Nerve Pain in Hands: Causes and Treatment
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Nerve pain in the hands and fingers is the result of direct or indirect damage to the radial nerve, ulnar nerve, median nerve, or branchial plexus nerve root. There are three main causes of damage:
Overuse injuries that place repetitive stress on joints and the nerves that pass through them
Degeneration of bones, joints, and muscles that can compress or stretch nerves
Medical conditions or medications that directly damage nerves
Identifying the causes of nerve pain may involve functional movement tests, imaging studies, and nerve conduction tests. Treatment options include rest, splinting, physical therapy, medications, and specialist procedures like transcutaneous electrical nerve stimulation (TENS).
The article looks at the causes of nerve pain in the hands and fingers and explains what is involved in the diagnosis and treatment of the various nerve-associated conditions.
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What Causes Nerve Pain Issues in Hands?
When the nerves servicing any part of the upper extremities are damaged—which can happen due to overuse, injury, autoimmune disorders, diabetes, and numerous other causes—the pain can radiate to the hands and fingers accompanied by numbness, burning, or tingling sensations. This can significantly limit the motion and function of the hand along with your quality of life.
The anatomy of the hand is complex, comprised of bone, muscles, ligaments, tendons, and nerves that regulate sensation and movement. It is because of this complexity that there’s a great deal of variation in the characteristics of nerve pain and the conditions that cause them.
Pinched Nerve
Impingement of the nerves in the hand can lead to pain, numbness, and tingling. A variety of conditions can cause a pinched nerve, including injury or arthritis, though it’s most often associated with carpal tunnel syndrome. It’s more common in adults over 50 but can affect people of any age.
Carpal Tunnel Syndrome
The most common compression-related nerve disorder, carpal tunnel syndrome is a progressive condition that affects about 5% of the population. Older people and women are more likely to develop this condition, caused by persistent inflammation of the nerves that trigger the onset of pain, tingling, and numbness in the hand.
This syndrome can arise due to overuse of the hand, during pregnancy, or from chronic conditions such as diabetes.
Peripheral Neuropathy
Peripheral neuropathy refers to damaged nerves outside of the brain and spinal cord. In the hands, this condition can lead to muscle weakness, numbness, and loss of coordination, in addition to pain.
Causes of peripheral neuropathy vary, including injury, autoimmune conditions like lupus and rheumatoid arthritis, and infections.
De Quervain’s Disease
Also known as de Quervain’s tenosynovitis or stenosing tenosynovitis, this is nerve damage due to the inflammation of tendons in the hand and thumb. It occurs when the sheath of the tendon connecting the thumb and the wrist becomes inflamed, leading to pain, weakness, swelling, and a “grating” feeling in the wrist.
It can occur due to injury or repetitive hand motions that pressure the thumb, as in knitting, lifting heavy objects, or activities involving extreme hand squeezing.
Trigger Finger
Trigger finger and trigger thumb are forms of tendonitis that affect the index finger and thumb, respectively. This condition's primary symptom is catching or locking of the affected finger when it’s straightened or bent.
Trigger finger can be caused by conditions like arthritis or diabetes and by repetitive stress injuries.
Dupuytren’s Disease
Sometimes referred to as Dupuytren's contracture, this is an abnormal thickening and hardening of tissue in the hand, which can lead to nerve pain and severely limit function.
When the tendons in the hand and palm become affected (a condition called palmar fasciitis), this causes fingers to become bent and difficult to straighten.
Cubital Tunnel Syndrome
Cubital tunnel syndrome is a compression of the ulnar nerve at the elbow, leading to tingling, numbness, and pain in the forearm and fingers, as well as the hand's inability to grip. Often mistaken for other conditions, it’s caused by bone spurs, arthritis, or previous fractures.
Ganglion Cysts
The development of these fluid-filled sacs on the hands and wrists can also cause nerve pain. The most common type of growth seen in this part of the body, ganglion cysts are noncancerous. They often go away on their own, though treatment may become necessary.
These emerge in the joints—often affecting the wrist, specifically—and can become problematic when they impact the nerves, affecting function and causing pain.
Osteoarthritis
The most common type of arthritis, osteoarthritis is the progressive breaking down of the cartilage surrounding joints due to aging and natural wear and tear. This causes inflammation, impacting the nerves of the hands and disrupting their function.
Hand osteoarthritis can lead to stiffness and discomfort which can severely disrupt hand motion and function.
Rheumatoid Arthritis
An autoimmune disease that occurs when the body’s immune system erroneously attacks the joints, rheumatoid arthritis is another cause of nerve pain in the hands. It leads to pain, stiffness, and swelling, sometimes severely disfiguring fingers.
