Persistent Left-Sided Pain and Numbness: What Specialist to See?

Numbness and pain in the left hand and left foot, with alternating pain on the left side. Pain extends from the hand to the back, lower back, buttocks, and down to the leg?

I have been experiencing symptoms for over a year.
Initially, I felt a tightness in my chest, so I went to a cardiologist who performed an electrocardiogram, echocardiogram, and exercise stress test.
The doctor diagnosed me with mitral valve prolapse but said it wasn't a significant issue.
Afterwards, I started to feel numbness and tingling in my left hand and foot, and I felt unsteady while walking, as if my head was heavy and my legs were light.
I visited a neurologist who conducted nerve conduction studies on my arms and legs, which showed no abnormalities, and I also had imaging of my cervical spine that was normal.
However, I still experience numbness and tingling.
Doctor, which specialist should I see next, or what tests should I undergo? At first, I suspected I might have had a stroke, but since the symptoms have persisted for so long, that seems unlikely.
This situation is really concerning for me.

Kai, 30~39 year old female. Ask Date: 2017/08/01

Dr. Chen Taicheng reply Family Medicine

● If you experience numbness or pain that seems to move around, consider conditions such as muscle inflammation, fibromyalgia, or rare spinal neuropathies.
It is advisable to prepare relevant tests such as electrocardiograms, electromyography from neurology, or other imaging studies (such as of the cervical or lumbar spine) before consulting with rheumatology, orthopedics, and neurology for further evaluation and treatment.
Wishing you good health, Dr.
Chen Tai-Cheng from the Family Medicine Department of Taoyuan Hospital cares about you~

Reply Date: 2017/08/01

More Info

Based on your description of persistent left-sided pain and numbness, it seems that you have already undergone several evaluations, including cardiac assessments and neurological examinations, which have not revealed any significant abnormalities. Given the complexity of your symptoms, it is essential to consider a few different avenues for further evaluation and treatment.

Possible Causes of Your Symptoms
1. Cervical Radiculopathy: Although your cervical spine imaging did not show abnormalities, sometimes subtle issues like disc herniation or foraminal stenosis may not be evident on initial scans. These conditions can cause nerve root compression, leading to pain and numbness radiating down the arm and leg.

2. Thoracic Outlet Syndrome: This condition occurs when blood vessels or nerves in the space between your collarbone and your first rib become compressed. Symptoms can include pain, numbness, and weakness in the arms and hands.

3. Peripheral Neuropathy: This condition can result from various factors, including diabetes, vitamin deficiencies, or autoimmune diseases. It can cause numbness and tingling in the extremities.

4. Musculoskeletal Issues: Sometimes, persistent pain and numbness can arise from muscle strain or ligament injuries, especially if there has been a history of physical activity that may have led to overuse or injury.

5. Psychogenic Pain: Chronic pain can sometimes have a psychological component, where stress and anxiety exacerbate physical symptoms.

Recommended Next Steps
1. Consult a Pain Specialist: Given the chronic nature of your symptoms, a pain management specialist can help assess your condition more thoroughly. They may recommend treatments such as nerve blocks, physical therapy, or other interventions that can help alleviate your pain.

2. Physical Therapy: Engaging in a structured physical therapy program can help strengthen the muscles around the affected areas, improve flexibility, and reduce pain. A physical therapist can also provide specific exercises tailored to your condition.

3. Further Imaging: If you haven’t already, consider getting an MRI of your cervical spine and possibly your thoracic spine. This imaging can provide a more detailed view of the soft tissues and nerves that may not have been visible on X-rays.

4. Electromyography (EMG) and Nerve Conduction Studies: These tests can help determine if there is any nerve damage or dysfunction contributing to your symptoms. They can provide valuable information about the electrical activity of your muscles and the speed of nerve conduction.

5. Holistic Approaches: Sometimes, complementary therapies such as acupuncture, chiropractic care, or massage therapy can provide relief for chronic pain conditions.
6. Neurologist Follow-Up: Since you have already seen a neurologist, it may be beneficial to return for a follow-up appointment, especially if your symptoms have changed or worsened. They may consider additional tests or referrals to other specialists.

Conclusion
Persistent left-sided pain and numbness can be challenging to diagnose and treat, especially when initial evaluations do not yield clear answers. It is crucial to continue seeking care and advocating for yourself. A multidisciplinary approach involving pain specialists, physical therapists, and possibly further imaging or nerve studies may provide the best chance for relief. Remember to keep a detailed record of your symptoms, including any changes or triggers, as this information can be invaluable to your healthcare providers in determining the best course of action.

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