Fourth and Fifth Finger Numbness: Is Your Neck to Blame?

You're listening to the Restoring Human Movement Podcast, where movement experts discuss the latest evidence-based practices to help you and your clients move with mastery. And now, your host. Good morning, everybody. It's Sebastian, your co-host with the Restoring Human Movement Podcast. Now, if you've been following the show, we've been doing a bunch of lower extremity conditions, lower back, groin, sports hernias, even all the way down the heel to the plantar fascia or heel area. Today, I'm going to tangent upward a little bit. Overall, we have seen a lot of upper extremity conditions over the years, and one of them in particular, which is very common, is numbness to the fourth and fifth digit of the hand, which is the ring and pinky finger.

So I'm going to cover that today because we do have quite a few YouTube videos which still generate a lot of questions from us, and so I'd like to clarify some of those questions for people if I can. Remember, this is not medical information or advice to you. You need to make sure that you're actually being examined by someone who is qualified to look at the condition. And I don't say that just for liability purposes. It is your responsibility to actually make sure you get properly diagnosed because if you don't, having problems in the future may be a result of just having poor care in the beginning, a lot of people can get better from a condition that creates numbness to the fourth and fifth digit, but a lot of people wait super, super long, and then it becomes just a little bit more challenging.

So what are some causes of numbness in the fourth and fifth fingers? Now, I'll say there's a few ways that I'm going to spin this, and a lot of, there's endless topics I can talk about with this and diagnosis and causes, but I'd say the most common one or the biggest identifier is that if you have it in both hands, then there's a probability it's coming from your neck or spine somehow. Yeah, you may not have neck pain, a lot of times stiffness, but the reason why this is is because it's way less probable to have bilateral cubital tunnel syndrome or bilateral carpal tunnel, which goes to different digits.

And it is possible, anything is possible, but is it probable? No, it's usually not probable. It's more reasonable to actually look at the spine and have a good examination, a physical examination done to rule out possible causes there. Older individuals could have something called central stenosis, which is like a version of arthritis, but it affects the central canal and it just narrows it. So, or you can have what we call foraminal stenosis. It can be two sides, bilateral foraminal stenosis, which on imaging findings may be things like arthritis found around the small joints of the spine. It may say terms like degenerative disc disease, which flattens the height of one segment on another, which makes the hole smaller, which is the foramen.

The hole is the foramen. The nerve comes out of these holes on both sides, innervates parts of the arm and the hand, and then the one that goes down into the hand, at least the fourth and fifth digit, is C8. C7 goes the middle finger and so on. You can look at dermatomal patterns on Dr. Google, Google, if you'd like. But the reason why I say you should look at the spine first, again, is because it is the most probable, it's the most common. We've seen literally thousands of people with numbness into the hand at our office here. We're in Costa Mesa, California, and they're really not too challenging for the most part.

There are ones that are a little bit harder, but when we look at it and we examine the entire arm as well as the neck, and even sometimes the CNS, the central nervous system, then it gives us a better starting point and a better success rate. On younger individuals, it's really common to have more called discogenic symptoms. Discogenic is usually worse when looking down. It can create tingling to the fingers even when looking down. People who spend a lot of time on their cell phone are seated too long. A lot of times it happens to them. But this is not mutually exclusive. It doesn't have to be you're young, you're a disc referral or a referral from a C8, and you're older than you're a stenotic one or a degeneration one.

It's kind of all over the board, and that's why an examination for your unique reason is really important. Another possible cause is going to be entrapment of the ulnar nerve of the cubital tunnel. This is the one that probably a lot of you have looked over, and it's because a lot of times sensitivity or pain is also at the elbow at times. And yes, it does happen, and that is more common with people who have the neck part as well because the nerve is swollen and it doesn't slide well through different interfaces, bony or soft tissue interfaces of the arm. They call this a double crush scenario.

Double crush is when there's entrapment or pressure on that nerve track in multiple locations. The ulnar nerve is, it goes through the hand as well or the bottom part of the wrist, which cyclists, they call it handlebar palsy, but there's endless parts of the arm that it can be entrapped in. The elbow is a really common one. Sometimes it's not just necessarily an entrapment there, but there's irritation around the nerve, which creates a peripheralized response or tingling to the fingers. There's nothing wrong with the nerve itself, but then there's something wrong with the elbow. And so people who have inflammatory conditions or inflammation around the elbow or the joints or the tendons of the elbow sometimes have collateral associated to irritating the nerve as it's passing through.

It literally passes through the area. And if you put your finger underneath your elbow on the inner side, you can kind of flick it. It feels like a guitar string. And so we call it, we call it a funny bum. Like that's, that's the ulnar nerve right there. And so those are the most common reasons. It's, it's neck referred, but also there is going to be the elbow or the cubital tunnel aspect. Again, cubital tunnel is normally one side. So if you have double-sided, there's a possibility it's neck related and you just have to get a good physical exam done. If that provider believes that there's a need for an image, they should be telling you that.

