Neuropathy in Hands: What Causes Nerve Damage?
Neuropathy of the hands can occur alone or with neuropathy of other extremities
Medically reviewed by Cara Beth Lee, MD
Peripheral neuropathy is a type of nerve damage. Most peripheral neuropathies affect the fingers, hands, toes, and feet, but carpal tunnel syndrome is a type of neuropathy that specifically affects the hands.
The symptoms can include tingling, diminished sensation, and weakness, and it can happen as a consequence of many different underlying medical conditions, such as malnutrition, untreated diabetes, and alcohol.
Medical treatment can alleviate discomfort, and some therapies may help prevent the progression of peripheral neuropathy. This article will discuss the symptoms of neuropathy in the hands, causes, treatment, complications, and specialists to see for the condition.
What Is Peripheral Neuropathy?
Peripheral neuropathy is damage of the peripheral nerves. These include nerves that travel throughout the body to detect and relay sensory information from the skin, as well as nerves that directly stimulate muscle movement.
The Feeling of Neuropathy in Hands
Neuropathy is usually a gradual process. The nerve damage can begin months or years before symptoms develop. There are a few types of rapidly progressive peripheral neuropathy, and treatment is more likely to cure the condition when neuropathy occurs very quickly than when it happens gradually over time.
Symptoms of hand neuropathy usually begin in the tips of the fingers before progressing to the hands or arms.
Neuropathy of the hands feels like:
Tingling
Burning sensation
Pain
Decreased sensitivity to temperature, pain, or touch
Diminished fine motor control (as a result of decreased sensation)
Weakness
The uncomfortable symptoms can often fluctuate, and it can feel worse when you are tired. Sometimes, the variation in discomfort can occur without any pattern.
With peripheral neuropathy, the loss of sensation and weakness tend to worsen over time, and you shouldn't expect improvement in these symptoms when they've occurred.
Neuropathy in Feet With Hand Symptoms
It’s common for people with neuropathy in the hands to also have neuropathy of the feet. Peripheral neuropathy can affect the feet before it affects the hands.
Generally, neuropathy affects distal parts of the body—these are the parts that are farthest from the center of your body, such as the fingers and toes or the hands and feet. These distal areas have tiny nerve branches that facilitate movement and sensation. Tiny distal nerve branches are more susceptible to damage.
Learn More: Understanding Small Fiber Neuropathy Pain
Why Do I Have Neuropathy in My Hands?
Neuropathy develops due to nerve damage. Several different medical conditions and risk factors can cause damage to the body's nerves.
Nerve damage can occur due to inflammation, lack of proteins, or toxin exposure.
Common causes of hand neuropathy include:
Untreated diabetes: Untreated diabetes causes high blood sugar, which can lead to nerve damage.
Chronic alcohol overuse: Alcohol has numerous effects on the body, and nerve damage is one of the irreversible effects of long-term alcohol use disorder.
Nutritional deficiency: Nutritional deficiencies, particularly of vitamin B12, can prevent the nerves from maintaining their health.
Carpal tunnel syndrome: This common condition is caused by overuse and inflammation around the nerves that run in the wrist. Compression of the nerve leads to pain, loss of sensation, and weakness of the hands.
Medication side effects: Many medications, including chemotherapy, may lead to peripheral nerve damage.
Guillain-Barré syndrome (GBS): This autoimmune condition causes rapidly progressive neuropathy that usually begins in the feet and travels up the legs, involving the trunk and arms.
Chronic inflammatory demyelinating polyneuropathy (CIDP): This disorder causes recurrent neuropathy symptoms in the legs, arms, and trunk. It is often thought of as a chronic disease similar to GBS.
Thyroid disease: Hyperthyroidism (overactive thyroid) and hypothyroidism (underactive thyroid) can each cause neuropathy.
Cancer: Cancer, especially blood cancers, can cause harmful protein accumulation in certain areas of the body. Cancer-related proteins and inflammation sometimes damage the peripheral nerves.
Inflammatory disorders: Diseases that cause significant inflammation, such as lupus, can cause inflammatory damage to the peripheral nerves.
Traumatic nerve damage: Nerve trauma can lead to inflammation that triggers neuropathy.
Nerves are protected by fatty insulation called myelin. Usually, demyelination (myelin damage) occurs before the nerve cells are damaged. Some types of neuropathies are reversible with treatment, such as the inflammatory demyelinating neuropathy of GBS or CIDP.
Many types of neuropathies—such as diabetic neuropathy or alcoholic neuropathy—are not reversible, but the symptoms of discomfort can be managed with medication.
Testing for Hand Neuropathy
Neuropathy in the hands can be diagnosed based on symptoms, physical, examination, and diagnostic testing. Usually, with hand neuropathy, the physical examination will identify diminished sensation in the fingers and hands. Additionally, reflexes are diminished, and weakness may result.
