A man in his 50s came to the clinic because both hands went numb every time he drove. About fifteen minutes behind the wheel and the numbness set in, and he had to shake his wrists a few times before it eased. By now he was also finding it hard to hold a pen or move a computer mouse.
Examining his hands, the doctor found that the opponens pollicis, the muscle that brings the thumb across to touch the other fingers, trembled when pushing against resistance on both sides, with the left side weaker; the left abductor pollicis brevis was slack. All three familiar tests for the carpal tunnel, Tinel, Phalen and Flick (shaking the hand eases the numbness), were positive. Carpal tunnel syndrome was fairly clear, but the examination still continued further up the arm.
The path of the median nerve
The median nerve is formed from nerve roots in the neck. It passes through the armpit, runs down the inner side of the upper arm close to the coracobrachialis muscle, reaches the elbow, threads between the two heads of the pronator teres in the forearm, then goes through the carpal tunnel to the thumb, index finger, middle finger and half of the ring finger. Along the way there are many narrow spots where the nerve squeezes through gaps between muscles or bands of fibrous tissue.
A review by Padua and colleagues (2016) ranks carpal tunnel syndrome as the most common peripheral nerve entrapment. At the elbow and forearm, the median nerve can also be trapped, for example in pronator teres syndrome; the syndromes in this area are less common but can still significantly reduce movement and sensation in the hand (Bartoletti and colleagues, 2025).
Numbness in the fingers does not necessarily mean the nerve is compressed at the wrist. Pain or numbness felt away from the actual problem is a fairly familiar story in musculoskeletal pain in general.
Two compression sites often go together
A cross-sectional study of 291 people with cervical radiculopathy (a pinched nerve root in the neck) confirmed by electromyography found that 181 of them, or 62.2%, also had carpal tunnel syndrome, a situation the medical literature calls double crush; this group was older. How severe the wrist problem was did not track with how severe the neck problem was, so Teymouri’s group (2023) did not treat one compression site as the cause of the other, and only noted that the two sites often occur in the same person.
So if one site has been dealt with and the hand is still numb, the other sections of the nerve should be examined as well.
Why driving so often makes the hands numb
At the examination table, people whose hands go numb while driving tend to describe the same posture: both arms reaching forward, the wrists held at an angle on the steering wheel for many minutes at a time, the shoulders slightly hunched, and the car vibrating steadily under the hands. That posture may both make the carpal tunnel tighter and stretch the nerve higher up. When shaking the hands eases the numbness, it only tells you the pressure has dropped, not that the nerve is fine.
How the doctor examines along the path of the nerve
Back to the case above. When the doctor performed the median nerve tension test, gradually straightening the arm, elbow and wrist to stretch the nerve along its length, his numbness got worse. When the doctor pressed on the coracobrachialis area on the inner side of the upper arm, near the armpit, the numbness eased clearly. The doctor also found that the deep myofascial chain at the front of the arm, a band of connective tissue running from the chest down to the base of the thumb, was not working properly. The diagnosis was carpal tunnel syndrome together with a compression site higher up.
Everyone who comes in with numb hands is checked along the path of the nerve in this way, to find the section where stretching makes the numbness worse and pressing makes it ease, like the coracobrachialis area in this case. The basis of Applied Kinesiology muscle testing is set out in our article why doctors use muscle testing; the results are read together with a standard neurological examination, and with electromyography when needed.
In that session, the doctor corrected the myofascial chain at the front of the arm and treated the related nerve receptors, comparing muscle strength before and after each step. At the end of the session, repeating the nerve tension test no longer brought on numbness, the opponens pollicis was firmer, and the trembling under resistance was gone. One case cannot speak for anyone else; the number of sessions and how well people respond differ from person to person, and some people need to work with a specialist as well.
When numb hands come with weakness, muscle wasting or chest pain
You should have electromyography and see a neurologist when:
- The fleshy pad at the base of the thumb (the thenar eminence) is gradually flattening and sinking in;
- Your hand is numb all the time, with no break;
- Your hand keeps getting weaker, you often drop things, or you find it hard to do up buttons.
Call emergency services (115 in Vietnam) right away if hand numbness comes with chest pain, or if you suddenly have numbness or weakness on one side of the body, a drooping mouth or difficulty speaking. The typical signs, the underlying conditions that often go with it and when to have electromyography are covered in detail in our article on numb hands at night.
Further treatment at the clinic
Most people with carpal tunnel syndrome respond well to treatment (Padua and colleagues, 2016). For compression at the elbow and forearm, conservative treatment comes first; nerve gliding exercises and avoiding irritating movements are an essential part, and decompression surgery is reserved for when conservative treatment is not enough, according to Bartoletti’s review.
At Tam Duc, the doctor chooses the approach according to the sections that have been pinpointed. Acupuncture uses points along the inner forearm and around the wrist. Pooling 16 trials with 1,025 people, Dong and colleagues (2023) found that acupuncture alone relieved pain better than a night wrist splint, although overall symptom levels did not differ; acupuncture combined with other treatments may further improve symptoms and hand function. Adverse events related to acupuncture were uncommon, but the certainty of the evidence was low or very low. The herbal decoction is modified to fit the constitution the doctor recognizes when taking your pulse and looking at your tongue. You will be shown nerve gliding exercises and how to hold the steering wheel and rest your hands. At each follow-up visit, the doctor checks the thenar muscles as a marker to track progress; if the muscle has already wasted, or conservative treatment is not enough, you will be referred to a specialist to consider surgery.
Worth keeping
- Note how many minutes of driving it takes before the numbness starts, which fingers go numb, and whether shaking your hands helps;
- Each time you stop at a red light, loosen your grip on the wheel and relax your wrists and shoulders;
- Every week, try writing a few lines and doing up buttons; if you are getting clumsier, see a doctor early;
- When you come for your appointment, bring any electromyography results and neck scans you have had;
- If hand numbness comes with chest pain, or you suddenly have numbness or weakness on one side of the body, call emergency services (115 in Vietnam).
At a consultation for numb hands, Dr. Dinh Ngoc Duc (MD, MSc in Traditional Medicine) will check all the way from your neck down to your wrist, so a short-sleeved top or one with sleeves that roll up easily will make things easier.
References
- Padua L, Coraci D, Erra C, Pazzaglia C, Paolasso I, Loreti C, et al. (2016). Carpal tunnel syndrome: clinical features, diagnosis, and management. Lancet Neurol 15(12):1273-1284. https://doi.org/10.1016/S1474-4422(16)30231-9
- Teymouri A, Emami Razavi SZ, Azadvari M, Hosseini M (2023). Characteristics of carpal tunnel syndrome in patients with cervical radiculopathy: A cross-sectional study. Health Sci Rep 6(9):e1575. https://doi.org/10.1002/hsr2.1575
- Bartoletti D, Gupta A, Bohne W, Gresham S, Ghayyad K, Kachooei AR (2025). Peripheral Nerve Syndromes at the Elbow: A Review of Current Treatments. Arch Bone Jt Surg 13(12):800-806. https://doi.org/10.22038/ABJS.2025.87645.3996
- Dong Q, Li X, Yuan P, Chen G, Li J, Deng J, et al. (2023). Acupuncture for carpal tunnel syndrome: A systematic review and meta-analysis of randomized controlled trials. Front Neurosci 17:1097455. https://doi.org/10.3389/fnins.2023.1097455
