Right hand burning pain and numbness.

Thank you Lori,

I finally get to see a hand specialist Tuesday. And can’t get to see a neurologist and pain management specialist and physical therapist until August. I’m afraid my problem is more serious than what I think a massage therapist can repair. Unfortunately. The pain is unbearable specifically at night. Swollen hand, shooting pain in arm , hand and fingers that won’t bend.
I’d appreciate any feedback. Thank you so much.

@mebee and @loribmt

Your descriptions of hand swelling and arm/hand numbness at night suggests symptoms like those in Thoracic Outlet Syndrome or TOS. I have TOS, and there are variations of it, but basically it causes a compression of nerve and blood vessels under the collar bone (between collar bone and rib cage). These are small spaces. I have treated TOS with a physical therapist who does myofascial release for several years. It helps to loosen up that overly tight tissue that is further restricting the small spaces where the nerves need to be able to glide. My hands used to turn blue and get cold. When you are sleeping, such as on your side and possibly with an arm in the raised position, the shoulder can get compressed cutting off circulation. Turning the head also cuts off circulation in the neck. Having your shoulders forward such as in reaching while typing on a keyboard also compresses the front of the chest wall, so getting the shoulders back with good posture is important to help alleviate symptoms.

The diagnostic tests for TOS can be Doppler ultrasound studies that show diminished circulation when raising the arms, and cut off circulation turning the head when the doc listens to your pulse. I was told this is a "rare" condition by a doc who didn't understand it and the results of the Doppler imaging he ordered, but what is rare is finding a doctor who understands the condition. When I was at Mayo for spine surgery, they confirmed my TOS diagnosis in their vascular lab. Treatment for TOS most often is physical therapy and myofascial release. Some basic PT stretching would be to stretch the front of the chest and arms by laying on your back on a foam roller with outstretched arms or using a doorway to lean against while standing.

@mebee Since you have upcoming appointments, it is worth asking about TOS. It is most often missed by doctors because it isn't covered well in med school and is misunderstood. It is somewhat common and can also be caused by repetitive stress injuries or a whiplash. There can also be other conditions that could exacerbate TOS. I had a hand surgeon who did carpal tunnel surgery completely miss my TOS condition and blame me when I told him that I still had my hands tingling after his Carpal Tunnel release surgery. He took my pulse and told me I was fine. Even after I went back to him after getting a proper diagnosis, he wouldn't help me by sending me to physical therapy. He claimed he wouldn't be able to judge if therapy would help me or not because he didn't know about TOS. It is common for the TOS diagnosis to be missed for several years.

Here is some information.

"How to truly identify and treat thoracic outlet syndrome (TOS)"
https://mskneurology.com/how-truly-treat-thoracic-outlet-syndrome/
Diseases and Conditions - Thoracic Outlet Syndrome (Mayo Clinic)
https://www.mayoclinic.org/diseases-conditions/thoracic-outlet-syndrome/symptoms-causes/syc-20353988
Here is our discussion on Myofascial Release.
-Neuropathy - "Myofascial Release Therapy (MFR) for treating compression and pain"
https://www.mayoclinic.org/diseases-conditions/thoracic-outlet-syndrome/symptoms-causes/syc-20353988

@mebee and @loribmt

Your descriptions of hand swelling and arm/hand numbness at night suggests symptoms like those in Thoracic Outlet Syndrome or TOS. I have TOS, and there are variations of it, but basically it causes a compression of nerve and blood vessels under the collar bone (between collar bone and rib cage). These are small spaces. I have treated TOS with a physical therapist who does myofascial release for several years. It helps to loosen up that overly tight tissue that is further restricting the small spaces where the nerves need to be able to glide. My hands used to turn blue and get cold. When you are sleeping, such as on your side and possibly with an arm in the raised position, the shoulder can get compressed cutting off circulation. Turning the head also cuts off circulation in the neck. Having your shoulders forward such as in reaching while typing on a keyboard also compresses the front of the chest wall, so getting the shoulders back with good posture is important to help alleviate symptoms.

The diagnostic tests for TOS can be Doppler ultrasound studies that show diminished circulation when raising the arms, and cut off circulation turning the head when the doc listens to your pulse. I was told this is a "rare" condition by a doc who didn't understand it and the results of the Doppler imaging he ordered, but what is rare is finding a doctor who understands the condition. When I was at Mayo for spine surgery, they confirmed my TOS diagnosis in their vascular lab. Treatment for TOS most often is physical therapy and myofascial release. Some basic PT stretching would be to stretch the front of the chest and arms by laying on your back on a foam roller with outstretched arms or using a doorway to lean against while standing.

@mebee Since you have upcoming appointments, it is worth asking about TOS. It is most often missed by doctors because it isn't covered well in med school and is misunderstood. It is somewhat common and can also be caused by repetitive stress injuries or a whiplash. There can also be other conditions that could exacerbate TOS. I had a hand surgeon who did carpal tunnel surgery completely miss my TOS condition and blame me when I told him that I still had my hands tingling after his Carpal Tunnel release surgery. He took my pulse and told me I was fine. Even after I went back to him after getting a proper diagnosis, he wouldn't help me by sending me to physical therapy. He claimed he wouldn't be able to judge if therapy would help me or not because he didn't know about TOS. It is common for the TOS diagnosis to be missed for several years.

Here is some information.

"How to truly identify and treat thoracic outlet syndrome (TOS)"
https://mskneurology.com/how-truly-treat-thoracic-outlet-syndrome/
Diseases and Conditions - Thoracic Outlet Syndrome (Mayo Clinic)
https://www.mayoclinic.org/diseases-conditions/thoracic-outlet-syndrome/symptoms-causes/syc-20353988
Here is our discussion on Myofascial Release.
-Neuropathy - "Myofascial Release Therapy (MFR) for treating compression and pain"
https://www.mayoclinic.org/diseases-conditions/thoracic-outlet-syndrome/symptoms-causes/syc-20353988

I don’t know if you are still a mentor, but this sounds exactly like what I am dealing with the last 2 months or so. Unable to get nerve conduction test until February. I will definitely research this and mention to my internist next visit. Thank you!

Good morning, To follow up with my story, I finally had an EKG and was diagnosed with Carpal Tunnel syndrome. Which led to surgery on my left wrist. All burning, pain throughout the body stopped the day after surgery. It took well over a year of horrific pain - between appointments to finally get my problem resolved. Hopefully yours won’t take so long.

@docgus Hello and welcome! Yes, I am a mentor on Connect and I’ve been around here awhile. You may not need to go through nerve testing to diagnose thoracic outlet syndrome. There is also a vascular form of it. A doctor can listen to your pulse in your neck and when you turn your head, the pulse diminishes is you have a positive response. Physical Therapy helps and the best ones for this can also do myofascial release to loosen tight fascia. A neurologist can diagnose this or a vascular surgeon. There are also Doppler ultrasound tests while you raise your arms in different positions. Posture is very important and stretches to the front of the chest on a foam roller help. In case you have another type of restriction of vascular, your doctor should try to eliminate possibilities like blood clots that can cause swelling. A Doppler scan is used for that too.