Numbness and Tingling in the Hands and Arms: Care in St. Thomas, U.S. Virgin Islands

Numb or tingling hands have more than one cause, and the treatment depends on which. The neck, the shoulder outlet, the wrist and the nerves themselves can each produce it. Dr. Bradley Keys, Doctor of Chiropractic, examines hand and arm numbness at Tradewinds Chiropractic & Wellness in St. Thomas, treats the causes that respond to conservative care, and refers the rest.

What this feels like

Pins and needles in the fingers that wake you at night and ease when you shake the hand out. Tingling that runs from the neck or shoulder blade down the arm into the thumb, or into the ring and little fingers. Dropping things, or a grip that has quietly weakened. Both hands buzzing, often with the feet.

Which fingers, one side or both, what brings it on, and whether the neck hurts are the details that point to the cause.

What is usually going on

Four causes account for most of it.

A nerve root in the neck (cervical radiculopathy, or a pinched nerve). A bulging disc or arthritic narrowing irritates a root as it leaves the spine. The tingling follows that root's territory down one arm, the neck is often stiff or sore, and turning or extending the head makes it worse.

Carpal tunnel syndrome. The median nerve is squeezed at the wrist. Numbness lands in the thumb, index and middle fingers, spares the little finger, is worst at night and in the morning, and flares with gripping, typing, or a long day on the helm. The neck is usually fine.

Thoracic outlet. Nerves and vessels to the arm pass between the collarbone, the first rib and the scalene muscles of the neck. Slumped shoulders, heavy overhead work, or an old collarbone injury can narrow that passage. Symptoms tend to hit the whole hand or the inner arm and worsen with the arms overhead.

Peripheral neuropathy. The small nerves themselves are unwell, most often from diabetes, but also thyroid problems, B12 deficiency, alcohol or chemotherapy. Numbness is in both hands, often both feet first, in a glove-and-stocking pattern, and is not tied to neck position or wrist use. Covered on our peripheral neuropathy and diabetic neuropathy pages.

A nerve can also be pinched at the elbow, which gives ring and little finger numbness, and an irritated shoulder sometimes sends tingling down the arm; our shoulder pain page explains that overlap.

How we treat it at Tradewinds

The first visit maps the numbness finger by finger, then tests reflexes, strength and sensation for each nerve root and runs the provocation tests for the wrist, elbow and thoracic outlet. We take digital x-rays of the neck on site when arthritis or narrowing is suspected.

Dr. Keys is the Chair of the Virgin Islands Board of Chiropractic Examiners, a member of the Virgin Islands Chiropractic Society, and the International Chiropractors Association representative for the U.S. Virgin Islands.

When the source is the neck, care is specific adjustment to restore motion at the involved level, nerve glide exercises for the arm, and spinal rehabilitation for posture and the deep neck muscles. When it is the wrist, Dr. Keys adjusts the small bones of the wrist and elbow (extremity adjusting), works the forearm with instrument assisted soft tissue mobilization, and coaches night positioning and workstation setup. Mild to moderate carpal tunnel often responds; severe cases with muscle wasting need a hand surgeon. Thoracic outlet gets first rib and upper back adjustment, soft tissue work on the scalenes and chest, and shoulder posture rehabilitation. All of these are on our services page.

We expect a measurable change within a few weeks for neck and wrist causes; if nothing moves, we refer for a nerve conduction study rather than guess.

When you should see someone else

Call 911 if numbness comes on suddenly on one side of the body, especially with a drooping face, slurred or confused speech, trouble seeing, a severe headache, or loss of balance. Treat it as a stroke; minutes matter.

Go to the emergency room if numbness or weakness is spreading fast, affects both arms and both legs, comes with trouble walking or loss of bowel or bladder control, or follows a fall or crash.

See a neurologist for a nerve conduction study when it is unclear whether the problem is at the neck or the wrist, when both sides are involved, or when weakness is measurable. See your physician for bloodwork if neuropathy is suspected and you have not been tested for diabetes, thyroid or B12. If your feet are numb as well, start with numbness and tingling in the feet.

Visitors, crew and cruise passengers

Deckhands and captains out of Red Hook and Crown Bay bring us a lot of wrist and thoracic outlet numbness by the end of charter season. If you are visiting, one visit is usually enough to sort neck from wrist and send you home with a plan. We take walk-ins and same-day appointments.

Getting seen

Tradewinds Chiropractic & Wellness is in the VI Medical Foundation Building, Suite 202, 9150 Estate Thomas, St. Thomas, USVI 00802, just east of Charlotte Amalie. Hours are Mon, Wed, Thu: 10:00 am to 1:00 pm and 3:00 pm to 7:00 pm. Tue, Fri: 7:00 am to 2:00 pm. Closed Sat and Sun.

Call (340) 690-4994 or email info@tradewindschiropractic.com. We take walk-ins and same-day appointments. We see patients from St. Thomas, St. John and Water Island and have more than 180 five-star Google reviews. New patient forms are on the forms page to print and fill in.

Questions patients ask

Numbness and tingling in my hands and arms, who do I see in St. Thomas?

Dr. Bradley Keys at Tradewinds Chiropractic & Wellness in Estate Thomas examines hand and arm numbness, sorts out whether it is coming from the neck, the wrist, the thoracic outlet or the nerves themselves, and treats the causes that respond to conservative care. If it came on suddenly on one side with face droop or slurred speech, call 911 instead. Otherwise call (340) 690-4994.

Is it carpal tunnel or a pinched nerve in my neck?

Carpal tunnel usually affects the thumb, index and middle fingers, is worst at night, and the neck feels fine. A pinched nerve in the neck tends to run from the neck or shoulder blade down the arm, is often one-sided, and gets worse when you turn or extend your head. An exam usually separates the two; a nerve conduction study settles it when it does not.

Why are my fingers numb at night?

Night numbness in the thumb side of the hand is the classic sign of carpal tunnel, because the wrist curls while you sleep and squeezes the median nerve. Sleeping with the arm overhead or the neck kinked can do the same thing through the thoracic outlet or a neck root. Which fingers are involved tells us which.

Can a chiropractor treat numbness in the hands?

When the cause is a nerve root in the neck, the wrist, or the thoracic outlet, yes. Treatment is specific adjustment of the spine or extremity, soft tissue work, nerve glides and rehabilitation. Neuropathy from diabetes or other medical causes is handled through our peripheral neuropathy program and alongside your physician.

When do I need a nerve conduction study?

When the exam cannot tell whether the problem is at the neck or further down the arm, when both sides are involved, or when there is measurable weakness or muscle wasting. A neurologist performs it. We refer for one when it will change what we do.