Diagnostic testing may include electromyography (EMG) and nerve conduction velocity (NCV) studies, which may show changes indicative of nerve damage.
Treating Neuropathy in Hands
The treatment for neuropathy in the hands is the same as for neuropathy anywhere else in the body. It is directed toward the cause.
Treatments include:
Vitamin B12 supplementation for alcoholic neuropathy and vitamin B12 deficiency
Blood sugar control for diabetic neuropathy
Immune suppression treatment may include intravenous corticosteroids, plasmapheresis (blood exchange to remove immune proteins), or intravenous immunoglobulin (IVIG) for treating GBS or CIDP.
Disease-modifying treatment for inflammatory disorders
Cancer treatment for blood cancer or other types of cancer
Surgery for carpal tunnel syndrome or other compressive neuropathies
These treatments may help prevent neuropathy from getting worse. If intervention begins at an early stage, it can prevent the condition from causing significant symptoms.
How to Manage Pain From Neuropathy in Hands
In addition to preventing further nerve damage, treating neuropathy in the hands may also involve pain control.
This type of pain is described as neuropathic pain, and the treatment for it is different than it is for pain from a cut or a broken bone. It’s important that you talk to a healthcare provider to make sure that your pain management is appropriate for neuropathy.
Additionally, some treatments might be contraindicated if you have an underlying disease, so you need to be sure that you don’t have any contraindications—even before you start using over-the-counter (OTC) therapies.
Therapies for pain from hand neuropathy can include:
Using a warm pad or cool pack on your hands
Wearing gloves
Massage
Topical creams or gels, such as lidocaine or capsaicin
OTC oral treatments, including Tylenol (acetaminophen), Advil (ibuprofen), or Aleve (naproxen)
Prescription anticonvulsants, such as Neurontin (gabapentin) or Tegretol (carbamazepine)
Prescription antidepressants, such as Elavil (amitriptyline)
Nerve transection (cutting the nerve) surgery for severe, treatment-resistant pain
Learn More: What Type of Nerve Pain Medication Is Right for Me?
Secondary Complications From Neuropathy in Hands
Hand neuropathy can have consequences that affect your abilities and your health. Sensory loss and weakness can lead to injuries and infections. You can have an increased chance of hurting your hands without full strength.
When your hand sensation is diminished, you might not be able to feel injuries or early symptoms of an infection—and if these issues go untreated, they can become serious.
Complications of hand neuropathy can include:
Cuts, scrapes, and wounds on the fingers or hands
Infected fingers or hands
A broken bone or joint injury in the fingers or hands
Burns
Septicemia (an infection that spreads through the body)
You can also lose your ability to manage day-to-day tasks and self-care. Doing things like buttoning buttons or shaving can be difficult when you lose motor control.
Related: Overview of Hand Weakness
Specialists to See for Neuropathy in Hands
If you have neuropathy of the hands, you need medical care from a team of specialists. Your care involves medical treatment of the underlying condition causing your neuropathy, pain control, and therapy exercises to help you manage the disability of living with neuropathy.
Specialists you might need to see include:
Neurologist: A neurologist is usually involved with diagnosing sensory changes and weakness and may diagnose and treat peripheral neuropathy and similar disorders.
Endocrinologist: If you have an underlying and current disorder contributing to your neuropathy, such as diabetes or thyroid disease, you may need an endocrinologist to manage your condition.
Pain specialist: If your pain is medication-resistant or severe, a pain specialist may perform a procedure to help reduce your pain.
Physical therapist: A physical therapist may work with you to help you optimize your strength and movement when living with a disability due to neuropathy.
Occupational therapist: An occupational therapist can help you learn to take care of your daily tasks of living and self-care.
Oncologist: Neuropathy related to cancer or cancer treatment would require intervention from an oncologist (cancer specialist).
Nutritionist or dietitian: If your neuropathy is related to diabetes or nutritional deficiency, you may need to work with a specialist to create a dietary plan so that you can get the nutrients you need.
Surgeon: Some types of peripheral neuropathy are associated with compression (such as carpal tunnel syndrome), which surgery may relieve.
Summary
Neuropathy of the hands is common. It can develop as part of peripheral neuropathy that affects the hands and feet. Hand neuropathy can develop specifically due to carpal tunnel syndrome.
Peripheral neuropathy may cause discomfort, diminished sensation, and weakness. If you have any of these symptoms, a healthcare professional can diagnose your condition with a physical examination and possibly diagnostic testing.
Treatment of peripheral neuropathy includes symptomatic management and treatment of the underlying cause. You may need physical and occupational therapy to help you maintain the best control of your movements when living with peripheral neuropathy.
