There are many possible causes of numbness and tingling in the upper or lower limbs. Some of these causes may include: nerve injury, prolonged sedentary position, pressure on the nerves due to a herniated disk, enlarged vessels, or tumors, shingles, abnormal levels of salts and minerals in the body, or congenital conditions. Other medical conditions such as carpal tunnel syndrome, diabetes, or strokes may lead to numbness and tingling.
Local pressure on a nerve may cause distinct patterns of numbness that may also be associated with weakness or spasms. Compression of the ulnar nerve at the wrist may cause numbness and tingling of the little and ring fingers. Compression of the same nerve at the elbow may present numbness on the back of the ulnar side of the hand. Likewise, compression of the radial nerve just above the wrist may cause numbness on the back side of the thumb and index finger. Compression of the median nerve just below the elbow joint may present numbness on the palmar side from the middle finger to the thumb.
If the cause of the symptoms has been determined, ensure to follow the necessary steps as prescribed by your doctor to reduce or eliminate the condition. Certain exercises may be recommended to alleviate pressure on the peripheral nerves causing the numbness and tingling. Control blood sugar or vitamin levels with the appropriate daily dosage. Do not take large doses of any vitamins or supplements until discussion has been made with a medical professional. Large amounts of vitamins or supplements may result in nerve toxicity which can cause numbness and tingling.
Further testing may include X-rays, MRI, nerve or blood tests to help diagnose or treat the appropriate condition.
Exercises to Reduce Numbness and/or Tingling:
1. Ulnar Nerve Flossing
Begin in a seated position with tall posture and shoulders down. Then create a circle with your thumb and index finger and bring the elbow and forearm up while pointing the heel of the hand upwards forming a mask over your eye with the circle. Hold this for a second and then return the arm and hand back to the starting position. Repeat this for sixty seconds, doing five sets three times per day. The progression of this exercise is to first start with the head rotated away, then bringing the thumb and index finger over the eye. The duration is also for 60 seconds for 5 sets, three times per day.
2. Radian Nerve Flossing
Begin by extending the shoulder and arm with the elbow straight behind you while flexing the wrist and the hand out to receive a “low - five” from behind you. Return the arm and hand back to neutral position by the side and repeat this for up to thirty seconds when you initially start to get the hang of it and then increasing it to sixty seconds. Do five repetitions each time three times per day. The progression of this exercise involves the rotation of the head and neck to the opposite side first and then reaching back with the arm and hand for the “low-five” and then return the head and arm and hand back to the neutral start position. Do this for 60 seconds for 5 repetitions three times per day.
2. Median Nerve Flossing
Begin by placing your left hand on your right shoulder & look away to the opposite side. Abduct the shoulder to 90 degrees and together extend the elbow, wrist and fingers fully. Then turn your head to the right side and release the whole right upper extremity by flexing the fingers, wrist and elbow together. Repeat this again by looking to the opposite side and extending the entire right upper extremity again. Do this for 60 seconds for 3 sets 3 times per day.
When to See a Medical Professional:
Go to the hospital or call 911 if:
· You are unable to move or have weakness in the body
· You do not have control of limb movement
· You have a loss of bladder or bowel control
· You are disoriented (confused) or have a loss of consciousness
· You have difficulty walking, talking, or a change in vision
· You notice signs and symptoms of a heart attack or stroke
Most people who get tennis elbow don’t play tennis! In fact, less than 5% of all cases of tennis elbow occur in people who play tennis. Tennis elbow can happen to anyone who repeatedly uses their elbow, wrist, and hand for their job, sport, or hobby.
What Is Tennis Elbow (Lateral Epicondylitis)?
Tennis elbow is a painful condition caused by overuse of the “extensor” muscles in your arm and forearm, particularly where the tendons attach to rounded projections of bone (epicondyles) on the outside or lateral aspect of the elbow. The muscles you use to grip, twist, and carry objects with your hand all attach to the “lateral epicondyle” at the elbow. That’s why a movement of the wrist or hand can actually cause pain in the elbow.
Prolonged use of the wrist and hand, such as when using a computer or operating machinery —and, of course, playing tennis with an improper grip or technique—can lead to tennis elbow. It can happen to athletes, non-athletes, children, and adults. It occurs more often in men than women, and most commonly affects people between the ages of 30 and 50.
Signs and Symptoms
Symptoms of tennis elbow can occur suddenly as a result of excessive use of the wrist and hand for activities that require force, such as lifting, twisting, or pulling. Forceful activities—like pulling strongly on a lawn mower starter cord—can injure the extensor muscle fibers and lead to a sudden onset of tennis elbow.
More commonly, though, symptoms of tennis elbow develop gradually over a period of weeks or months as a result of repeated or forceful use of the wrist, hand, and elbow. If you work as a grocery store cashier, you might have symptoms of tennis elbow as a result of repetitive (and often too forceful) typing—combined with continuous lifting of grocery bags.
