What could be causing a sensation in my thumb like veins filling, accompanied by hand weakness, and how should I manage it as a 63-year-old?

Vascular Assessment is Critical—This Sensation Requires Urgent Evaluation for Arterial Insufficiency

Your symptom of a "vein filling" sensation in your thumb combined with hand weakness at age 63 demands immediate evaluation to exclude arterial occlusion, which can progress rapidly to tissue loss if untreated.

Immediate Red Flags Requiring Emergency Evaluation

You need urgent vascular surgery consultation if you have any of the following 1:

• Unilateral involvement (only one hand/thumb affected—not both sides)
• Rest pain in the thumb or hand
• Color changes: white, blue, or dusky discoloration of the fingertip
• Tissue changes: any ulcers, skin breakdown, or darkening of tissue
• Rapid progression of symptoms over hours to days

The sensation you describe—feeling like veins are filling—combined with weakness suggests either arterial insufficiency with collateral vessel recruitment or venous obstruction forcing blood through alternate pathways 2.

Critical Distinction: One Hand vs. Both Hands

If only your thumb/one hand is affected:

• This indicates arterial occlusion rather than a systemic vasospastic disorder 1
• Unilateral presentation with weakness suggests Stage II-III ischemia requiring urgent intervention 1
• Digital blood pressure measurement will show significantly reduced pressures in the affected digit 1

If both hands are involved:

• Consider systemic conditions like Raynaud's phenomenon, though the "filling" sensation is atypical 1
• Bilateral symmetric involvement has a broader differential but is less immediately limb-threatening 3

Essential Immediate Workup

You need the following tests within 24-48 hours 1, 2:

1. Digital blood pressure measurement to differentiate arterial occlusion from vasospasm 1
2. Duplex ultrasound of the upper extremity to assess arterial flow and exclude deep vein thrombosis 2
3. Complete blood count and inflammatory markers to screen for vasculitis or connective tissue disease 1
4. Antinuclear antibody (ANA) testing if secondary Raynaud's or connective tissue disease suspected 1

Specific Conditions to Consider at Your Age

Arterial Occlusive Disease (Most Urgent)

• At 63, you're at risk for atherosclerotic arterial disease, especially with diabetes, hypertension, or smoking history 1
• The "filling" sensation may represent collateral vessels attempting to bypass an obstruction 2
• 90 of 91 affected fingers in one study showed significantly low digital pressures with arterial occlusion 1

Upper Extremity Deep Vein Thrombosis

• Unilateral swelling with visible venous distension indicates obstruction at the subclavian or axillary vein level 2
• The bulging veins you're feeling represent collateral circulation bypassing obstructed deep veins—a hallmark of venous thrombosis 2
• Duplex ultrasound has >80% sensitivity and specificity for upper extremity DVT 2

Carpal Tunnel Syndrome (Less Likely Given Your Description)

• Typically causes numbness and tingling in thumb, index, middle, and radial ring fingers 4
• Weakness of thumb opposition when severe 4
• The Durkan maneuver (firm pressure across carpal tunnel) is 64% sensitive and 83% specific 4
• However, carpal tunnel doesn't typically cause a "vein filling" sensation 4, 5

Thumb Base Osteoarthritis

• Affects approximately 33% of postmenopausal individuals radiographically 4
• Causes weakness with gripping and pinching activities 6
• Does not cause vascular sensations 6

Management Algorithm Based on Presentation

If You Have Rest Pain or Tissue Changes:

1. Emergency vascular surgery referral within hours 1
2. Do not delay for imaging—clinical assessment takes priority 1
3. This represents Stage III-IV ischemia with risk of tissue loss 1

If You Have Weakness Without Rest Pain:

1. Urgent outpatient vascular evaluation within 24-48 hours 1
2. Obtain duplex ultrasound to assess arterial and venous flow 2
3. Digital blood pressure measurement to quantify ischemia 1

If Vascular Studies Are Normal:

1. Consider neurologic evaluation for peripheral nerve compression 7, 8
2. Electrodiagnostic testing if carpal tunnel or other neuropathy suspected 4
3. MRI of cervical spine if radiculopathy suspected 7

Common Pitfalls to Avoid

• Do not dismiss unilateral symptoms as benign—this presentation demands urgent evaluation for vascular obstruction 2
• Do not attribute symptoms to "aging" or arthritis without excluding arterial disease first 1
• Do not wait for symptoms to worsen—arterial occlusion can progress from slow deterioration to rapid tissue loss 1
• Recognize that catheter-associated thrombosis may be initially asymptomatic, manifesting only as unusual sensations before overt swelling 2

Immediate Actions You Should Take

1. Contact your primary care physician today to arrange urgent vascular evaluation 1
2. Avoid cold exposure and keep the hand warm (but not hot) 1
3. Elevate the hand if swelling is present 2
4. Do not apply direct heat or extreme cooling, which can worsen tissue damage 3
5. Monitor for progression: worsening pain, color changes, or numbness require emergency evaluation 1

The combination of an unusual vascular sensation with weakness in a 63-year-old is not a normal finding and requires systematic evaluation to exclude limb-threatening arterial disease.