The feeling that your hand is painfully hot, tingling, or “on fire” is a specific type of abnormal sensation known as paresthesia. This burning discomfort signals that your sensory nervous system is being irritated or damaged somewhere along its path from the fingertips to the spinal cord. While temporary paresthesia is common, a persistent or recurrent burning sensation suggests an underlying issue is disrupting nerve communication signals. Pinpointing the source of this irritation is the first step toward finding relief.
Nerve Compression Syndromes
The most frequent cause of localized burning hand pain involves mechanical compression of a nerve. When a nerve is squeezed, the pressure can restrict blood flow, leading to nerve irritation and a sensation of burning or tingling. This is known as an entrapment neuropathy, and the most common example is Carpal Tunnel Syndrome (CTS).
CTS occurs when the median nerve, which runs through a narrow passageway in the wrist called the carpal tunnel, becomes compressed. This compression causes characteristic symptoms like numbness, tingling, and a burning sensation in the thumb, index, middle finger, and half of the ring finger. Symptoms often worsen at night or upon waking because wrist positioning during sleep increases pressure inside the tunnel. The burning sensation is caused by nerve ischemia, where reduced blood supply causes the nerve fibers to misfire.
Another common entrapment is Cubital Tunnel Syndrome, which involves the ulnar nerve as it passes through the cubital tunnel on the inside of the elbow. Compression here results in a burning or tingling sensation primarily felt in the pinky and the other half of the ring finger. Activities that involve prolonged elbow bending, such as holding a phone or leaning on a desk, can exacerbate this condition by stretching and compressing the ulnar nerve.
Systemic Causes: Peripheral Neuropathy
When the burning sensation is not confined to the distribution of a single nerve and affects both hands and often the feet, the cause is systemic peripheral neuropathy. This condition involves generalized damage to the peripheral nerves, particularly the small sensory fibers responsible for pain and temperature. The most frequent systemic cause of this type of nerve damage is Diabetes Mellitus (diabetic neuropathy).
Sustained high blood sugar levels associated with diabetes damage the small blood vessels that supply oxygen and nutrients to the nerve fibers. This metabolic and vascular injury causes the nerves to degenerate, leading to chronic burning pain, numbness, and tingling. This nerve damage typically follows a “stocking-glove” distribution, beginning in the feet and progressing up the legs before affecting the hands.
Other systemic conditions can also induce widespread nerve irritation, including nutritional deficiencies, such as a lack of Vitamin B12. Vitamin B12 is necessary for maintaining the myelin sheath, the protective coating around nerve fibers. Without sufficient B12, the nerves become vulnerable to damage, leading to paresthesia. Chronic kidney disease can similarly cause uremic neuropathy, where the buildup of toxins irritates the nerves, leading to symptoms in the hands and feet.
Circulation and Inflammation-Related Issues
Some causes of burning hands are related to problems with localized blood flow or inflammatory processes, rather than direct nerve compression or systemic neuropathy. Complex Regional Pain Syndrome (CRPS) is a chronic pain disorder that often follows an injury, causing continuous burning pain that is disproportionate to the original trauma. CRPS is characterized by abnormal changes in the affected hand’s temperature and color, which may appear blotchy, red, or excessively sweaty.
A vascular issue called Raynaud’s Phenomenon can also cause a burning sensation. This condition involves spasms of the small arteries in the fingers, usually triggered by cold or emotional stress. The fingers initially turn white and numb due to lack of blood flow, but the burning occurs during the rewarming phase when blood rushes back into the vessels.
Localized inflammation of the skin can trigger a burning feeling, such as in Contact Dermatitis, which is a reaction to an irritant or allergen. The skin’s barrier is compromised, resulting in localized redness, itching, and a stinging or burning sensation. The reactivation of the chickenpox virus causes Shingles (herpes zoster), which can present as a sharp, deep-seated burning pain in the hand, often preceding the characteristic blistering rash that follows the path of a single nerve.
Action Steps and Medical Consultation
A transient burning sensation that quickly resolves, such as when a hand “falls asleep,” is usually harmless and is not a cause for concern. However, symptoms that are persistent, recurrent, or interfere with daily life warrant a medical evaluation to identify the underlying cause. If symptoms are related to repetitive motion, initial self-care steps include resting the hand, avoiding the triggering activities, and wearing a wrist splint to maintain a neutral position.
Immediate medical attention is necessary if the burning hand sensation begins suddenly, especially if it is accompanied by other neurological red flags. These urgent signs include new or rapidly worsening muscle weakness, sudden paralysis, difficulty speaking, confusion, or a sudden, severe headache. The presence of these symptoms may indicate a serious condition like a stroke, which requires emergency intervention. For any burning hand pain that lasts more than a week, or if symptoms are keeping you awake at night, schedule an appointment with a healthcare provider.