But normally we don't need to jump to an image right away. By the way, if you're dealing with trauma, this podcast is not for you. Trauma is a wild card. You need to go be examined ASAP. And that is, is there's endless things that can happen with that. It's not my specialty. So I'm just going to say, you need to go get checked out like immediately. A hospital is a good starting point. Second question I got on here is how can I tell if my numbness is due to an ulnar nerve entrapment? Well, the distribution is a big deal. If it's to the pinky and ring finger, that is the ulnar nerve distribution, but also it's C8.

So they overlap. But if it involves the index finger or the thumb, it's not only the ulnar nerve. It could be something higher up where the median nerve, even the backside of the hand, the radial nerve and the ulnar nerve come together, which is around the brachial plexus or the upper part of the shoulder, but also too, they have nerve roots in common. So that would be a reason to look at the spine as well. But usually if it's the pinky finger involved, it's more of a ulnar nerve or a lower cervical complaint. And that would be the best indicator. A lot of times imaging like MRIs can corroborate the story when you end up finding more activity and findings at the lower cervical spine.

Or things like nerve conduction studies can confirm that it's more at the elbow or at the wrist or in different locations. Are there treatment options for numbness of the ring and little finger? Yes, there is. We find that actually conservative care, rehabilitation, lifestyle changes, manual therapy can be really, really helpful for most people. I would say that easily 80% of the people that we see are just a lifestyle rehab treatments or manual therapy management type of scenario. They don't always feel that way because they're very worried about it, especially if their tingling has been going on a long time.

By the way, if you're having, you can't use your hands, motor loss and stuff like that. You need to get, you need to see somebody. So this is, I should just actually over, I should rewind this entire podcast and start again, actually, but I'm not. You should always be examined. I don't know if I said that earlier, but motor loss is kind of a big deal. So you don't want to have it. I'm not saying you can't get rid of it. I'm not going to spend too much time on this, but if you wait too long, it becomes so much harder. And so you should see somebody ASAP for any of these, just to make sure that you've been thoroughly checked out, that you're actually going to recover from this.

But treatment wise, we tend to use a treatment method called the McKenzie method, which is like end range loading in a favorable location. We've used it for the cervical referral parts, which works super well for us. It's not something we want to use super long because there is, when you're decompressing something, you're also compressing something else when you're getting specific. And I've also used it, a similar methodology at the elbow. Now, this is something that is more of like a, we call it a movement medication for us. It's a way to decrease people's symptoms and centralize the problem really quickly.

Centralization is when it comes out of the fingers and then the fingers feel normal, but the elbow feels abnormal. And then it starts to work its way up like a thermometer. And then the shoulder blade, which is really common when the people have the nerve referred from the neck scenario. They get that shoulder blade ache, excuse me, getting over sickness still. And then eventually it feels like just an upper trap stiffness. Like that's a perfect scenario of centralization. That's how we tend to manage it. And eventually when it starts to centralize, we can do other things with it, such as rehabilitation or introduce the movement that we had removed prior.

For a lot of people, the younger individuals, we end up just telling them like, stop staring at your phone so much, you know? And then later go ahead and search phone, you know, it's, it's not, it's never like, don't do this ever again. I think that's bad information. It's specific to a scenario. Don't do that again right now, or we're going to wait a few weeks. And I think good clinicians, ones that will empower you to be active again and not scare you out of things. I think they will oftentimes tell you that you need to be reintroducing activity and movement again. But in the beginning, sometimes we just end up removing it.

Another treatment method we use is something called active release. It's, it's, it's a type of soft tissue work that works super well. We also use a little bit of cross friction too, more of like a fascial type of approach. All of these work out well with, within certain parameters. Again, an evaluation tells us which one to start with. And for other people, we just change lifestyle. Again, you'd be surprised how many people actually have problems. They have problems of various conditions and they just stop doing the thing that provokes it for a little while and it goes away. Not to say it doesn't come back.

A lot of times these do come back because the amount of volume or time the person's, let's just use looking at the phone as an example. They'll stop it, you know, for a couple of weeks because they'll lose their phone. It'll, the condition will go away. And then they'll get their phone back and then they still have the same habit. They'll just be looking at their phone all the time. And so a lot of times, like the saying that we use is you're some of your hat, your old habits, not, not what you're doing right now. So it's all the old habits, which are creating this scenario. So lifestyle change, getting people to do 10,000 steps a day, believe it or not.

Arm swing is a huge component of even this basic nerve flossing. Even people with neck conditions, like one of the first things that they do like post-surgery is they tell them to walk. Low back surgery, one of the first protocols within a week, definitely within the week is they should be walking. And the movement is, is helpful. It greases things up. And so we can make a bunch of fancy shoulder and neck mid-back stretches, but walking is a super easy win for most people. 10,000 steps a day is the gold standard. Cardiovascular fitness, I think it's 150 minutes a week. I'd like to say elevated heart rate.

