Burning in the hands is almost always a NERVE symptom rather than a joint or tendon one.
- Joints ache.
- Tendons hurt when you load them.
Nerves…on the other hand (pardon the pun, ahem) – always 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.
Where it burns, one hand or two, and whether your feet burn too, does most of the sorting.
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
- Ring and little fingers: the ulnar nerve. Cubital tunnel syndrome
- The back of the thumb: a small skin nerve. Wartenberg’s syndrome
- 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.
Both hands and both 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.
If your feet burn as well, this is not a wrist problem and a wrist splint will not touch it.
- Diabetes and prediabetes, the commonest cause worldwide
- Vitamin B12 deficiency
- Thyroid disease
- Alcohol
- Medications, including some chemotherapy agents
This version needs blood tests, not a splint. See peripheral neuropathy or carpal tunnel and the diabetic hand.
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 reorganises. See scar management and burns to the hand
The 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
- Skin conditions, which burn on the surface rather than deep inside the finger
- Gout or infection, which burn but also swell, redden and refuse to move
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: glucose, HbA1c, B12 and thyroid. 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. See ice or heat
- Night splinting if it’s one hand and worse at night, because that’s when the position is worst. See which splint
- Desensitization for a hypersensitive hand: graded textures, several 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.
See someone promptly if
- Burning followed an injury, cast or operation and is worse than the injury explains
- The hand looks different from the other one: color, temperature, swelling, sweating, nail or hair change
- Light touch is intolerable
- Burning is constant rather than coming and going
- Your feet are involved
- There is weakness or visible muscle wasting
- It is spreading rather than settling
For the splints involved, see the carpal tunnel night splint.
Burning is a nerve telling you it is being squeezed, starved or frightened. The treatment depends entirely on which one.
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.