From the Guidelines
A workup for tingling in the middle and ring fingers should begin with a thorough evaluation by a neurologist or relevant specialist to rule out other causes of autonomic dysfunction, including diabetic screen, adrenal insufficiency, HIV, paraproteinemia, amyloidosis, and botulism, as suggested by the American Society of Clinical Oncology guideline update 1. When evaluating tingling in the middle and ring fingers, it is essential to consider various potential causes, including immune-related adverse events, especially in patients treated with immune checkpoint inhibitor therapy. The initial workup should include:
- Screening for other causes of autonomic dysfunction, such as diabetic screen, adrenal insufficiency, HIV, paraproteinemia, amyloidosis, and botulism
- Orthostatic vital signs to assess for any signs of autonomic dysfunction
- Consideration of electrodiagnostic studies (NCS and EMG) to evaluate for concurrent polyneuropathy, as recommended by the American Society of Clinical Oncology guideline update 1
- Consideration of paraneoplastic autoimmune dysautonomia antibody testing (eg, antiganglionic AChR, ANNA-1, and N-type voltage-gated calcium channel antibodies) to rule out any underlying autoimmune conditions
In addition to these evaluations, it is crucial to consider other potential causes of tingling in the middle and ring fingers, such as carpal tunnel syndrome, cervical radiculopathy, or cubital tunnel syndrome. However, the American Society of Clinical Oncology guideline update 1 provides a more comprehensive approach to evaluating these symptoms, especially in patients with a history of immune checkpoint inhibitor therapy. The guideline update 1 emphasizes the importance of a thorough evaluation by a neurologist or relevant specialist to determine the underlying cause of the symptoms and develop an appropriate treatment plan.
From the Research
Tingling in the Middle and Ring Finger
- Tingling in the middle and ring finger can be a symptom of various conditions, including carpal tunnel syndrome (CTS) and ulnar nerve entrapment (UNE) 2, 3, 4.
- CTS is a common compression neuropathy that occurs when the median nerve is compressed as it passes through the wrist 2, 3.
- UNE, on the other hand, occurs when the ulnar nerve is compressed at the elbow or wrist 5.
- Studies have shown that individuals with diabetes are at a higher risk of developing CTS and UNE due to biochemical and structural changes in the peripheral nerves 3, 5.
- Electrophysiological examinations, such as electromyography, can be used to diagnose CTS and UNE 5.
- Treatment options for CTS and UNE include surgery, physical therapy, and medication 2, 3, 6.
- Individuals with CTS and UNE may also experience impaired psychological health, as evidenced by increased use of psychotropic medication 6.
Possible Causes
- Compression of the median or ulnar nerve 2, 3, 4, 5
- Diabetes 3, 5
- Trauma or injury to the wrist or elbow 4
- Repetitive strain or overuse 4