Symptom Finder - Numbness and Tingling of the Extremities
Numbness and Tingling of the Extremities
If the complaint is in the upper extremities, it is necessary for the physician to begin the examination by performing examinations for Tinel sign, at the wrist, and Phalen test. If these are positive, the patient may have carpal tunnel syndrome. Next, check for Tinel sign at the elbow. This is positive in ulnar neuropathy, which is usually associated with loss of sensation in the fifth finger and lateral one-half of the fourth finger. Check for a thoracic outlet syndrome by performing Adson test. Check for cervical radiculopathy by performing cervical compression and Spurling tests.
Check the reflexes, power, and sensation to all modalities in the upper and lower extremities. If the reflexes are symmetrically depressed, consider the possibility of a polyneuropathy. If they are depressed in one or both upper extremities and increased in the lower, consider the possibility of a lesion of the cervical spinal cord.
If there are cranial nerve signs, there may be a lesion in the brain stem or cerebral cortex. Numbness and tingling and/or weakness of one side of the body usually means there is a lesion of the opposite cerebral hemisphere such as a stroke or space-occupying lesion. If the onset of the
hemihypesthesia and hemihypalgesia is acute, the reflexes on the side of the numbness and tingling will be depressed. If the onset is insidious, the reflexes will be hyperactive. In both situations, there will usually be pathologic reflexes.
If the numbness or tingling is in the lower extremities, one should begin by performing a straight leg raising test and/or a femoral stretch test to rule out a herniated lumbar disc. If there is loss of sensation in a dermatomal distribution, that would also be consistent with a herniated disc or other lesion of the lumbosacral nerve roots. Always do a rectal examination to determine tone and control of the rectal sphincter and a pelvic examination to look for a uterine or ovarian mass that may be compressing the sacral plexus. Stocking hypesthesia and hypalgesia suggests a polyneuropathy but may also be seen in the subacute combined degeneration of the spinal cord associated with pernicious anemia. If the reflexes are hyperactive and there are pathologic reflexes, suspect a cord tumor or multiple sclerosis. Look for a steppage gait. This is consistent with polyneuropathy, whereas a spastic gait would be consistent with multiple sclerosis or a thoracic cord lesion.
It is necessary to check the pulses in the lower extremities, not just the dorsalis pedis and posterior tibial pulses, but the popliteal and femoral
pulses as well. If these are diminished, they may represent peripheral arteriosclerosis or Leriche syndrome.
If the numbness and tingling are present in only the feet, consider the possibility of tarsal tunnel syndrome or Morton neuroma, provided that the peripheral pulses are good. Rarely, numbness and tingling of the feet are due to a parasagittal meningioma.
If the complaint is in the upper extremities, it is necessary for the physician to begin the examination by performing examinations for Tinel sign, at the wrist, and Phalen test. If these are positive, the patient may have carpal tunnel syndrome. Next, check for Tinel sign at the elbow. This is positive in ulnar neuropathy, which is usually associated with loss of sensation in the fifth finger and lateral one-half of the fourth finger. Check for a thoracic outlet syndrome by performing Adson test. Check for cervical radiculopathy by performing cervical compression and Spurling tests.
Check the reflexes, power, and sensation to all modalities in the upper and lower extremities. If the reflexes are symmetrically depressed, consider the possibility of a polyneuropathy. If they are depressed in one or both upper extremities and increased in the lower, consider the possibility of a lesion of the cervical spinal cord.
If there are cranial nerve signs, there may be a lesion in the brain stem or cerebral cortex. Numbness and tingling and/or weakness of one side of the body usually means there is a lesion of the opposite cerebral hemisphere such as a stroke or space-occupying lesion. If the onset of the
hemihypesthesia and hemihypalgesia is acute, the reflexes on the side of the numbness and tingling will be depressed. If the onset is insidious, the reflexes will be hyperactive. In both situations, there will usually be pathologic reflexes.
If the numbness or tingling is in the lower extremities, one should begin by performing a straight leg raising test and/or a femoral stretch test to rule out a herniated lumbar disc. If there is loss of sensation in a dermatomal distribution, that would also be consistent with a herniated disc or other lesion of the lumbosacral nerve roots. Always do a rectal examination to determine tone and control of the rectal sphincter and a pelvic examination to look for a uterine or ovarian mass that may be compressing the sacral plexus. Stocking hypesthesia and hypalgesia suggests a polyneuropathy but may also be seen in the subacute combined degeneration of the spinal cord associated with pernicious anemia. If the reflexes are hyperactive and there are pathologic reflexes, suspect a cord tumor or multiple sclerosis. Look for a steppage gait. This is consistent with polyneuropathy, whereas a spastic gait would be consistent with multiple sclerosis or a thoracic cord lesion.
It is necessary to check the pulses in the lower extremities, not just the dorsalis pedis and posterior tibial pulses, but the popliteal and femoral
pulses as well. If these are diminished, they may represent peripheral arteriosclerosis or Leriche syndrome.
If the numbness and tingling are present in only the feet, consider the possibility of tarsal tunnel syndrome or Morton neuroma, provided that the peripheral pulses are good. Rarely, numbness and tingling of the feet are due to a parasagittal meningioma.
