What’s making my fingers tingle and what can I do about it?

There are a number of different things that can cause tingling in the fingertips, including carpal tunnel syndrome, compression of the ulnar nerve around the elbow or in the hand, trapping of the nerves in the neck on account of a disc or extra bone from the osteoarthritis, or generalised nerve problems.

Carpal tunnel syndrome is the commonest. Carpal tunnel syndrome usually presents as pain and tingling in the fingertips. This occurs because of compression on the median nerve as it enters the hand in the carpal tunnel.

If the tendons which also travel in the tunnel become swollen, for example, if you develop a flexor tenosynovitis, then that can additionally take up space and then the nerve becomes squashed against a thick ligament at the front of the tunnel. The function of the nerve is to supply sensation to the thumb, index, middle and half of the ring finger.

As it leaves the carpal tunnel, it does a right angle and supplies the muscle at the front of the thumb, which allows the thumb to move away from the fingers.

If the nerve is squashed or compressed for a long time, then we worry that its ability to pick up sensation over the finger will be impaired and that you can lose the muscle which allows the thumb to move away from the fingers.

This movement away from the fingers is of real importance in your ability to generate a pinch. And so severe carpal tunnel syndrome is worrying for the loss of this function.

What you do about carpal tunnel syndrome is up to you, but we may recommend certain interventions dependent on the severity.

The severity of carpal tunnel syndrome is graded clinically dependent on whether the symptoms come and go or are constant. And whether there is loss of muscle strength.

It can also be graded from nerve tests, which are a useful way of stratifying treatment options as well.

For cases of mild or trivial carpal tunnel syndrome, then often a period of rest, especially at night in a splint called a Futura splint can be helpful.

This splint comes with a bar bent backwards at 30 degrees, but often the bar can be bent into a straight position, which is more sympathetic for the carpal tunnel. This can be combined with finger exercises.

Should that not work, then the option of steroid injections can be discussed.

These are usually temporary, but may give months to years of benefit and may be worth exploring if an operation isn’t suitable for you.

Steroid does carry small risk of thinning the skin or discolouring the skin across the front of the wrist, and if the skin becomes thin, then you shouldn’t have any more steroid in this area. Final option would be surgical decompression of the carpal tunnel.

This can be done under local anaesthetic or under local anaesthetic with sedation if you would like to feel relaxed during the operation.

The skin overlying the carpal tunnel is cut and the thick ligament which is causing compression of the nerve is divided.

The skin is then sewn up again.

This takes about 10 minutes to do and afterwards a bulky dressing is put over the hand to support and cool the wound. Usually in the first week after the surgery, we will want you to meet with a hand therapist who can change the dressing for you and start you off with exercises. During that week, you will need to elevate your hand so that the fingertips are above the elbow whilst you’re at home. This can be done by putting a cushion down by your side in bed at night, or by keeping your hands on several cushions if you’re at home sitting down.

Reference: Evidence-based treatment of carpal tunnel syndrome. Giele H. 2001 Curr Orthop 15, 249-255

We would happily meet with you to discuss these options in greater detail. If you want to give us a call on 0203 926 5615 or contact us on the email address info@gop.health.

For more information, or to book appointments, please see https://gop.health/conds_treats/carpal-tunnel-syndrome/

 

Or you can book directly with one of our Consultant Hand & Wrist Surgeons: