Which Specialist Should You See for Your Child's Hand Symptoms?

Which specialty clinic should I visit?

Dear Dr.
Tseng,
My daughter’s right ring finger suddenly became red, swollen, and numb about half a month ago.
After about two days, all her other fingers also became red and swollen, and sometimes they would go completely numb, but then it would resolve after a while.
We took her to see a traditional Chinese medicine doctor, who suggested consulting a neurologist.
However, when we visited the neurology department at Dali Renai Hospital, the doctor recommended seeing a rheumatologist because her fingertips were cold and showed signs of darkening.
Additionally, her toes also experienced coldness and occasional numbness.
Therefore, he suggested a thorough examination by a rheumatologist.
I would like to seek your opinion, thank you!

Shu-Wen, 30~39 year old female. Ask Date: 2004/02/19

Dr. Zeng Guosen reply Internal Medicine

Hello! According to online descriptions, Raynaud's phenomenon should be considered, and it could also be caused by vascular circulation disorders or vasculitis.
If symptoms persist, it is advisable to consult a rheumatologist.
Currently, the most important measures are to keep warm and monitor the situation.
Sincerely, Dr.
Tseng Kuo-Sen, Department of Internal Medicine, Taoyuan Hospital, Ministry of Health and Welfare.

Reply Date: 2004/02/19

More Info

When it comes to your child's hand symptoms, particularly the sudden onset of redness, swelling, and numbness in the fingers, it is crucial to approach the situation with a comprehensive understanding of potential underlying causes. Based on the symptoms you've described, it seems that your daughter may be experiencing a condition that could involve both neurological and immunological factors.

The initial recommendation to consult a neurologist is appropriate, especially since symptoms like numbness and tingling can often be related to nerve issues. However, the subsequent suggestion from the neurologist to see a rheumatologist or immunologist indicates that they suspect an autoimmune or inflammatory condition may be at play. This is particularly relevant given the symptoms of coldness and discoloration in the fingers, which could suggest issues with blood flow or vascular involvement.

Possible Conditions to Consider
1. Raynaud's Phenomenon: This condition is characterized by episodes of reduced blood flow to the fingers and toes, often triggered by cold or stress. It can cause the fingers to turn white or blue and may lead to numbness or tingling. In some cases, it can be associated with autoimmune diseases.

2. Vasculitis: This refers to inflammation of the blood vessels, which can lead to symptoms like those you described. Vasculitis can affect blood flow and may cause pain, numbness, and discoloration in the extremities.

3. Peripheral Neuropathy: This condition involves damage to the peripheral nerves and can result in symptoms such as numbness, tingling, and weakness. Various factors, including autoimmune diseases, can lead to peripheral neuropathy.

4. Autoimmune Disorders: Conditions like lupus, rheumatoid arthritis, or scleroderma can present with symptoms affecting the hands and may involve both joint and skin manifestations.

Recommended Steps
1. Consult a Rheumatologist: Given the symptoms of coldness, discoloration, and the potential for an autoimmune process, seeing a rheumatologist is a prudent next step. They can conduct specific tests to evaluate for autoimmune diseases and assess any inflammatory markers in the blood.

2. Comprehensive Evaluation: The rheumatologist may recommend blood tests, imaging studies, or even a biopsy if necessary, to determine the underlying cause of your daughter’s symptoms. This may include tests for antinuclear antibodies (ANA), rheumatoid factor, and other specific autoantibodies.

3. Follow-Up with Neurology: If the rheumatologist rules out autoimmune conditions, it may still be beneficial to follow up with a neurologist to explore other potential causes of the neurological symptoms.

4. Symptom Management: In the meantime, managing symptoms is essential. Keeping the hands warm, avoiding triggers that exacerbate symptoms, and possibly using medications to improve blood flow or reduce inflammation may be recommended based on the diagnosis.

Conclusion
In summary, your daughter's symptoms warrant a multidisciplinary approach. Starting with a rheumatologist seems to be the most logical step, given the potential for an autoimmune or vascular issue. It is essential to act promptly, as early diagnosis and intervention can significantly impact the management of any underlying condition. Be sure to keep a detailed record of her symptoms, including any triggers or patterns, as this information can be invaluable to the healthcare providers involved in her care.

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