When left untreated, it can cause peripheral neuropathy and carpal tunnel syndrome.
Diabetes
Among the many effects of type 2 diabetes is nerve pain in the hands. Nerve damage occurs as a result of blood sugar levels being elevated for prolonged periods of time. The symptoms include pain, tingling, and numbness in the hands.
When to See a Healthcare Provider
It’s good to be proactive if you’re feeling nerve pain, tingling, or other symptoms in your hands. Seek medical help if your symptoms are affecting your ability to function or do daily tasks, especially if you don’t know what’s causing the discomfort. In most cases, the sooner you’re managing or treating a condition, the better off you’ll be.
The signs that it is time to call your healthcare provider include:
Your symptoms disrupt daily living.
Pain is persistent, especially if it lasts for multiple days.
You’re unable to perform regular tasks with your hands.
Home management of symptoms is ineffective.
You have a loss of sensation and/or numbness.
Diagnosis of Hand Nerve Pain
Given the wide range of conditions associated with nerve pain in the hand, diagnosis can be complex and multifaceted. It involves a thorough examination of medical history, a physical examination, and possibly imaging studies.
Labs and Tests
Evaluation for nerve hand pain always begins with physical and functional testing, alongside an assessment of overall health. The specific approach depends on the case, but it typically includes:
Assessment of symptoms: Your healthcare provider will get a sense of the scope and scale of your pain, tingling, numbness, or other symptoms.
Physical examination: The healthcare provider will palpate (squeeze) different parts of the hand and wrist to attempt to localize the source of the pain and look for signs of cyst formation or deformity due to arthritis.
Functional testing: Your ability to perform tasks with your hands, such as grasping, gripping, and supporting weight may also be tested.
Movement testing: In addition to functional performance, the ability of the hand and wrist to move will also be methodically assessed. Specialized approaches can isolate specific conditions, such as Finkelstein’s test, which helps healthcare providers diagnose de Quervain’s disease, and the Durkan test, which isolates cases of carpal tunnel syndrome.
In addition to physical examination, several other tests may be called for to assess nerve health:
Nerve conduction studies: If physical testing and other means aren’t enough for diagnosis, these tests assess how well and how rapidly electrical signals can travel through the nerves in your hand and arm.
Electromyography (EMG): This test assesses electrical nerve activity when your hand, wrist, and arm muscles are at work versus at rest.
Blood tests: Assessments of blood may be necessary if certain forms of arthritis, diabetes, or autoimmune diseases are suspected.
Imaging
While physical examination and testing are enough to diagnose some cases, other patients require imaging for confirmation or to aid in treatment. These methods include:
Ultrasound: This form of imaging relies on sound waves to provide a sense of the interior structures of the hand and fingers. Some healthcare providers' offices or hospitals offer this specialized service.
X-ray: A longstanding approach, beams of electromagnetic radiation are used to provide a picture of structures within the hand. It’s helpful to assess nerve damage due to compression from bones or fractures.
Magnetic resonance imaging (MRI): This type of imaging relies on magnetic waves to create real-time video and imagery of affected areas. MRI allows healthcare providers to see if tissue inflammation is impacting nerve function.
Differential Diagnosis
In addition to conditions causing direct damage to nerves in the hands, a couple of others may also cause these symptoms, including:
Heart attack
Lupus
Pregnancy
Gout
Chemotherapy
Shingles
Infection
Additional testing may be necessary if these are suspected, and, of course, a heart attack is a medical emergency.
What Treatments Help With Nerve Pain in Hands?
Treatment approaches for nerve pain in the hand vary a great deal based on the specific case and the underlying condition. In many cases, managing pain may start with home remedies. However, medications, complementary treatments, or even surgery may be needed to correct the problem.
Depending on the specific case, management of the condition may involve a combination of approaches.
Lifestyle Treatment Options
There are many approaches you can try at home to help with nerve pain. These include:
Splinting: Wearing a special splint for your thumb or affected finger can help in certain cases. Your healthcare provider may advise you to wear one for a couple of weeks to see if symptoms improve.
Resting: Many nerve pain conditions resolve on their own. Allowing the affected area to rest for a sufficient time can help.
Heat and cold: Alternating heating and icing of the affected area promotes blood flow and can help manage inflammation and other symptoms. Heat tends to help with problems involving hand stiffness, while cooling helps with motion-related discomfort.
Exercises and stretches: If you work with a physical or occupational therapist, they may recommend certain exercises and stretches to help with hand or wrist pain.
