I slept. And not ever sleeping on my arms.

But to the point: at the time I was working at a food manufacturer and getting free salad dressing. I had never eaten caesar salad dressing before. I started eating it every day. Since the symptoms started when I started that job, I thought to take a break from the salad dressing. The symptoms went completely away within a couple days and haven't come back in a little over a year.

I think it may have been from the hydrogenated fats blocking my circulation. Other than that salad dresing (it was free!), I never consume bad fats. So it was new to my system.

I hope this helps.

Disclaimer: I am very responsive to self hypnosis (homeopathic sleeping pills work on me).
posted by 9000.68 at 9:09 AM on November 23, 2005

Carpal tunnel isn't the only tunnel out there. I suffered from cubital tunnel which occurs at the elbow, not the wrist. I also had numbness and tingling, but not as painful as your wife's sounds. Pain may have been lessened by my neuropathy due to diabetes, which should also be checked out by your wife's doctor. In my feet and legs, numbness is combined with (sometimes) excruciating shooting pains that make me seize up. Neuropathy can affect different people in different ways, and pain levels vary widely.
If it's cubital tunnel she would notice numbness mainly in her pinky and ring finger, and pain in the elbow. In any event, there are several variations of surgery one can have to correct it.
posted by genefinder at 9:17 AM on November 23, 2005

RSD?

Listen to the neurologist. She could suffer this pain indefinitely. See a doctor.
posted by billysumday at 10:07 AM on November 23, 2005

Could even be acid reflux. Try raising the head of the bed by placing a book under each leg at the top. Also, cut out chocolate, spicy foods and caffeine and see if that helps. My acid reflux, when it kicks in, is always worsened when I go to bed. And in addition to numb hands I sometimes get a tingly sensation in my armpits. Another way to see if acid reflux is the culprit is to take Tagament or Zantac (or the generic equivalent, which works just as well and costs much less). 200mgs or so should make a difference.

I am not a doctor, but this sounds a lot like what I was suffering from. It took a trip to the hospital thinking I was having a heart attack to diagnose it, but since then it has been easy to manage.

Good luck!
posted by terrapin at 10:10 AM on November 23, 2005

Does she have any dental problems? It could be TMJ.
posted by crapulent at 10:48 AM on November 23, 2005

Obviously, I second (or third or whatever) going to the doctor. My mom had the same thing, almost exactly as you describe it. For her, it was TMJ, which her doctor knew nothing about and took six months to diagnose properly. It was (according to her) the worst six months of her life. Get your wife to the doctor, and here's to hoping she gets better soon.
posted by mdbell79 at 10:55 AM on November 23, 2005

Tingling in extremites is usually referred to as peripheral neuropathy. If it is bad enough to cause her to not sleep then she needs to go to a doctor. It could be any of these things mentioned. I would start with a PCP, s/he could do some blood tests, see if anything jumps out and then go from there. I would definately want to be referred to a specialist of some sort. She needs a doctor to point her in the right direction.
Missing sleep could really exacerbate this too, so she really needs her PCP doctor to address this issue either by rxing something to help with the sensation or something to help sleep. At least until this issue is resolved.
I hope it is something easily fixed.
posted by TheLibrarian at 11:29 AM on November 23, 2005

It's not ALS, by the way. ALS is painless.
posted by ikkyu2 at 12:41 PM on November 23, 2005

Jesus fucking Christ. MS is pretty goddamn unlikely and it's irresponsible to even mention it within three zipcodes of a healthy woman. SparkyPine, go see a doctor and please keep your mind focussed on benign, fixable causes. ALS and MS are about as likely as a piece of blue lavatory ice crashing through your roof and killing you in the next ten minutes.
posted by docpops at 1:05 PM on November 23, 2005

She has neuropathy. It can be caused by many things - chemotherapy and diabetes are the most common but there are other causes, some mentioned here. I recomment this book.
posted by TheRaven at 2:20 PM on November 23, 2005

No one has mentioned heavy metal poisoning.
posted by docpops at 2:46 PM on November 23, 2005

It could just be stress. It sounds like something that was bothering me that muscle relaxants before bed have helped with. Turns out I was clutching my hands/arms really really tightly as I slept and causing all sorts of arm pain/numbness.
posted by pwb503 at 4:01 PM on November 23, 2005

I have had 3 healthy women friends (all in their late 20s, early 30s, one into rock climbing and healthy living, and no- they are not all from the same regional area) in their 30s diagnosed with MS all within 2 years. This is probably more than the average person...I hope. "The wife" sounds nothing like them but I don't see how you think MS is so rare and only striking women that are less that healthy.
Going to the doctor is the best idea. Ask questions and demand good care. Unfortunately with a symptom like this and many possible causes it is a matter of eliminating things. Your doctor should be able to come up with a plan of attack as far as getting an accurate diagnosis (blood test, imaging). If your doctor is not doing that get recommendations from friends for a better doctor. Do not feel obligated to stick with a dr that is not doing his/her job.
posted by TheLibrarian at 4:07 PM on November 23, 2005

