FINGER PINS AND NEEDLES
 
Finger Pins and Needles
What is it?
Pins and needles in the hand and fingers, known as "Paresthesia", describe sensations that some people will say are painful while others say they are more like tingles. These sensations can be constant or appear sporadically throughout the day or night and can be a sign of nerve damage. 

The hand is supplied by three nerves called the Median, Radial and Ulnar nerves and together they give sensation to the skin and movement to the muscles. Numbness and tingling can occur because one of them has trouble sending or receiving signals. In rarer cases more than one nerve is affected.

The most common nerve affected is the Median nerve which can get squeezed or compressed at the wrist (See Carpal Tunnel Syndrome). The signs of Median nerve compression include tingling, pain or numbness in the thumb, index and middle fingers and half of the ring finger.

Slightly less common is Ulnar nerve compression which originates in the Guyon's Canal also at the wrist. Symptoms affect the other half of the ring finger and the little finger.
Wartenberg's syndrome is a condition which affects the radial nerve and is often caused by wearing a tight metal watch, elastic hair bobbins or even hand cuffs around the wrist. 

The most likely cause for these conditions is compression on the nerve caused by soft tissue inflammation. Inflammation is a natural response to infection or injury and will usually heal by itself. However, inflammation which builds up over a long time, such as repetitive strain, can lead to sensory loss. Once the cause for compression is removed, the nerve will normally recover.
Finger Pins and Needles
How is it Diagnosed?
A thorough clinical examination by your Doctor or Hand therapist is usually sufficient to guide the diagnosis of nerve compression in the elbow or wrist. If compression is suspected at a higher level, such as the shoulder or neck, an electrical test called a nerve conduction study (NCS) is performed in a hospital.

If sensation is affected a test called semmes-weinstein monofilaments test can be used by a Hand therapist to trace the sensory loss into a map so the nerve affected can be identified. It also acts as a base-line for future testing so changes can be compared as the nerve heals.
Finger Pins and Needles
Complications
Other causes:
In rare cases symptoms such as numbness and weakness can indicate other neurological problems which need separately investigated by your GP, such as a tumour, ganglion, MS, Parkinson's or stroke.

Double crush:
Generally, when the correct treatment is applied to reduce compression on a nerve, healing normally takes about 8 weeks. However, if the symptoms are not resolving then one possibility needing consideration is a second site of compression on the same nerve called double crush syndrome. If you have had an old injury to the shoulder or neck it is important to mention this at the time of your assessment.

Trauma:
Swollen tendons, surgical repairs, tight scars and fractures can all place pressure on a nerve. These are acute, temporary problems and tingles in this case may even be a positive sign of nerve regrow. 

Slow onset:
The most common complication impacting successful treatment outcomes is the time lapsed since symptoms originally began. It is easy to understand why a person could become accustomed to pins and needles which slowly develop over time and not seek medical intervention. Unfortunately though, waiting until daily activities and ability to work are affected will mean healing takes longer and some people may need surgery.
Finger Pins and Needles
Treatment
The treatment for pins and needles starts by first removing compression if possible from the nerve affected. Wearing a custom splint made in a carefully selected position to reduce compression for 4 to 8 weeks may be all that you need to do.

An occupational risk assessment may be necessary to discover possible repetitive movements causing nerve compression. It can be a relief to know what minor changes to make to how you usually perform actions in work and at home or while performing sporting activities that may have caused your symptoms. Without an occupational risk assessment to examine how you perform actions, the problem is likely to recur once treatment has finished if no changes have been implemented.

Long standing nerve compression can progress and begin to affect muscle strength as well as sensation. In this case immediate treatment is very important. 
Finger Pins and Needles
What can Hand Kinetics do for you?
Hand Kinetics can assess your symptoms to isolate the nerve involved and treat nerve compression using non surgical methods. Having treatment on the same day as your appointment means healing can start immediately.

An appointment involves standardised assessment of sensation and grip strength in the affected hand and fitting you with a tailor made hand splint, worn for approximately 4-8 weeks if necessary. Most times this is worn while sleeping and for selected activities during the day. 
A risk assessment of any provoking activities with some practical recommendations on how to make small modifications to them greatly improves the speed of healing and prevents recurrence.


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