Hello, Those symptoms you describe correspond most likely to a nerve compression. Nerve compression can occur at several sites such as the wrist, the elbow, the shoulder or the neck, so some more precise information on the localization of the tingling sensations might be more helpful (which fingers, palmar or dorsal surface of the hand, inclusion of the forearm or the arm as well, neck pain, etc). A common cause that often includes both hands might be carpal tunnel syndrome, compression of the median nerve at the wrist, causing symptoms usually in first 3 fingers, the palm and may include the forearm. Symptoms often more pronounced at night. The next most common cause would be nerve compression in the neck, where symptoms generally are as far up as the neck. In terms of diagnostic steps, they are the same independently from the affected nerve. A neurological exam is the first step, to identify the distribution of symptoms, changes in reflexes, motor strength for individual muscles, information that help localizing the site of damage. Afterward, the next diagnostic step is ENMG (nerve conduction studies and electromyography). If the exam suggests a source to be in the neck a neck MRI might be needed as well. Management will depend on the affected nerve and the cause. Hope I have answered your query. Let me know if I can assist you further. Take care Regards, Dr. Iven Romic Rommstein, General Surgeon