What Causes Pain In The Hypothenar Area And Fingers?

Posted on Wed, 24 Aug 2016

Question: Pain in hypothenar weak pinky and ring finger - I am having spasms in my hypothenar when my pinky moves out from my other fingers or my hand is turned at the wrist palm up to the left see picture .... I have a sensation down my forearm which makes me think ulnar nerve, but i had a Nerve conduction test 1 month ago that showed no signs of nerve velocity issues. A hand dr said he saw no carpal, cubital or ulnar nerve issues on physical examination... I did have an mri that showed severe foraminal encroachment at c6 and moderate at c7... But that does not follow the dermatome map for where Im having problems.

I was having pain in my palm which was relieved to some degree with a cervical steroid injection at c6.

I am concerned about this weakness and spasm. It is affecting my grip and it is also painful when it spasms ... I need relief!

I may be getting another cervical steroid injection, but doubt that it will help this issue as they are focused on the "severe foraminal encroachment" at c6.

Is it possible c6 and c7 could cause this problem or is it more likely a local compression? If so, why would it not show up on NCV?

One last thing, my middle finger cannot be raised without my pinky coming up - see picture- its like something has change in my dexterity- my pinky, ring and middle finger are all being affected by what is going on.

Answered by Dr. Dr. Praveen Tayal (25 minutes later)

Brief Answer:
Muscle relaxants and methylcobalamin will help.

Detailed Answer:
Hello,
Thanks for posting your query.
The symptoms that you have described are likely to be due to ulnar nerve compression or a mild irritation at the level of cervical spine.
NCV should have detected the problem. But methylcobalamin deficiency can also cause some of these symptoms. Steroid injection at the level of C6 is less likely to help. It is better to get an MRI scan of the cervical spine done to detect any disc bulge at C8-T1.
A cervical rib also needs to be ruled out.
To relieve the muscle spasms, oral muscle relaxants will help.
I hope this answers your query.
In case you have additional questions or doubts, you can forward them to me, and I shall be glad to help you out.
Wishing you good health.
Regards.
Dr. Praveen Tayal.
For future query, you can directly approach me through my profile URL http://bit.ly/Dr-Praveen-Tayal

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. Dr. Praveen Tayal (3 hours later)

I had an mri with no c8-t1 issues. The nerve conduction did not find anything. I have naturally high b12 without supplementation. This is why Im confused and frustrated. Im worried about the weakness of my grip. What did you think of the pictures?

Any other feedback would be greatly appreciated.

Answered by Dr. Dr. Praveen Tayal (3 hours later)

Brief Answer:
Nerve related issue likely.

Detailed Answer:
Hello.
Thanks for writing again.
I have seen the images. A muscle wasting in the region is present. This is a nerve related issue. It can be a local compression also at the level of the wrist. Consulting a neurologist will help.
Hope my answer is helpful.
Do accept my answer in case there are no further queries.
Regards.

Above answer was peer-reviewed by : Dr. Raju A.T

Follow up: Dr. Dr. Praveen Tayal (2 hours later)

I appreciate your response. Any idea of the dexterity issues? Do you think a local wrist compression could cause that? And lastly, would a local compression cause forearm sensation?

Answered by Dr. Dr. Praveen Tayal (18 minutes later)

Brief Answer:
Nerve irritation at elbow likely.

Detailed Answer:
A local wrist compression is not likely to cause forearm sensation. In that case nerve irritation near elbow is expected.
The dexterity issues are also suggestive of a nerve related cause.
Regards.

Above answer was peer-reviewed by : Dr. Priyanka G Raj

Follow up: Dr. Dr. Praveen Tayal (8 hours later)

Last question, is pain in hypothenar suggestive of anything else ? The picture i sent was during cramp - please look at newly attached pic and tell me if you think true wasting when not in cramp. Also could c7 injection help settle compression - theyll be doing c6. And c7. Thank you!!

Answered by Dr. Dr. Praveen Tayal (4 hours later)

Brief Answer:
Any major muscle wasting is not there.

Detailed Answer:
The pain in hypothenar area can be related to mild inflammation or stiffness due to disuse. In the absence of cramp, any muscle wasting is not visible.
A steroid injection at C7 level can cause a minor improvement if the compression is at the level of cervical spine.
Regards.

Note: For further queries, consult a joint and bone specialist, an Orthopaedic surgeon. Book a Call now.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar