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Joints Ache. Tendons Complain. Nerves Burn.
Burning hands are almost always a NERVE problem rather than a joint or tendon one. Burning in specific fingers of one hand usually means a squeezed nerve, like carpal tunnel. Burning in both hands AND both feet usually means a body-wide cause, like diabetes or low B12, that needs blood tests. Burning after an injury, with a hand that looks different, needs assessing this week.
- Joints ache.
- Tendons hurt when you load them.
Nerves…on the other hand (pardon the pun, ahem)…cause weird, uncomfortable sensations: burn, tingle, electric shocks, worse at rest, worse at night, and often in a shape that doesn’t match where you think the problem is.
Burning at rest, when nothing is touching the hand, is nerve language.
Here’s the trouble. Burning hands get treated like sore hands. Creams, a brace off the pharmacy shelf, a hot pack. Meanwhile a squeezed nerve keeps losing fibers, or a blood sugar problem keeps going undiagnosed, and the burning is the only alarm you were going to get.
Where it burns, one hand or two, and whether your feet burn too, does most of the sorting. So let’s sort.
Why do my hands burn? The four patterns
- One hand, specific fingers: a nerve being squeezed somewhere between the neck and the fingertip.
- Both hands and both feet: a nerve problem in the body, not the wrist.
- After an injury, cast or operation, out of proportion: possible CRPS. The urgent one.
- Burning that isn’t nerves at all: rewarming after cold, skin, chemicals, gout or infection.
Burning in one hand, specific fingers: a nerve being squeezed
Burning that follows a nerve’s map rather than a glove shape is COMPRESSION.
- Thumb, index and middle fingers: the median nerve. Carpal tunnel syndrome, by far the usual suspect.
- Ring and little fingers: the ulnar nerve. Cubital tunnel syndrome, squeezed at the elbow.
- The back of the thumb: a small skin nerve. Wartenberg’s syndrome, often from a tight watch strap or bracelet.
- A stripe down the arm into one or two fingers, with neck or shoulder blade ache: the neck.
Burning can arrive at either end of compression.
Some people feel it FIRST, before any numbness, and describe it as “hot hands”, which rarely gets written down as a nerve complaint. Others get weeks of tingling before it turns into burning.
Either way, it’s a nerve that has been irritated long enough to act on rather than wait out. Start with the nerve map of the hand.
Why do my hands burn at night?
Cos night is when the position is worst. Most people sleep with the wrists curled and the elbows bent. Both positions squeeze the nerves that run past them, and pressure inside the carpal tunnel rises sharply with the wrist bent.
- Wake up burning or tingling, shake the hand, it settles in a few minutes: classic early carpal tunnel. See hands numb at night.
- Ring and little fingers worse after a night with the arm bent: the ulnar nerve at the elbow.
- Feet burn at night too, under the sheets: a body-wide nerve problem, next section.
Burning hands and feet: a nerve problem in the body
Symmetrical, gradual, worse at night, described as burning or walking on gravel. Feet usually go first, hands later. Clinicians call it a “glove and stocking” pattern.
If your feet burn as well, this is not a wrist problem and a wrist splint will not touch it.
- Diabetes and prediabetes, one of the commonest causes worldwide.
- Vitamin B12 deficiency, more likely if you’re vegan, older, or on long-term metformin or acid-reducing meds.
- Thyroid disease.
- Alcohol.
- Medications, including some chemotherapy agents.
This version needs blood tests, not a splint. See peripheral neuropathy or carpal tunnel.
One twist worth knowing: burning from damage to the very small nerve fibers (small fiber neuropathy) often gives a NORMAL nerve conduction study, cos the test measures the large fibers. A normal result there doesn’t mean nothing is wrong. See nerve conduction results explained.
Burning after an injury or operation, out of proportion
This is the one to know about, because the window on it is narrow.
- Burning pain that is out of proportion to the injury,
- with a hand that changes color or temperature,
- sweats or grows hair differently from the other one,
- swells, and
- cannot bear even light touch:
that combination is CRPS, and early recognition changes the outcome more than almost anything else in hand rehabilitation.
The tell I listen for is the bedsheet. If the weight of a sheet on the hand is unbearable, that is not ordinary post-injury pain.
Do NOT wait to see whether it settles. It needs assessing now, not at the next review.
Aching is a joint. Burning is a nerve. And burning that arrives with a hand that looks different is a same-week problem.
Burning that is actually good news
- A healing nerve. Burning and electric shocks along a repaired nerve are a sign of regrowth, not failure. Regenerating nerve fibers are noisy. See nerve repair recovery.
- A maturing scar. Surgical scars, healed burns and grafts burn and itch for months as the skin reorganizes.
