Medical Conditions That Affect the Hand Info

The hand is one of the best windows your body has onto your general health. Because it is packed with small joints, nerves, tendons, fine blood vessels, skin and nails (all close to the surface and easy to examine), a great many whole-body conditions leave their first clues there. Sometimes a hand problem turns out to be a purely local issue. But sometimes the very same symptom (stiffness, tingling, a colour change, a nail that looks different) is the earliest visible sign of something happening elsewhere in the body that is worth knowing about and often very treatable.

This page is a plain-English tour of the main medical conditions that show up in the hand. It isn't a checklist to diagnose yourself with; most aches and stiff fingers are ordinary wear and tear. But it explains why your surgeon may ask about your general health, take a close look at your nails and skin, or suggest a blood test or a referral even when you came in about your hand.

Diabetes — the great impersonator in the hand

Diabetes affects the hand more than almost any other medical condition. High blood sugar over time stiffens the soft tissues (the tendons, their lining and the ligaments), so people with diabetes get several common hand problems far more often than everyone else:

• Trigger finger (a finger that catches, clicks or locks): several times more common in diabetes than in the general population.
• Carpal tunnel syndrome (numbness and tingling in the thumb, index and middle fingers, often worse at night).
• Dupuytren's disease (cords and lumps in the palm that slowly bend the fingers down).
• A stiff, waxy hand (sometimes called diabetic cheiroarthropathy or "limited joint mobility"): the fingers won't fully straighten and the palms press together less easily.
• Frozen shoulder, which is strikingly more common in people with diabetes.

None of these prove you have diabetes, but having more than one of them, or getting them at a younger age, is a recognised reason to check. We've covered this in much more depth on our diabetes and upper-limb conditions page.

Thyroid disease — over-active or under-active

The thyroid gland sets your body's metabolic pace, and when it runs too fast or too slow it can show up in the hand. An under-active thyroid is a classic contributor to carpal tunnel syndrome and to trigger finger, partly through fluid retention and tissue changes around the tendons and nerves. Both an over- and an under-active thyroid are also linked with frozen shoulder. An over-active thyroid can additionally cause a fine tremor, sweaty palms, and nail changes such as the nail lifting away from its bed. Carpal tunnel that appears without an obvious cause is one of the reasons a thyroid blood test is sometimes arranged.

Inflammatory arthritis — when the immune system attacks the joints

A whole family of conditions causes the immune system to inflame the joints, and the hand is very often where they declare themselves, each with its own pattern:

• Rheumatoid arthritis tends to affect the knuckles and the middle finger joints, usually on both hands symmetrically, with morning stiffness and soft, swollen joints. See our inflammatory and rheumatoid arthritis page.
• Psoriatic arthritis can involve the joint closest to the nail, cause a whole finger to swell like a sausage, and often comes with nail pitting or skin patches. See our psoriatic arthritis page.
• Gout causes sudden, intensely painful, red, hot attacks, classically in the big toe, but the finger and wrist joints can be hit too, sometimes with chalky lumps over time. See our gout page.

The reason it matters to tell these apart from ordinary osteoarthritis is that inflammatory arthritis is driven by the immune system and responds to specific medicines that can protect the joints from damage, so early diagnosis changes the outcome.

Kidney disease

Long-standing kidney disease, especially in people on dialysis for many years, can lead to carpal tunnel syndrome through a build-up of a protein called amyloid around the wrist tendons. Kidney problems also disturb the body's calcium, phosphate and bone metabolism, which can weaken bone and occasionally show up as aches or changes seen on hand X-rays. These are reasons a surgeon may take note of your kidney history.

Pregnancy

Pregnancy is a common and reassuring cause of hand symptoms. The extra fluid the body holds in the later months raises the pressure inside the carpal tunnel, so carpal tunnel syndrome (tingling and numbness in the fingers, often worst at night) is frequent in pregnancy. The good news is that it very commonly settles on its own within weeks of delivery, so the first-line approach is usually simple measures like a night splint rather than surgery.

Circulation and connective-tissue conditions

Some conditions affect the small blood vessels and the connective tissue, and the fingers are where you notice them first:

• Raynaud's phenomenon: the fingers turn white, then blue, then red in the cold or with stress, as the small vessels clamp down. On its own it is usually harmless, but it can also be the opening sign of a connective-tissue disease. We cover it fully on our Raynaud's phenomenon page.
• Scleroderma (systemic sclerosis) tightens and thickens the skin of the fingers, can cause Raynaud's, painful fingertip ulcers, and stiffness of the small joints.
• Lupus (systemic lupus erythematosus) can cause joint pain, Raynaud's and skin and nail-fold changes.

A clue we specifically look for is abnormal vessels at the base of the nail (the nail fold): twisted, dilated loops there can point to scleroderma or lupus and are one reason your surgeon may look closely at your nails with a magnifier.

Other clues — the nails, skin and fingertips

The fingertips, nails and skin can hint at conditions well beyond the hand:

• Finger clubbing: the fingertips broaden and the nails curve over the ends, associated with some lung, heart and bowel conditions.
• Spoon-shaped nails can reflect iron deficiency, and pale nail beds can suggest anaemia.
• Nail pitting, lifting or colour changes can accompany psoriasis, thyroid disease or other illnesses.
• Yellow, thickened, brittle nails are common in diabetes and some circulation problems.
• Skin and colour changes: yellowish skin, easy bruising, or unusual redness of the palms can occasionally reflect liver conditions.

Individually these are often minor and very common. They become more meaningful when several appear together, when they affect all the nails at once, or when they come alongside feeling generally unwell.

Why your surgeon asks about your general health

When you come in about a hand or wrist problem, you may be surprised to be asked about your sugar levels, your thyroid, your medications, weight changes or how you've been feeling in yourself, and to have your nails, skin and pulses examined. This isn't padding. It's because the hand so often reflects the rest of the body, and spotting the wider picture can change both the treatment of your hand problem and, occasionally, uncover something treatable elsewhere. Where a general medical condition seems likely, the next step is usually a simple blood test or a referral to your GP or a physician, not surgery.

When to see someone

See your GP or come back to us, rather than waiting, if:

• A hand symptom comes alongside feeling generally unwell: fevers, weight loss, fatigue, or feeling off in yourself.
• Joint pain, swelling or stiffness affects both hands at once, or comes with early-morning stiffness that takes a while to ease.
• You notice colour changes in the fingers (white/blue/red), painful fingertip ulcers, or new tightening of the finger skin.
• The nails on many fingers change together: pitting, lifting, spooning, clubbing or a colour change.
• Carpal tunnel symptoms or trigger fingers appear in several digits, on both sides, or at a younger than expected age.

Most of the time, a hand problem is just a hand problem. But because the hand is such an honest reporter of general health, it's always worth mentioning the bigger picture. Sometimes the hand is the first to know.