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Neurology (Expert Forum)
Pain and sizzeling in left hand fingers
Answered by
Lama Chahine, MD - Neurology
Cleveland Clinic
Cleveland - OH
This forum is for questions and support regarding neurology issues such as: Alzheimer's Disease, ALS, Autism, Brain Cancer, Cerebral Palsy, Chronic Pain, Epilepsy, Fibromyalgia, Headaches, MS, Neuralgia, Neuropathy, Parkinson's Disease, RSD, Sleep Disorders, Stroke, Traumatic Brain Injury.
Doctor's Answer
by Lama Chahine, MD, Apr 21, 2009 08:22PM
, Apr 21, 2009 08:22PM
Thanks for using the forum. I am happy to address your questions, and my answer will be based on the information you provided here. Please make sure you recognize that this forum is for educational purposes only, and it does not substitute for a formal office visit with your doctor.
Without the ability to examine you and obtain a history, I can not tell you what the exact cause of your symptoms is. However I will try to provide you with some useful information.
I will discuss several options broadly, since I am not sure which two fingers you are talking about (there would be different explanations if it was your thumb/index finger vs. your ring and pinky finger). Potential causes could be carpal tunnel syndrome (median neuropathy), ulnar neuropathy, or radiculopathy.
The median nerve supplies innervation to the lateral aspect of the palm and the first 3 digits. The median nerve can be injured anywhere along its course. If your symptoms are confined to just your hand, it may be the nerve was injured somewhere at the wrist. The carpal tunnel is the area in the wrist that the median nerve passes through. If the median nerve is compressed in the carpal tunnel, it can cause symptoms in the first three digits of the hand most often, but in some patients shooting pains can occur all the way up to the elbow or even the arm. The symptoms are often worst at night. Carpal tunnel syndrome can be caused by repetitive movements at the wrist like typing. Treatment includes wearing a wrist brace and in severe cases surgery.
For your hand/arm symptoms, you may benefit from seeing a neurologist in order to evaluate you and possibly order some testing. These may or may not include, depending on your full history and physical examination, an MRI of the neck, or an EMG/NCS, a test which tests how electricity is conducted along nerves and how muscles respond.
The ulnar nerve supplies innervation to some of the muscles and the skin on the side of the arm closer to the body (the "medial" forearm and hand), including the pinky and ring finger. Ulnar neuropathy is a type of irritation of the ulnar nerve.. Ulnar neuropathy causes numbness, tingling, or pain into the arm and hand on the side of the little finger. This is sometimes called "handlebar palsy", because it frequently happens in bicyclists who sustain repeated shocks and bouncing that can occur while holding the handlebars when riding. Other activities that involve stress on the hands and wrists may also irritate the ulnar nerve and cause ulnar neuropathy.
Another potential cause to your symptoms is radiculopathy: the spinal cord is encased by bones called vertebra. Nerves start to form as they come off the spinal cord and exit through holes formed between the vertebra. If a nerve is compressed on as it exits through these holes, particularly in an area called the nerve root, a radiculopathy results. The compression could be due to arthritis of the spine or due to a herniated disc or other lesions. The symptoms include pain at the level of the problem (i.e. neck or back etc) and pain that may radiate (shoot) down the arm or leg (depending on where the problem is). In more advanced cases, muscle weakness or sensory symptoms such as tingling or numbness may occur. A radiculopathy is often diagnosed based on history, physical examination, and MRI of the spine
I recommend evaluation by your primary doctor (PCP/internist) and after he/she evaluates you with history and examination, further testing may be ordered or referral to a specialist may occur depending on his/her assessment.
Thank you for this opportunity to answer your questions, I hope you find the information I have provided useful, good luck.
Without the ability to examine you and obtain a history, I can not tell you what the exact cause of your symptoms is. However I will try to provide you with some useful information.
I will discuss several options broadly, since I am not sure which two fingers you are talking about (there would be different explanations if it was your thumb/index finger vs. your ring and pinky finger). Potential causes could be carpal tunnel syndrome (median neuropathy), ulnar neuropathy, or radiculopathy.
The median nerve supplies innervation to the lateral aspect of the palm and the first 3 digits. The median nerve can be injured anywhere along its course. If your symptoms are confined to just your hand, it may be the nerve was injured somewhere at the wrist. The carpal tunnel is the area in the wrist that the median nerve passes through. If the median nerve is compressed in the carpal tunnel, it can cause symptoms in the first three digits of the hand most often, but in some patients shooting pains can occur all the way up to the elbow or even the arm. The symptoms are often worst at night. Carpal tunnel syndrome can be caused by repetitive movements at the wrist like typing. Treatment includes wearing a wrist brace and in severe cases surgery.
For your hand/arm symptoms, you may benefit from seeing a neurologist in order to evaluate you and possibly order some testing. These may or may not include, depending on your full history and physical examination, an MRI of the neck, or an EMG/NCS, a test which tests how electricity is conducted along nerves and how muscles respond.
The ulnar nerve supplies innervation to some of the muscles and the skin on the side of the arm closer to the body (the "medial" forearm and hand), including the pinky and ring finger. Ulnar neuropathy is a type of irritation of the ulnar nerve.. Ulnar neuropathy causes numbness, tingling, or pain into the arm and hand on the side of the little finger. This is sometimes called "handlebar palsy", because it frequently happens in bicyclists who sustain repeated shocks and bouncing that can occur while holding the handlebars when riding. Other activities that involve stress on the hands and wrists may also irritate the ulnar nerve and cause ulnar neuropathy.
Another potential cause to your symptoms is radiculopathy: the spinal cord is encased by bones called vertebra. Nerves start to form as they come off the spinal cord and exit through holes formed between the vertebra. If a nerve is compressed on as it exits through these holes, particularly in an area called the nerve root, a radiculopathy results. The compression could be due to arthritis of the spine or due to a herniated disc or other lesions. The symptoms include pain at the level of the problem (i.e. neck or back etc) and pain that may radiate (shoot) down the arm or leg (depending on where the problem is). In more advanced cases, muscle weakness or sensory symptoms such as tingling or numbness may occur. A radiculopathy is often diagnosed based on history, physical examination, and MRI of the spine
I recommend evaluation by your primary doctor (PCP/internist) and after he/she evaluates you with history and examination, further testing may be ordered or referral to a specialist may occur depending on his/her assessment.
Thank you for this opportunity to answer your questions, I hope you find the information I have provided useful, good luck.
