Swelling and pain of both index fingers


Hi -As a newcomer to this site I would like to know if anyone else has the experience of "swelling and pain of both index fingers"and also at the base of these fingers, also the inability to straighten fully or indeed close fully!!-I am waiting to see a Neurologist re Carpal Tunnel and although a lot of my symptoms are very similar to CT I have not seen MY symptoms mentioned anywhere! Thankyou


Hard to assess from a short text description on the net but my first thought with that would be of a local problem with the index fingers rather than of CTS. With carpal tunnel syndrome, although the fingers often feel 'sausage-like' subjectively - they usually remain fully flexible and do not generally swell objectively unless there is another problem too, such as trigger digit or sometimes rheumatological disorders such as scleroderma, various forms of arthritis or vascular disease. Try the questionnaire and see if it comes out with a low score. You could try posting a photograph if feeling hi-tech. JB


Thankyou Very Much for your reply-Sorry but sending a photo is far to Hi-Tech for me but I'll try to give you a bit more info(Wasn't sure that you would even get the initial message so that's why I kept it so short!)and see what your ideas are.
I'm a 63 year old female who up to a few weeks ago felt in very good health
It started about 8 weeks ago with pain in my upper(left) arm and a very sore left index finger which as I said is swollen and tender(also swollen at the base of the index finger on the palm side) -I have the same problem with the right hand index finger too but not my right arm! Also some pain in the palm of my hands
The other symptoms are(when I'm sat or lied down) pins and needles the whole way down from my shoulder/ back,/.neck? If I raise my arms I get pins and needles too!
During the night my arm is very painful and my hands "cramp up" and by the time I get up in the morning I can hardly move my hands which are very stiff and sore and my arm continues to be very painful!
I'm finding that 'squeezing ' a dish cloth etc is difficult,opening jars etc and if I read a book at all I'm left with my hands 'cramped up'
Also hoovering is difficult and I have a cleaning job for a living and I'm frightened I might be doing irreparable damage
I did the test yesterday and this is how it panned out
Severity-LH 2.73 RH2.91 Functional Impairment LH 2.75 RH 2.88 Symptom Score Ann 34% LRP 28%

Does all this make any kind of sense to you? My blood tests came back negative re arthritis -I'm awaiting results of an xray on left finger! Also awaiting result of blood test for calcium defficiency! My Doc has sent a referral letter to a Neurologist but there is a 13 week waiting list so would you advise me to go private if possible?
I would Really Welcome your feedback THANKYOU! CH


That's a pretty difficult history. There are certainly a few features of the story which would fit in with carpal tunnel syndrome and I can see why your GP might have had that thought and arranged referral to a neurologist. On the other hand, that is certainly not a classical textbook history of typical CTS and there are a variety of features, such as the index finger swelling which would be distinctly rare in simple CTS. That is pretty much borne out by the 34% symptom score which is enough that we would consider it worth testing for CTS but we would not be too surprised if the tests turned out to be normal. I have quite a low threshold for testing for CTS because it is such an easy problem to treat most of the time and I would rather test more people and get some negatives in order to catch as many people as possible who do have a treatable disorder.

As I rather thought from the short description, some of it sounds distinctly rheumatological - how long does the stiffness of the hands take to wear off in the morning? The blood test for rheumatoid disease, which is likely to be the one done at first in primary care, by no means guarantees that you do not have some form of arthritis so you could make a case for seeing either a rheumatologist or a hand surgeon rather than a neurologist - but you have to pick one to start with really.

I would not generally advise people to go private. Although I do a little private work myself (for reasons which we need not go into here), I think that no-one should feel compelled to resort to the private sector because of NHS queues. If your  symptoms are interfering with your ability to work then your GP may be able to pressure the hospital to come up with an earlier appointment. It is also sometimes the case that rheumatology or hand surgery clinics have different length waiting lists to neurology so a change of tack might mean faster progress depending on where in the country you are. In my own area neurology is longer then rheumatology at present and hand surgery is very variable depending on which surgeon you go to see. Remember though that your GP is in a much better position to assess your problem than I am via the internet and has presumably chosen a neurology referral for a reason. He/she is probably also aware of the relative lengths of the queues for the different specialities and may have taken that into account.

If you want to explore the carpal tunnel possibility further - wearing a splint on one hand at night is a fairly inexpensive and harmless experiment - you can find all the details in the treatments pages here. You can also try Phalen's test for yourself to see if that provides support for the diagnosis - again instructions are here in the 'diagnosing' pages. 

Good luck with getting it sorted out. I would be delighted to hear the eventual diagnosis. JB


Hi again-Thank you so very much for your in depth reply to my problem(s)-

I don't want to waste your time if you don't suspect CTS but I really do value your professional opinion.
Regarding the stiffness in my fingers (ie middle, ring and little finger on both hands)-they remain stiff and sore permanently now to be honest(9 weeks on!) and both my index fingers remain tender,swollen and will not straighten out!_(Thankfully at least(at the minute) my thumbs are ok.....!
One thing I didn't mention before is that I've had Reynauds all my life-don't suppose that could have any bearing on the subject do you?
I did the Phalen's test and had some pins and needles immediately in my hands-does that prove anything?
I will TRY the splint method (My Doctor asked my husband to MAKE one which wasn't a success at all!) so I will buy one to see if it gives me any night time relief.
I've taken on board what you said about a Hand Surgeon and Rheumatologist but wonder how to broach the subject with my Doctor.The waiting list is 13 weeks for the Neurologist (I did enquire about private consultation and it is upwards of £200 for initial visit and £110 thereafter!) and now I'm sceptical that it would not be beneficial or even worse go down the wrong route!!
I still have the pain in my left outside upper arm but wonder could this just be a separate problem as I've had a Frozen Shoulder in the past -(although my Doctor said This Wasn't!)
Could you Please suggest anything to ease the swelling in the fingers at all-I was taking Ibrupofen but Doctor said to stop taking them so the only medication I'm on is Paracetamol 4 times daily.
Thankyou Very Much for your TIME

Cheers Chrishicks


The rapidly positive Phalen's test certainly offers a bit of support for at least part of the problem being CTS - but Phalen's does produce some false-positive results so it is not absolute proof - one key thing to observe is the distribution of tingling in the fingers when you do the test, ie which fingers tingle exactly.

I tend to think of Raynaud's as a coincidental nuisance rather than being related to my own interest of CTS but it is relevant to some rheumatological diagnoses so that history might push us more in the direction of a rheumatology referral. The upper arm may or may not be a separate problem, impossible to judge online, and I'm afraid that it has to be the same answer in trying to suggest something for the swelling - not something I could get into without seeing you as I cannot really tell what the problem is remotely. (I might of course have no idea even with you sitting front of me but diagnosis via the internet is pretty much impossible for most things - about the only thing it is really good for is getting an opinion on a skin lesion from a dermatologist if you have a good photo of the rash!) 

There should be no serious problem with asking your GP about it again while enduring a long wait for the neurology appointment which is currently planned - sometimes seeing another GP at the same practice is a useful exercise.

I'm sorry the NHS is being so slow for you in this case - I blame successive governments. JB

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