That way you don't have to do a certain heart rate base. But even if you do like jog, slow down, jog, slow down, that is movement medication. It's elevated heart rate, even in the break period, because you never really full get back to full resting heart rate. And then you try to make it about 150 minutes a week. Now, other things that we use other, we use really rehabilitation and treatment protocols like DNS, dynamic neuromuscular stabilization. It works out really well to build, build activity in areas where tissues or muscles are dormant. But then we end up using it also to help out with movement compensation, which sometimes is part of this puzzle.

It's really easy to coach, at least for us. We do it with telehealth. It does take some skill and education for people to know what they're doing when coaching it. But we use this a lot of times with all of our telehealth sessions, which we are licensed in different states if you guys need us, by the way, especially if we're not able to do things like our manual therapy. So if one of these other methods doesn't really work, then we can coach a person into what to do. And a good coach can usually use their words really well with this type of thing and get a good result. Fourth question, when should I seek medical attention?

And I mentioned that earlier, I think immediately, I think everybody should, again, be adults about this. I think this is a hard thing now with the internet age and even podcasts like this. It's like, don't assume you're going to get the best care if you're just searching on the internet for information. Like, go to a professional. It'll help you out. It'll help make it so it goes away faster and you'll be less worried about it. So it's a, let's all be adults about this. Number four, I'm sorry, number five, can lifestyle changes help prevent? Yeah. So I covered that earlier. Totally. Lifestyle is a huge part.

I'm, I already talked about the walking, the physical activity, stuff like that. Weight training is important at all ages. Weight training is important, but then it comes down to like what is appropriate for the age in that person too. If we have an 80 year old person in here, are we going to be benching 300 pounds? No, it's kind of stupid. Like why they need to be doing that, especially if they haven't before. Now, if they walked in and they were able to bench 300 pounds and without even blinking, I'll probably have them do it. You know, I don't want to make them weaker just because I'm worried about them hurting themselves.

It's their choice. Again, they're an adult. I may advise them about what I think is the smartest thing to do, but ultimately it is your choice. It's your life. But weight training, especially for younger individuals, they oftentimes go too hard and they're a little reckless. People who are into their fifties and sixties and to end up being super cautious, like way too cautious, meaning that they're scared to do certain things when they could easily integrate them back into their workout routine. We have something that we look at in people's programs. We call it making, you know, like have we found a hole that we can plug in their program?

So an example of that, I just saw someone the other day and so he is trying to stay in good shape. He's in his fifties. I did what we call an audit. I asked him about his workout routine and so he told me he had like great diet. He had like, he had pretty good cardio. He did a lot of benching, did some like rowing exercises. And I asked him, where are your leg ones? And he said, yeah, I haven't really gotten back to that because I was worried. I was worried I was going to hurt myself. He had a back injury years ago. And I said, well, let's, let's go over the pros and cons of this. Like, let's just say like the con is you hurt yourself again.

Let's mitigate that risk and let's just elevate the weight, like make it higher. Don't go as low, go slower. Don't do so many reps, do high time under tension, start with an isometric. You know, there's endless ways to mitigate that risk without making the person like super, super worried, but also like not making them weak. And then what is the, what is the problem with not adding it back in? They don't have complete support. Like a good, well-rounded program is kind of like a good diet. Like you should have, you know, X amount of water. You should have lean proteins, healthy fats, fruits, vegetables, nuts, et cetera.

Right. And then a weight training program or resistance training program is kind of the same. Like you need to have a push, upper body push and a pull and a lower body squat and hip hinge. And then you need to do some loaded carries and then a bunch of accessory work and other things and cardio and so on. And these are meat potato things. Like this is more broad than bicep curls or doing shrugs and things like that. These are categories that need to be filled somehow. And if you don't know how to do it, that's why people exist like strength coaches to do it, uh, help you through it. I like to say that everybody has this, they have this development of like their weight training.

And if you were to stereotype most guys in America, when they're 15 years old and they go to the gym, what do they do? Chest and tris back and by, right? It's like, they do the same thing. And then when they go, and this has been decades and decades has happened, like people in their fifties right now also probably started with that. Some people still do that in their fifties. But the 15 year old kids like now it's like, we've come a long ways from just doing bodybuilding Arnold style, but still that is the first thing they learn, which is fine. But also it's incomplete. Maybe we need to add different periodization in.

Maybe we need to change their volume. Like they're novice, but they're strong. And so we need to make sure that we're actually like organizing the person a little bit better and like lifestyle. Yeah. I talked about all the things, but like weight training is a big part and also recklessness with weight training is a big part too. So if you guys are looking for help, again, we have telehealth options. Just give us a call 714-502-4243, or you can go to our website, p2sportscare.com. I have a book that I wrote on this as well. If you haven't seen it already, go take advantage of that. It's really good to have some videos in it as well.

And we have a bunch of free stuff on YouTube, but again, the book is more organized. So I would start there. And again, if you want to come see us in person, that's always the best option. We're in Costa Mesa, California. People vacation here. It's great. We're right by John Wayne Airport. So fly on in, come see us. We'll examine you, diagnose you, and tell you exactly what to do. All right, guys, we'll see you next time.