Pain and other symptoms are always very real to the person experiencing them, but because they rely on the brain’s interpretation (and sometimes misinterpretation) of stimuli, they do not always line up well with their own causes.
Keep this in mind as we discuss some sources of hand symptoms which are not nerve related. My punch really didn’t make contact, but the mere sight of it was enough for his brain to generate the pain which seemed like an appropriate response to the anticipated hit. Similarly, when I was a boy, I would sometimes jokingly throw a punch past my younger brother’s shoulder, and when he would grab his arm and say, “That hurt!” I would argue back that “I didn’t even touch you!” As a medical professional I now understand that we were both right.
The most classic example is phantom limb pain, where a person feels genuine discomfort in a hand or foot that no longer exists! When peripheral nerves are damaged, however, they send confusing signals to the brain, and the brain in turn produces abnormal feelings like numbness and tingling.īut our brains can even create sensations without any peripheral nerve signals to cue them. When the nerves and the brain are working properly, the things we feel make sense: a fluffy cat feels like a fluffy cat and cold steel feels like cold steel. In the first place, it is important to understand that all the things we feel-touch, pain, temperature, and even the “pins and needles” sensation of paresthesia-are products of our own brain interpreting the stimuli it receives. So what is going on with these patients? This is a big question, but in this post, I hope to shed a little light as we explore a few of the possible causes for carpal tunnel-esque symptoms (pain, numbness, and tingling in the hands) which lie outside the realm of peripheral nerve dysfunction. Indeed, of the 338 patient records I examined, 14% of those referred with suspicion of CTS had no evidence of nerve damage found with electrodiagnostic testing. A third possibility is that the test may yield normal results. In most of these patients, EMG/NCS serves to confirm the presence of median nerve pathology and to describe how severe it is, but other disorders like radiculopathy and ulnar nerve compromises can also be found masquerading as carpal tunnel syndrome. Several weeks ago I published a blog describing the kinds of neurologic disorders revealed by electromyography and nerve conduction studies (EMG/NCS) in patients who are suspected of carpal tunnel syndrome (CTS) on clinical grounds.
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