losing feel for the game

Wednesday, December 15, 2010

It took almost 20 years, but an injury finally caught up with Brett Favre. The shoulder problems had been plaguing him for over a year but it was the latest hit that caused his hand to go numb and end the iron man streak. Doing medical commentary from afar is a good way to get the diagnosis wrong, but it does offer opportunity to talk about hand numbness and where the anatomy can get messed up.

The hand works because electrical signals are sent to and from the brain. The brain decides it wants the hand to move. That request is transmitted through the spinal cord and out through the cervical nerves that leave the cord in between the vertebral bodies of the neck. These nerve roots enter the armpit (axilla) and form the brachial plexus, a tangle of nerves that only medical students can remember and neurosurgeons understand. From there, the split occurs into the specific nerves that supply the hand, the radial, median and ulnar nerves.

In addition to sending request for the hand to move, the brain receives sensation information back from the hand including touch, pain, vibration, temperature and position. For a person to pick up a cup of coffee not only does the hand have to move but it has to constantly give feedback about who hard to grasp the handle, how quickly to lift it to the mouth and where it is in relation to gravity. As well the brain has to be reminded that coffee can be hot. This same information flows to and from the quarterback’s hand as he tries to throw a football.

Sometimes it’s easy to know why a hand goes numb and a doctor’s visit isn’t needed. Hit your funny bone and the ulnar part (the little finger or pinkie side) of your hand will become very painful and go numb. The ulnar nerve is exposed at the elbow and bumping the nerve irritates it and causes pain. Sometimes the answer isn’t so easy. The doctor needs to have a systematic approach to look for reasons why a hand goes numb. After to visiting with and examining the patient, the first decision is whether the potential problem is central or peripheral.

Central refers to the brain and spinal cord. If that part of the brain or spinal cord stops working, the part of the body that it controls stops working as well. Potential diagnoses may include stoke, bleeding, tumor or diseases like multiple sclerosis.

Peripheral refers to the nerves after they have left the spinal cord. Anything that affects the nerve’s function can cause it to malfunction and again, the part of the body that it sends messages to may be affected. At the level of the neck, the nerve can be irritated because of a herniated disc or arthritis narrowing its passageway to the arm. If the arm is stretched, the brachial plexus can be irritated or torn. Nerves can be damaged because of laceration, broken bones and other trauma. Nerves can also be damaged because of underlying medical issues including diabetes, alcoholism and vitamin deficiencies.

The hand is almost indispensible in the routines of daily life. The loss of hand or finger function, whether it is motor (movement) or sensory 9feeling) can change how a person lives their life. Imagine being unable to feel whether a pan on the stove was hot when you put you grabbed it or were unable to pick up a pen or type on a keyboard because of lack of coordination.

We presume that football players have their careers ended because of knee injuries or concussion. Sometimes they end when a quarterback can’t feel the laces on the ball.

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