Your symptoms may include:
- Pain that radiates into your forearm and wrist
- Difficulty doing common tasks, such as turning a doorknob or holding a coffee cup
- Increased pain when you use your wrist and hand for lifting objects, opening a jar, or gripping something tightly, such as a knife and fork
- Stiffness in the elbow
- Weakness in the arm
How Is It Diagnosed?
Tennis elbow usually occurs due to repeated movements. As a result, other muscles and joints in this region of the body may be affected as well. Your physical therapist will perform a careful examination not only of your elbow but of other areas of your body that might be affected and might be contributing to your pain. Your therapist will perform special manual tests that help diagnose the problem and help detect conditions such as muscle weakness that might have led to the problem in the first place. For instance, the therapist might ask you to gently tense or stretch the sore muscles to identify the exact location of the problem. Rarely is an x-ray required to diagnose this condition.
How Can a Physical Therapist Help?
The First 24 to 48 Hours
For the first 24 to 48 hours after acute onset of your pain, treatment includes:
- Resting the arm by avoiding certain activities and modifying the way you do others
- Using 10-20 minute ice treatments
- Using elastic bandages or supports to take the pressure off of the painful muscles
Your physical therapist will decide if you should use a brace or support to protect your muscles while the area is healing. Depending on severity, your therapist may recommend that you consult with another health care provider for further testing or for consideration of additional treatment such as medication. In rare cases, treatments such as cortisone injection or surgery might be needed. Your physical therapist can help you determine whether you need a referral to another health care provider.
Your physical therapist can design a specific treatment program to speed your recovery. There will very likely be exercises and other treatments that you will be expected to do at home. Your physical therapist also might use special physical therapy treatments to help relieve pain, such as manual therapy, special exercises, ice or heat treatments or both, and electrical stimulation.
For an “acute” case of tennis elbow—one that has occurred within the past few weeks— it’s important to treat as early as possible. Left untreated, tennis elbow may become chronic and last for months and sometimes even years. This is especially true if treatment is focused only on relieving pain and not on correcting the muscle weakness and bad habits that might have led to your condition in the first place.
Improve Your Ability to Move
Your physical therapist may use manual therapy to enable your joints and muscles to move more freely with less pain.
Improve Your Strength
Insufficient muscle strength can lead to tennis elbow. Sometimes the weakness is in the muscles of the wrist and forearm. In many cases, the problem stems from weakness of the supporting postural, or “core,” muscles. In fact, you might find that it is necessary to improve your overall level of fitness to help manage your elbow condition. Based on the evaluation, your physical therapist can determine the type and amount of exercises that are right for you.
Physical therapists prescribe several types of exercises during recovery from tennis elbow:
- Early in the treatment, when the pain is most intense, your therapist may recommend passive exercises in which your wrist and elbow are moved without the use of your muscles.
- As your symptoms improve, you can move the wrist and elbow actively without assistance.
- As the muscles become stronger and the symptoms have lessened, you will be able to begin using weights or resistance bands to further increase your strength. The amount of weight will need to be carefully monitored to make sure you continue to progress and avoid re-injuring your muscles.
Use Your Muscles the Right Way
Your physical therapist can help you retrain your muscles so that you use them properly. For example, when you lift a heavy grocery bag, you should contract the muscles around your shoulder blade and trunk to provide support for your arm muscles. This simple movement can be easily taught to you by a physical therapist can lessen the stress to the injured muscles and help you return to your normal activities while avoiding re-injury.
Return to Your Activities
Your physical therapist will help you remain active by teaching you how to modify your daily activities to avoid pain and further injury. Sometimes it’s necessary to make changes at work, on the playing field, or in the home. Your physical therapist can help you make simple modifications to your work site, your computer set-up, your kitchen devices, your sports equipment, and even your gardening tools to lessen the strain to your hand, wrist, and forearm. Your therapist will emphasize the importance of taking stretch breaks so that your muscles get frequent rest from repetitive movements and standing or sitting in the same position.
Tennis may be a contributing factor to tennis elbow for several reasons. Sometimes the problem results from over-training. In other cases, the weight of the racquet or its grip may need to be adjusted. For others, the problem may stem from improper form, poor overall fitness, or a lack of strength in the supporting or “core” muscles of the trunk and shoulder blades. A physical therapist can help analyze the source of the problem and help find a solution.
Can this Injury or Condition be Prevented?
Yes! You can help prevent tennis elbow by staying fit, using proper technique in your sport or in your job, and using equipment that is well designed and appropriate for your body type and your level of activity. Your physical therapist can show you how. If you had tennis elbow years ago, you might be at risk for re-injury if the tendons did not have time to completely heal or if your muscle strength and joint mobility were not fully restored. Returning to sports or activities before you have fully recovered might result in an elbow that has persistent pain or is easily or frequently re-injured. A physical therapist can help determine when you are ready to return to your activities and sports and can help make sure that your elbow, forearm, and wrist are strong and ready for action.