Done Recovering From Covid? Not if you Hand is Numb

by Meghan Griech, PT, DPT, cert MDT, CKTP

This article takes 6 minutes to read

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Lots of new vocabulary words were added this year: social distance, masking, quarantine. Although all these have been introduced to us due to Covid-19 and the continuing global pandemic, there is another word that is showing up again, but for new reason: proning.

Patients who were treated in Intensive Care Units (ICUs) in the prone position (laying on your stomach) for ventilation, are developing tingling, numbness, weakness or sharp pains throughout their arm/hand. Why is this happening? There are a couple possibilities, but studies are relating it to this positioning while on a ventilator during COVID-19 treatment.

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Proning and the Brachial Plexus

The Brachial Plexus is the large network of nerves that control the sensation and/or muscle movement throughout the arm. This system of nerves attaches the spinal cord to the hands, providing the signals so we can wiggle our fingers, feel a cup in our hand, reach overhead – every movement and sensation from our neck to our hand. Any change to the nerves,(ie: compression, trauma, athletic injury, overstretching, or cancer), can cause the nerve conduction to change and the brachial plexus to not impulse correctly down the arm, causing weakness, tingling, pain, reduced ability to feel like you can move your arm or hand correctly.

So what happens to the Brachial Plexus in the prone position? The prolonged position of having the head rotated in one direction can cause the brachial plexus to be over stretched, causing a neuropraxia.

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Brachial Plexus Injury Symptoms

A Brachial Plexus neuropraxia is when the nerves are stretched to the point of injury. Symptoms (tingling, numbness, pain , weakness) depend on where along the brachial plexus the compression or traction occurred. Also the severity of the nerve injury will also affect how strong the symptoms are and how long they last. Injuries to nerves that root higher up on the spinal cord, in the neck, affect the shoulder. If nerves that originate lower in the brachial plexus are injured, the arm, wrist, and hand are affected.

Brachial plexus injury pain can be temporary to chronic, severe to mild. The type of injury and extent of the injury determines the Brachial Plexus length of time it will take for the nerves to recover and how much recovery will occur.

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Common symptoms of brachial plexus injuries are:

Burning or stinging in the shoulder or arm, can be severe and sudden
Weakness in the arm to hand
Inability or decreased ability to move the shoulder, arm, wrist or hand
Numbness or decreased feeling in the hand or arm
Feeling of heaviness in arm and hand

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Diagnosing a Brachial Plexus Injury

If you have any question of concern about your brachial plexus, contact your PCP. Your PCP will examine the hand and arm, testing sensation, function and strength. They might send you for a diagnostic test (x-ray, MRI, CT scan or a nerve conduction study). They could also send you to a neurologist for further evaluation or to physical therapy.

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What is a Physical Therapist going to do?

A physical therapist is going to assess your complete arm, for strength, sensation, dexterity and overall changes in function. They will establish a plan to learn exercises that may help restore function in the arms and hands and improve range of motion and flexibility in stiff muscles and joints. In mild cases physical therapy will establish a plan of care that will guide you to your recovery, however, depending on the severity of the brachial plexus injury, a brace or splint may be necessary, and even surgery in very severe cases.

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*Disclaimer: All information in this article is intended for instruction and informational purposes. The author(s) are not responsible for any harm or injury that may result. This information is used to supplement not replace any advice you were provided from your doctor or another medical health professional. No guarantees of specific results are expressly made or implied with this article.