Q: My pinky finger has been numb with tingling for two weeks. Should I be worried? Do I need to treat it?

A: Your symptoms suggest irritation, compression or disease of the ulnar nerve. This nerve supplies sensation to the fifth (pinky) finger. The problem, called ulnar neuropathy, may involve the whole nerve or arise from one point along its course.

The most common place for these problems is the elbow, where the nerve travels through a groove near the skin's surface. It's easy to compress the nerve just by leaning on the elbow. The site of nerve trouble can also be in the neck, armpit or wrist. Even a tight ring on the fifth finger can cause numbness and tingling.

Some of the more common causes of ulnar neuropathy include:

Injury to the elbow, wrist or hand

Compression during surgery

Arthritis of the elbow or wrist

Diabetes

Ganglion cyst in the wrist

Disc disease in the neck (where the major nerves of the arm originate)

Some people with numbness and tingling of the fifth finger also have weakness in the hand or forearm muscles. Or, there may be numbness in other fingers, the forearm or upper arm.

The combination of symptoms and findings on physical examination can help your doctor sort out where the problem is. For example, if the fifth finger is numb without weakness, the problem is probably located in the wrist. But if weakness is also present, the nerve problem is more likely to be higher up, maybe in the elbow. Sometimes additional tests are useful, such as neurophysiologic studies that record muscle and nerve activity.

Treatment depends on the cause. If nerve compression is the cause, it's important to avoid pressure on the nerve. Avoid wearing a tight ring on that finger. Don't lean on your elbows or wrists. Wear a protective brace over the elbow or wrist. An immobilizing brace or cast may be recommended for trauma-induced neuropathy. Anti-inflammatory drugs (such as ibuprofen) or immune suppressing drugs may improve neuropathy related to rheumatoid arthritis. Tight control of blood sugar (as with insulin) may reduce the risk of nerve damage from diabetes. Surgery may be offered for some cases of neuropathy related to trauma, arthritis, ganglion cysts or disc disease.

It's important to see your doctor, especially if symptoms persist. Identifying the cause may be important not only to relieve your symptoms but also for your overall health.

(Robert H. Shmerling, M.D. is associate physician at Beth Israel Deaconess Medical Center and associate professor at Harvard Medical School. Robert H. Shmerling, M.D. is associate physician at Beth Israel Deaconess Medical Center and associate professor at Harvard Medical School. He has been a practicing rheumatologist for over 20 years at Beth Israel Deaconess Medical Center, Boston, Mass.)

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