A painful tingling hand

This is part of a series of occasional articles on common problems in primary care. The BMJ welcomes contributions from GPs. #### What you need to know A 48 year old woman presents with pain and tingling in the thumb, index, and middle finger of her left hand. Her symptoms are worse at night and wake her from sleep. Shaking her hands relieves the discomfort. Pain, numbness, and tingling in the hands are common, with a population prevalence of 14.4%.1 The most common entrapment neuropathy and most likely diagnosis is carpal tunnel syndrome.2 The incidence of carpal tunnel syndrome is 192.8 per 100 000 in women and 87.8 per 100 000 in men.3 Consider the patient’s symptoms anatomically. Figure 1⇓ shows the sensory innervation of the hand. Fig 1  Sensory innervation of the hand ©Keele University 2013 ### Causes of pain and numbness in the hand #### Median nerve compression Compression of the median nerve in the carpal tunnel gives rise to sensory dysfunction. Patients might describe numbness, tingling, pain, or aching of the thumb, index, middle finger, and radial half of the ring finger. Aching often extends to the elbow. Motor deficit includes weakness in flexion of the index and middle finger and weakness in thumb abduction and opposition.4 5 Carpal tunnel syndrome affects women more than men at a ratio of …