Medications
As with many conditions involving pain, nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, naproxen, and aspirin can be helpful in relieving pain.
Prescribed pharmaceuticals include:
Opioid painkillers such as oxycontin and Percocet may be indicated, though these aren’t intended for chronic pain.
Lidocaine patches, which deliver a topical anesthetic through the skin, may also help with peripheral neuropathy.
Anticonvulsant drugs like carbamazepine, Trileptal (oxcarbazepine), and Lamictal (lamotrigine) have shown efficacy for nerve pain.
Tricyclic antidepressants like Elavil (amitriptyline), Sinequan (doxepin), and Pamelor (nortriptyline) are effective when prescribed at lower doses.
Serotonin-norepinephrine reuptake inhibitors (SNRIs) are antidepressants like Cymbalta (duloxetine) and Effexor (venlafaxine), which have proven effective in treating chronic nerve pain.
Corticosteroid drugs, particularly the steroid drug prednisone, may be prescribed to reduce inflammation and pain.
Procedures and Therapy
If medication and at-home management don’t succeed in resolving nerve pain in the hand, there are other options that can be attempted prior to surgery.
These include:
Transcutaneous electrical nerve stimulation (TENS): This noninvasive medical approach involves transmitting electrical signals through the skin to affected areas. Though evidence for this approach is still lacking, stimulating affected nerves is thought by some to ease chronic nerve pain.
Physical therapy: For chronic nerve pain in the hand, working with a physical therapist may be helpful as you learn exercises and stretches that can help ease the pain.
Aspiration: Aspiration is used to drain ganglion cysts. It is performed with a specialized syringe after the surrounding area is numbed. Though this can ease pressure on the nerves, if the root of the cyst remains, it can grow back.
Complementary and Alternative Treatments
Some studies have shown that acupuncture can help with pain in the hand. Acupuncture is thought to stimulate nerves by applying needles to specific areas in the hand, wrist, arms, shoulders, and back. Though research is ongoing, this approach is considered one of the more effective complementary therapies for nerve pain.
Vitamin B12 supplements are also thought to help. It is well known that vitamin B12 deficiency can cause peripheral neuropathy when severe. Some practitioners believe that vitamin B12 supplements can help reverse this.
Some studies have shown that vitamin B12 supplements can reduce pain in people with nerve pain caused by diabetes (diabetic neuropathy), suggesting the same may be true for people with other types of nerve pain. More research is needed.
Related:The 8 Best B12 Supplements of 2023, According to a Dietitian
Surgery
Surgery is typically reserved when all other options have failed to provide relief. Surgery is generally performed on an outpatient basis and may include:
Carpal tunnel release surgery: This surgery aims to ease pressure on the affected nerve in your hand. It is done by cutting the ligament around the carpal tunnel (the passageway in your hand through which the median nerve passes).
Decompression surgeries: Pinched nerves can be treated by decompressing (loosening) the structures surrounding the affected nerve. This type of approach is falling out of favor due to possible complications.
Ganglion cyst excision: Ganglion cysts that grow back may need to be removed surgically, referred to as surgical excision, along with surrounding ligaments and tissue.
Reconstructive surgery: Used for people with severe arthritis, this involves replacing damaged bones with a reshaped tendon. It can be especially helpful in restoring thumb function and reducing pain.
Joint fusion: This is used to stabilize arthritic joints by fusing the adjoining joints together. Though joint fusion can ease pain, it does so at the expense of joint mobility.
Joint replacement. Severely damaged joints may need to be replaced with prosthetic joints. Joint replacement surgery is delayed as long as possible so that it can last for the rest of a person's life rather than having to be replaced.
How to Prevent Nerve Pain Issues
As nerve pain is often caused by progressive or repetitive damage to joints, bones, and tendons, there are things you can do to prevent nerve-related pain in the hands:
Check ergonomics: If you work on a computer, adjust the position of your keyboard to keep your wrists in a relaxed, neutral position. Wrist rests can help. It’s also a good idea to take regular breaks to stretch your wrists.
Maintain a healthy weight: Living with excess pounds places extreme stress on joints (including the shoulder and spine). It also increases the risk of type 2 diabetes. Speak with your healthcare provider about ways to reach your ideal weight, including diet and routine exercise.
Skip alcohol: Excessive alcohol use can damage nerves. Limit your intake to no more than two drinks per day if you are male and one drink per day if you are female. If you can't control your drinking, seek treatment.
Warm-up: Before engaging in sports or strenuous or repetitive activities, warm up with hand and wrist stretches. This increases blood flow to joints and may help reduce inflammation during the activity.
