A painful tingling handBMJ 2016; 355 doi: https://doi.org/10.1136/bmj.i6386 (Published 01 December 2016) Cite this as: BMJ 2016;355:i6386
- Claire Burton, general practitioner and, GP research fellow,
- Linda S Chesterton, senior lecturer in physiotherapy,
- Graham Davenport, GP clinical champion and honorary senior lecturer
- Arthritis Research UK Primary Care Centre, Primary Care Sciences, Keele University, Keele, UK
- Correspondence to: C Burton
- Accepted 3 November 2016
This is part of a series of occasional articles on common problems in primary care. The BMJ welcomes contributions from GPs.
What you need to know
Most people who present with pain and tingling of the hand have carpal tunnel syndrome
Watchful waiting, wrist splinting, and corticosteroid injections can be considered in primary care for patients with mild to moderate symptoms of carpal tunnel syndrome
Offer referral for a surgical opinion if the patient has severe symptoms or does not respond to conservative treatment within three months
A 48 year old woman presents with pain and tingling in the thumb, index, and middle finger of her left hand. Her symptoms are worse at night and wake her from sleep. Shaking her hands relieves the discomfort.
Pain, numbness, and tingling in the hands are common, with a population prevalence of 14.4%.1 The most common entrapment neuropathy and most likely diagnosis is carpal tunnel syndrome.2 The incidence of carpal tunnel syndrome is 192.8 per 100 000 in women and 87.8 per 100 000 in men.3
What you should cover
Consider the patient’s symptoms anatomically. Figure 1⇓ shows the sensory innervation of the hand.
Causes of pain and numbness in the hand
Median nerve compression
Compression of the median nerve in the carpal tunnel gives rise to sensory dysfunction. Patients might describe numbness, tingling, pain, or aching of the thumb, index, middle finger, and radial half of the ring finger. Aching often extends to the elbow. Motor deficit includes weakness in flexion of the index and middle finger and weakness in thumb abduction and opposition.4 5 Carpal tunnel syndrome affects women more than men at a ratio of …