Things that burn but aren’t nerves
- Rewarming after cold. Fingers go white, then blue, then burn red as blood returns. That sequence is Raynaud’s, and the burning is the recovery phase rather than the problem.
- Heat or chemical exposure, including irritants that get through gloves. Chili-cutting hands count. It settles in hours, not weeks.
- Skin conditions, which burn on the surface rather than deep inside the finger, and usually show a rash or cracking.
- Gout or infection, which burn but also swell, redden and refuse to move.
How do doctors find the cause of burning hands?
Mostly with questions and a pair of hands. The tests confirm what the examination already suspects.
- The map. Exactly which fingers, which side, front or back. A nerve’s territory is fixed. A glove pattern isn’t a nerve territory.
- Provocation tests. Tapping over the nerve (Tinel’s), holding the wrist bent for up to a minute (Phalen’s), or the elbow bent, to see if your symptoms come on.
- Sensation and strength. Light-touch filaments, two-point discrimination, grip and pinch strength, and a look at the thumb base and the web between thumb and index for muscle wasting.
- Blood tests if both sides are involved: glucose, HbA1c, B12 and thyroid as a minimum.
- Nerve conduction studies, to confirm and grade compression, or to show a body-wide neuropathy.
How to stop your hands burning: what actually helps
Not the things people reach for first.
- Map it. Draw the burning area on a photo of your own hand. Nerve problems respect borders. Body-wide ones don’t.
- Check the feet. Two seconds, and it changes the whole direction.
- Get bloods if both hands are involved. Some of the causes are correctable and stay undiagnosed for years.
- Position beats temperature. Ice and heat do very little to a compressed nerve, and a hand with altered sensation can be burnt by both. Taking the pressure off does the work.
- Night splinting if it’s one hand and worse at night: a wrist splint holding the wrist straight, worn every night for 4 to 6 weeks before you judge it. See the carpal tunnel night splint.
- Nerve glides, gentle and never into burning: 5 slow reps, 2 to 3 times a day. If they flare the symptoms, back off the range. See carpal tunnel nerve glides.
- Desensitization for a hypersensitive hand: graded textures, soft to rough, 5 to 10 minutes, 3 to 4 times a day, over weeks. Tedious, and it works.
- Anti-inflammatories are usually the wrong drug class. Nerve pain responds to different medication, which is a conversation with your doctor.
Aching asks you to rest it. Burning asks you to find out what is irritating the nerve.
People with burning hands have usually tried three creams and a brace before anyone asks whether their feet do it too. That question takes four seconds and changes the entire direction.
How long does nerve burning take to settle?
Nerves run on a window. Where you sit in it decides what’s realistic.
- OPEN: burning or tingling that comes and goes, mostly at night. The nerve is irritated, not damaged. With night splinting and position changes, in my experience most people notice a difference within 4 to 6 weeks.
- CLOSING: burning or numbness that is now constant, or you’re dropping things. Nerve fibers are being lost. This is the point to get a proper assessment and a nerve conduction study rather than another month of waiting.
- SHUT: long-standing numbness with visible wasting at the thumb base or between thumb and index. Surgery can still relieve pain and stop it getting worse, but feeling and strength may not fully return. The goal changes from cure to protection.
Body-wide neuropathy runs on a different clock. Fixing the cause (better sugar control, B12 replacement) usually stops it progressing. Recovery of what’s already lost is slow, months, and sometimes partial.
Get it checked today if
- Burning and weakness are spreading up from the hands and feet over days, or you’re struggling to walk or climb stairs. That’s an emergency room visit, not an appointment.
- Burning followed an injury, cast or operation and is worse than the injury explains, especially with a hand that looks different from the other one: color, temperature, swelling, sweating, nail or hair change.
- Light touch, even a bedsheet, is intolerable.
- A finger or hand is hot, red, swollen and painful to move, especially with a fever.
- Your cast feels too tight, with burning, numbness or fingers going pale or dusky. Go back to whoever put it on, today.
Get it checked if
- Burning is constant rather than coming and going.
- Your feet are involved.
- There is weakness, clumsiness or visible muscle wasting.
- It is spreading rather than settling.
- Night splinting for 4 to 6 weeks hasn’t changed anything.
Burning is a nerve telling you it is being squeezed, starved or frightened. The treatment depends entirely on which one.
Written by Nigel Chua, hand occupational therapist in practice since 2005. Thousands of hands, wrists and elbows assessed and treated. My credentials are here. This article explains; it doesn’t examine. Burning that is constant, spreading, or in a hand that looks different deserves a proper look this week.
Every article on this site is written using the Closing Window Method: name the window your condition runs on, find where you are in it, and act while it’s still open.