Evidence-Based Treatments for Common Causes of Hand Numbness

1. Carpal Tunnel Syndrome (CTS)
Conservative Treatments:

• Wrist splinting, particularly at night, helps reduce pressure on the median nerve.
• Nonsteroidal anti-inflammatory drugs (NSAIDs) may relieve pain but do not improve nerve function.
• Corticosteroid injections can provide temporary symptom relief by reducing inflammation.

Advanced Interventions:

• Carpal tunnel release surgery is recommended for severe or refractory cases. This procedure enlarges the carpal tunnel to relieve nerve compression.

2. Ulnar Neuropathy at the Elbow
Conservative Treatments:

• Activity modification, such as avoiding prolonged elbow flexion and leaning on elbows.
• Nighttime elbow splints to keep the arm straight and reduce nerve compression.

Advanced Interventions:

• Surgical decompression or anterior transposition of the ulnar nerve is indicated when conservative treatment fails or when there is progressive weakness.

3. Cervical Radiculopathy
Non-surgical Management:

• Physical therapy with cervical traction and strengthening exercises.
• NSAIDs and oral corticosteroids for short-term symptom relief.

Surgical Options:

• Anterior cervical discectomy and fusion (ACDF) or cervical foraminotomy may be necessary if symptoms persist or worsen.

4. Peripheral Neuropathy

• Glycemic control is critical in diabetic neuropathy.
• Medications such as gabapentin, pregabalin, or duloxetine are effective for neuropathic pain.
• Vitamin B12 supplementation in deficient individuals.

Lifestyle Interventions:

• Regular exercise and foot care education in diabetic patients help prevent complications.

5. Thoracic Outlet Syndrome (TOS)
Conservative Management:

• Physical therapy focusing on posture correction and strengthening of shoulder muscles.
• Avoidance of repetitive overhead activities.

Surgical Treatment:

• First rib resection or scalenectomy in severe neurogenic or vascular TOS.

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6. Systemic and Other Causes

• Multiple Sclerosis: Managed with disease-modifying therapies (DMTs) and symptomatic treatment.
• Stroke/TIA: Requires immediate medical evaluation, antithrombotic therapy, and risk factor management.
• Vitamin B12 Deficiency: Intramuscular or oral B12 replacement therapy.
• ALS (Amyotrophic Lateral Sclerosis): Multidisciplinary care, riluzole, and edaravone for modest disease progression delay.

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​References

• Lewis, J. Carpal Tunnel Syndrome: An Overview.
• Zivkovic, S., et al. (2020). Quality Measures in Electrodiagnosis: Carpal Tunnel Syndrome. Muscle & Nerve.
• AAEM Practice Parameter. Electrodiagnostic Studies in Ulnar Neuropathy at the Elbow.
• Simmons, Z., et al. Neuroanatomy for Nerve Conduction Studies. AANEM Course Book.
• Amyotrophic Lateral Sclerosis. Educational Review.
• Distally Predominant Symmetrical Axonal Polyneuropathies. Educational Review.