I never said MS was rare. I said this patient, with nocturnal paresthesias in her hands and arms, is unlikely to have MS. I also can tell you that every woman between 15 and 80 that comes in to my office with any neurological symptoms thinks she has MS even if she doesn't say so, because MS is common, and scary, and having had something similar I know firsthand how terrifying it is to suggest it even when the evidence is weak. So throwing it out like it's possible on an online forum because one or several of your friends had MS and had complaints that you think were similar is irresponsible and unnecessarily scary as hell.
posted by docpops at 4:27 PM on November 23, 2005

Until you see a doctor about his, try having her sleep in a recliner with each forearm and hand on a pillow. Mimic that position in bed if you don't have a recliner. It's a good, neutral position for body alignment, and maybe she'll be more comfortable.
posted by puddinghead at 6:05 PM on November 23, 2005

I don't want to be alarmist, but that is how my mother discovered her diagnosis of lung cancer. Damned weird symptom, and one that I wouldn't have associated with a lung disease: "Peripheral neuropathy, evidenced by pain, tingling, or numbness in hands or feet."

Good luck with a speedy visit to the doctor, and I sure hope it turns out to be something non-serious.
posted by Savannah at 6:38 PM on November 23, 2005

I said this patient, with nocturnal paresthesias in her hands and arms, is unlikely to have MS.

Actually, if the description of the symptoms was precisely 'paresthesias in the hands and arms,' I'd be much *more* concerned about MS. The age and gender are correct for MS and it has a prevalence of about 1 in 750; if you dismiss every set of paresthesias that comes into your E/R, docpops, you'll miss a few cases of MS a year.

But this is a very different presentation.

First of all, the pain is a prominent feature; the sensory paresthesias that, retrospectively, herald the onset of MS in more than 50% of cases tend to be annoying but not pace-around-at-4AM-crying painful. They are more usually found on the lower limbs and/or abdomen, but can be on any part of the body including the face.

Second of all, there's no mention of any symptom above the wrist. If there were, it would change everything. While not foolproof, confinement of symptoms to below the wrist strongly suggests the lesion is either psychogenic or in the carpal tunnel. It strongly argues against a focal central nervous system lesion, as in MS. The nocturnal worsening of symptoms is typical of neuropathy in general, of which carpal tunnel syndrome is a particular type.

Third of all, there's daytime impairment of function of the hands. This pretty well rules out lesions isolated to the ulnar nerves, such cubital tunnel syndrome (which is almost never bilateral.) This supports carpal tunnel syndrome and suggests it has progressed to motor involvement, which is generally a later or more severe feature.

Hypothyroidism, pregnancy, other systemic illnesses, and recent changes in weight (loss more frequently than gain) are commonly associated with bilateral carpal tunnel syndrome.

The next appropriate step depends strongly on elements of the history and physical exam. Conservative management (splinting and observation) can be appropriate in some cases; in others, an aggressive approach to further diagnosis (blood work, electromyography) and possible invasive treatments are important.

I am tempted to write more here but it would be hugely irresponsible. I repeat, this person needs to be examined in person by someone who knows what she is doing, preferably a neurologist (a clinical neurophysiologist, like me, can do EMGs), but absolutely a physician with experience in this.

I don't mean to imply above that pregnancy's a systemic illness, by the way.
posted by ikkyu2 at 7:27 PM on November 23, 2005

THIS JUST IN:

After telling her that I posted this, she elaborated with her symptomology. The pain radiates above her wrists and favors her left arm more than her right. However, the intensity is certainly more in her hands. During the day, like today for instance, it is still present but not as noticeable. She says she can usually "shake off" the pain in her right arm/hand but not her left.

Also, she had a "neck x-ray" that did not show anything, she says. I completely forgot about that when I first asked this question (we've been together for over 24 yrs so I tend to not listen very close anymore....heh).

Friday, 10am she sees the doc. He'll probably just order more tests, yeehaw...more waiting for the symptoms to resolve on their own.
posted by SparkyPine at 8:04 PM on November 23, 2005

Enh - now it could be anything. :)

Hope she's feeling better soon.
posted by ikkyu2 at 9:21 PM on November 23, 2005

sorry for misunderstanding your comment docpops!
posted by TheLibrarian at 6:26 AM on November 24, 2005

ikkyu2,

Good response. To clarify, I didn't mean to imply that I'm dismissive toward the prospect of pare/dysesthesias being MS. I assume every case of neurologic malbehavior could be, and out of empathy for the patient's own fears, assume they are worried as well, even though they rarely say so. So I always ask. I've had, oddly enough, transverse myelitis (which is certainly in the differential) and subacute combined degeneration in the past, so I have some particularly specific insights, interest, and knowledge of how some of these things present.

I reacted more from the standpoint of imagining the fear of a husband reading some of these comments and wondering whether to share them further.

You and I both know the differential here, and have been careful to parse our words.

By the way, I work in a busy multispecialty group, not an ED.
posted by docpops at 10:53 AM on November 24, 2005