Why do i keep getting pins and needles in my hands and my hands always cold?

Carpal Tunnel: You may have carpal tunnel syndrome. I recommend an exam with a hand surgeon to evaluate and treat.

Paresthesias: Pins and needles are paresthesias. The nerve or nerves are not getting enough blood flow. Without more info like how long this has been going on, which parts of your hand/fingers are effected, is there any difference betwwen day and night, how's your health otherwise i can't give you a better answer/.