Hand pain and tingling: taking a closer look at your symptoms

Night-time tingling in the thumb, index and middle fingers and part of the ring finger can be consistent with carpal tunnel syndrome. The median nerve is under pressure in a narrow passage at the wrist. Some people shake their hand to obtain temporary relief. This pattern is a clue, but does not establish the diagnosis on its own. If the little finger and the adjacent side of the ring finger are mainly affected, the ulnar nerve may be involved. It can be compressed at the elbow, for example. Keeping the elbow bent for a long time may worsen these symptoms. Treatment aimed only at the wrist might then miss the problem. When there are relevant signs, the elbow and forearm are therefore included in the examination.

Nerves run from the cervical spine through the arm into the fingers. Irritation around a nerve root can therefore cause symptoms extending into the hand. Tell us if you also have neck pain or if moving your head changes the sensation. Symptoms on both sides or changes in sensation elsewhere in the body can also affect the direction of the assessment. Certain conditions, such as diabetes, are also relevant. This does not mean that every episode of tingling in someone with diabetes is automatically explained by it. We consider existing diagnoses as part of the overall picture. Depending on the findings, further assessment by your GP or a neurologist may be necessary. ‘Neck and arm pain and cervicobrachialgia’ explains this assessment in more detail. An irritated nerve root in the cervical spine is one possible explanation; a problem at the carpal tunnel or elbow is another. The page shows which distinctions matter for treatment, without requiring you to determine the cause yourself beforehand.

Pain at the base of the thumb when gripping may point to osteoarthritis of the thumb base joint. If moving a tendon is what hurts, irritation of the tendon or its sheath may be involved. The precise location and the movement that triggers the pain help to distinguish between these possibilities. With osteoarthritis, the extent of joint wear visible on imaging does not necessarily match the severity of symptoms. If several joints are swollen and remain noticeably stiff for a long time in the morning, an inflammatory joint condition should also be investigated. A rheumatology assessment may be important. We want to avoid this pattern being understood simply as age-related wear and tear. Different causes call for different treatment goals.

We examine the hand, test movement and strength, and note the distribution of any altered sensation. Depending on the question, we add specific tests and examine neighbouring areas. However, one painful test does not answer every question. The findings need to fit the course of your symptoms and your everyday circumstances. If nerve compression is suspected, a nerve conduction test may help. It examines how electrical signals travel along a nerve. Whether this neurological examination outside our practice is needed depends on the specific question. X-rays mainly answer questions about bones and joints; ultrasound can show changes in suitable soft-tissue structures. MRI is not automatically the first examination for tingling.

Helpful feedback is as specific as possible: are you waking less often? Is sensation normal again between episodes? Can you handle buttons or cutlery more securely? It is equally important to report new weakness or an expanding area of numbness. Less pain alone does not tell us whether a nerve is recovering. Bring existing neurological results, reports and images, along with any splints you have used. Mention previous measures and their effects, even if they only helped briefly. Planning focuses on what can reasonably help in your current situation. A particular treatment does not have to be chosen simply because it was mentioned before or worked well for someone else.