And no, not everything is TMS which I think some are too eager to diagnose on these forums.
The stated proviso for using these TMSWiki forums is that people get themselves medically checked out to their own satisfaction first. Therefore, no one ever "diagnoses" someone else as experiencing TMS on these forums.
And actually, when you ask whether you should have an EMG, nerve conduction study, or consider surgery, you're asking questions that ultimately require a medical assessment. If we were to tell you not to pursue those options, we'd effectively be assuming your symptoms are TMS—and none of us can know that.
However, in response to your question, "How do I truly know if this is TMS?", what I can tell you is that, from both my own experience and that of many others, TMS can be a great mimicker. The brain can produce symptoms in areas where we're most likely to assume there's a structural problem—for example, a body part that was previously injured or surgically operated on, or an area we use frequently, such as the hands. That can make it difficult to distinguish between a mind-body process and a structural condition.
As
@Adam Coloretti (coach) says, sensations are real, whether they're caused by TMS or something else.
And, yes, numbness and tingling can be TMS (whether they be on their own or accompanied by pain).
To try to help towards determining whether hand and arm symptoms may be driven by a mind-body process rather than conditions such as carpal tunnel syndrome or cervical radiculopathy, mind-body/TMS-aware clinicians often look for patterns that don't fit neatly into a single nerve pathway. Structural nerve compression typically follows a more consistent anatomical distribution, whereas mind-body symptoms sometimes do not. However, these patterns are merely an indication and not diagnostic, and structural conditions do not always present in textbook fashion either.
Some examples that can occur with mind-body symptoms include:
Crossing nerve territories: Numbness or tingling doesn't remain within the distribution of a single nerve. For example, symptoms affect both the index finger (typically associated with the median nerve) and the little finger (typically associated with the ulnar nerve), either simultaneously or by alternating between them. That's unusual for a single nerve entrapment, though not impossible, as anatomical variations do occur.
Shifting locations: Tingling or pain moves from one wrist to the other, or migrates into the shoulder and neck without a clear physical trigger.
Symptom impermanence: Significant numbness, weakness, or pain disappears completely during highly engaging, enjoyable, or relaxing activities.
Structural contradictions: Symptoms are severe during low-demand activities such as typing but absent during activities that would ordinarily be expected to aggravate a structural problem.
Delayed flare-ups: Symptoms consistently appear many hours or even days after a physical activity rather than during or immediately after it.
Some psychological and behavioural clues often reported include:
High symptom imperative: Symptoms begin or worsen during periods of significant emotional stress, major life changes, or unresolved emotional conflict.
Personality traits: Perfectionist, people-pleasing, highly conscientious, or self-pressuring tendencies.
Generally speaking, spine care guidelines, including those referenced by the UK's National Institute for Health and Care Excellence (NICE), suggest that surgery for cervical radiculopathy is more commonly considered when there are progressive neurological deficits (such as muscle wasting or diminishing reflexes) or when symptoms persist despite conservative treatment.
And I understand that carpal tunnel surgery is rarely an emergency, and conservative measures such as splinting or steroid injections are often tried first. However, persistent numbness accompanied by muscle wasting at the base of the thumb warrants prompt medical attention, as it may indicate ongoing nerve damage.
is TMS usually pain related? This numbness and tingling feels very real.
As mentioned earlier, numbness and tingling can be TMS. I've experienced both in my saddle and coccyx regions while sitting, and also in my dominant hand, where the symptoms closely mimicked De Quervain's tenosynovitis.
Interestingly, my symptoms with the latter only began to resolve when surgery became a realistic possibility after many months of numbness, tingling, and severe pain. My interpretation was that whatever fear had been driving the symptoms was ultimately outweighed by the prospect of surgery and its associated risks.
It's also worth remembering that the brain can associate even enjoyable activities with danger if they're highly repetitive, physically demanding, or emotionally stimulating. As a result, symptoms can occur during activities we enjoy just as readily as during activities we dislike.
