A NOTE FROM DR. ALTMAN

Weakness in the arms and hands can be perceived in many different ways. The particular muscle or muscle group involved will determine how weakness manifests itself, alone or with/without pain and numbness.

For example, there are tiny muscles in the hand called intrinsic muscles that are largely responsible for fine motor skills, the unique dexterity we have when using our hands. Whether playing the piano, sewing, knitting, typing on a keyboard or using a cellphone; all these tasks require fine motor skills supplied through these intrinsic muscles. The majority of our intrinsics get their nerve supply from the ulnar nerve. When you strike the inside of your elbow (the “funny bone”), and experience a shock in your hand, you are in fact striking the “ulnar nerve” located quite superficially just behind the inside of our elbow. This is the nerve that supplies most of the intrinsic muscles in our hand as well as providing feeling in the small and ring fingers. Compression of this nerve behind the elbow is quite common and can be a major cause of severe disability in the hand. “Cubital tunnel syndrome”, compression of the ulnar nerve at the elbow is second only to “carpal tunnel syndrome” in frequency.

Perhaps your thumb is weak and you have difficulty picking up bottles or grabbing hold of a milk carton. The ability of your thumb to be placed into “opposition”, the act of raising your thumb up out of the palm of your hand, is impaired due to weakness of the muscles that perform this function. This weakness can also be due to compression of the median nerve, which crosses the wrist through the carpal tunnel. The median nerve sends a branch to the muscles that move the thumb in addition to enabling feeling in the thumb, index and long fingers. Compression of the median nerve in the wrist can cause carpal tunnel syndrome.

The shoulder’s rotator cuff muscles are the first to contract when we raise our arm overhead. These muscles, which give rise to the rotator cuff tendon, may be weakened by inflammation or the tendon may tear either from chronic inflammation or an injury. When the rotator cuff tendon is compromised, weakness may result making it very difficult to lift objects overhead. A bulging disc in the neck, or an arthritic bone spur may pinch a nerve in the neck resulting in a weakened electrical signal to the rotator cuff muscles and a weak arm.

We often take for granted the unique interdependence of all the working parts of our bodies, which allow for our daily activities. When these functions are lost or compromised, we can suddenly feel very vulnerable. The expertise of an orthopaedic sub-specialist in treating conditions of the entire upper extremity can hopefully restore this loss of function.

OTHER COMMON SYMPTOMS