Numbness and Tingling in Your Hands or Feet: Is It Your Neck, Your Back, or Something Else?

Your hand falls asleep every night and you wake up shaking it out. Your fingers tingle when you hold your phone. Your foot goes numb on long drives, or there's a patch on your shin that just feels "off."

Numbness and tingling are your nerves telling you something is irritating them. The question is where. A nerve can get squeezed at the neck, the low back, the elbow, the wrist or the ankle, and some numbness isn't mechanical at all. Treating the wrong spot is why so many people wear a wrist brace for months and get nowhere.

The good news: where you feel it is a clue to where it's coming from.

Hands and arms: neck, elbow, or wrist?

From the neck. Nerves exit the spine in the neck and run all the way to your fingertips. When a disc, arthritis or a stiff, irritated joint crowds a nerve root, you can feel it far down the arm:

• Thumb and index finger: often the C6 nerve root
• Middle finger: often C7
• Ring and pinky fingers: often C8
• Clues it's the neck: neck pain or stiffness, pain that runs from the shoulder blade down the arm, and symptoms that change when you turn or tilt your head

At the wrist (carpal tunnel). The median nerve gets squeezed in the wrist:

• Numbness in the thumb, index, middle and half the ring finger, but not the pinky
• Worse at night, and you wake up shaking your hand out
• Dropping things, or trouble with buttons
• More on that on our carpal tunnel page

At the elbow (cubital tunnel). The ulnar nerve, your "funny bone":

• Ring and pinky fingers
• Worse with the elbow bent for long stretches, like holding a phone or sleeping with your arms curled

Double crush. Here's the part that gets missed: a nerve that's already irritated at the neck is more vulnerable further down at the wrist or elbow. Some people have both. That's why we check the whole path and not just the spot that hurts.

Feet and legs: low back, or further down?

From the low back. Nerve roots in the low back feed the legs and feet. A disc issue or narrowing can irritate them, often with back pain or sciatica:

• Top of the foot and big toe: often L5
• Outer foot, sole or heel: often S1
• Front of the knee and inner shin: often L4
• Clues it's the back: symptoms that change with sitting, bending or standing, plus pain that travels from the buttock down the leg

Further down the leg:

• Outer shin and top of the foot, sometimes after crossing your legs or a tight boot: the peroneal nerve near the knee
• Burning or tingling on the sole, worse after standing: possibly tarsal tunnel at the inner ankle

When it's "something else"

Not all numbness is a pinched nerve, and I'm not going to pretend it is. Clues it may be medical rather than mechanical:

• Both feet, starting in the toes and creeping upward in a "stocking" pattern (later the hands, in a "glove" pattern). That's peripheral neuropathy. Common causes include diabetes or prediabetes, low B12, thyroid problems, alcohol, and some medications.
• Numbness that moves around, comes with vision changes or loss of balance, or doesn't follow any nerve pattern
• Cold, pale or discolored fingers or toes, or calf pain when you walk that eases with rest (possible circulation problems)

If your pattern looks like any of these, I'll tell you, and you'll leave with a referral for the right blood work or specialist, not a care plan from us.

Test, don't guess: how we find the source

• A detailed history: where it is, when it happens, what makes it better or worse
• A neurological exam: sensation mapping, reflexes and muscle strength. Weakness tells us as much as numbness does.
• Nerve tension and provocation tests: neck tests such as Spurling's, wrist tests such as Phalen's and Tinel's, and a straight-leg raise for the low back
• Motion Study X-Rays when we suspect the spine, to see where segments are stuck or crowding a nerve
• A referral for nerve conduction testing or an MRI when the findings call for it

How we treat it

Once we know where the nerve is getting irritated, we treat that spot:

• Adjustments to restore motion in stiff segments of the neck or back
• Spinal decompression when a disc is involved. More in herniated disc without surgery.
• Nerve glides and targeted exercises that help the nerve move freely through its path
• Soft-tissue work at the wrist, elbow or hip where the nerve passes through tight tissue
• Cold laser to calm irritated tissue around the nerve, as part of a plan
• Radial Shockwave Therapy as a possible next step, depending on how the nerve and the tissue around it respond (or don't) to the rest of your care
• Fixing the habit that feeds it: phone and desk posture, sleep position, how you sit in the car

We re-test strength and sensation along the way, so you know whether it's working.

A word on timing: nerves are patient but not endlessly so. Numbness that comes and goes is a warning. Numbness that's constant, spreading or bringing weakness with it shouldn't be waited out.

Red flags: get help now

Call 911 for:

• Sudden numbness or weakness on one side of the face, arm or leg, slurred speech, confusion or vision loss. These can be signs of a stroke.

Go to the ER the same day for:

• Numbness in the groin, inner thighs or "saddle" area, or new trouble controlling your bladder or bowels. This can be cauda equina syndrome, a surgical emergency.
• Weakness that's getting worse fast, like foot drop (your toes catch or your foot slaps) or a hand that won't grip
• Tingling that spreads quickly up both legs or arms over hours to days
• Numbness after a fall, car accident or neck injury

See your doctor soon for numbness with fever, unexplained weight loss, or a history of cancer.

The bottom line

Numbness and tingling aren't something to just live with, and they aren't always a wrist problem. Find out where the nerve is actually being irritated, treat that spot, and get the medical work-up when the pattern calls for it.

Learn more about our nerve numbness and tingling care in St. Louis, see our carpal tunnel and sciatica pages, or book an exam.