Right-Sided Numbness: Causes and Solutions

There is a tingling sensation in the right hand and foot?

Hello Doctor, I have been experiencing numbness in my right hand and right foot recently.
This has been ongoing for about six months, but it tends to ease up after I get up and move around.
However, I do experience pain in my lower back, which only occurs when I lean back or bend forward.
I have undergone numerous tests, but the cause remains elusive.
My blood tests have all come back normal, and I have also had a carotid ultrasound, cervical MRI (with contrast), head CT scan (with contrast), nerve conduction studies, and lower back X-rays.
There is a thyroid nodule that was found, but a fine-needle aspiration confirmed it to be benign, with no signs of hyperthyroidism or hypothyroidism.
All of the above tests returned normal results.
Currently, I feel relatively normal only right after waking up, but throughout the day, I notice a difference in sensation between my left and right limbs.
My right hand and foot do not feel weak, but the sensations are more pronounced in the palms of my hands and soles of my feet, with some feeling in my calves and thighs, and slight sensations below my elbows.
The symptoms are accompanied by a tingling and numbness sensation.
However, I cannot seem to find the underlying cause.
What could be wrong with me?

Xiao Xue, 30~39 year old female. Ask Date: 2016/09/21

Dr. Jiang Junyi reply Neurology

Hello, based on your description, it seems that your symptoms improve after getting up and moving around.
Have you undergone testing for ankylosing spondylitis? Additionally, current imaging studies have a limitation; they cannot provide dynamic analysis.
For instance, does your intervertebral disc compress the nerve roots when you are standing in the afternoon? It is advisable to change positions regularly: shift your posture every 15 minutes to allow your back tissues to rest.
Maintaining a position for an extended period can lead to tissue fatigue and inflammation, so moving around briefly can reduce the likelihood of muscle inflammation.
Muscle stretching exercises: after the acute pain phase, it is recommended to develop a habit of gentle stretching every 15 to 20 minutes at angles that do not provoke back discomfort.
I suggest you consult with a neurologist or a rehabilitation physician to discuss further examination and treatment.
Wishing you good health and peace.

Reply Date: 2016/09/21

More Info

Understanding right-sided numbness, especially when accompanied by lower back pain, can be quite complex. Your symptoms suggest a potential neurological or musculoskeletal issue, but given the extensive testing you've undergone, it may be challenging to pinpoint the exact cause. Let's break down your symptoms and explore possible explanations and solutions.

Symptoms Overview
1. Right-Sided Numbness: The numbness in your right hand and foot, particularly noticeable in the palms and soles, could indicate nerve involvement. This might be due to compression or irritation of nerves, possibly in the cervical spine (neck area) or lumbar spine (lower back).

2. Lower Back Pain: The pain that occurs when bending backward or forward suggests that there may be an underlying issue with the lumbar spine, such as a herniated disc, spinal stenosis, or muscle strain.
3. Normal Test Results: It's reassuring that your blood tests, imaging studies (like CT and MRI), and nerve conduction studies have returned normal results. This often rules out significant structural problems, such as tumors or major vascular issues.

Possible Causes
1. Nerve Compression: Even if imaging studies appear normal, subtle nerve compression can occur due to muscle tightness or minor disc issues that may not be readily visible on scans. Conditions like sciatica or a pinched nerve in the cervical or lumbar region could lead to numbness and pain.

2. Cervical Radiculopathy: If there’s irritation or compression of the nerves in the neck, it can cause numbness and tingling in the arm and hand. This often occurs with certain neck positions or movements.

3. Lumbar Radiculopathy: Similarly, issues in the lower back can lead to symptoms radiating down the leg. This could explain the numbness in your right foot.

4. Muscle Imbalances: Chronic muscle tension or imbalances can lead to referred pain and numbness. If certain muscles are overactive or tight, they can compress nerves, leading to your symptoms.

5. Postural Issues: Poor posture, especially during sleep or prolonged sitting, can exacerbate nerve compression and lead to numbness.

Recommendations
1. Physical Therapy: Engaging in a structured physical therapy program can help address muscle imbalances, improve posture, and relieve nerve compression. A physical therapist can provide exercises tailored to your specific needs.

2. Ergonomic Adjustments: Evaluate your sleeping and sitting positions. Using ergonomic furniture and maintaining good posture can alleviate pressure on your spine and nerves.

3. Pain Management: If your pain persists, consider discussing pain management options with your healthcare provider. This could include medications, injections, or alternative therapies like acupuncture.

4. Regular Monitoring: Since your symptoms have been persistent, regular follow-ups with your healthcare provider are essential. If symptoms worsen or new symptoms arise, further evaluation may be necessary.

5. Lifestyle Modifications: Incorporating regular physical activity, stretching, and strengthening exercises can help maintain spinal health and reduce symptoms.

6. Consultation with Specialists: If symptoms continue without improvement, consider consulting a neurologist or a spine specialist for further evaluation. They may recommend additional tests or treatments based on their expertise.

Conclusion
While it can be frustrating to experience symptoms without a clear diagnosis, understanding the potential causes and exploring various treatment options can lead to relief. It’s essential to remain proactive in your healthcare journey, advocating for further evaluations if necessary, and exploring all avenues for treatment. Remember, your body is unique, and what works for one person may not work for another, so a personalized approach is crucial.

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