Persistent Numbness in Hands and Feet: Possible Causes and Solutions

Numbness in the hands and feet?

Hello Doctor, since September 25th, I have been experiencing numbness in my fingers upon waking up.
Initially, I thought it would resolve on its own, but by September 26th, the numbness extended to my toes and the soles of my feet.
As of now, October 31st, the numbness in both my hands and feet has persisted for over a month without improvement, although it hasn't worsened either.
The numbness is located in the first and second joints of my fingers and in the toes and the entire soles of my feet, but there is no pain associated with it.
Additionally, I do not experience any pain in my spine, neck, or lower back.
The numbness does not decrease with activity; in fact, it seems to increase when I touch my hands and feet.

On October 25th, I went to the hospital for blood tests, nerve conduction studies, and a lumbar puncture, but the results were all reported as normal.
The cerebrospinal fluid analysis was also normal, except for a noted slowing of nerve conduction, which the doctor said would be monitored.
I have been taking B1 and B12 supplements for neuropathy, as well as circulation medications, for about a month, but there has been no improvement in the numbness.
I would appreciate your guidance on what kind of conditions could be causing this numbness in my hands and feet.
Thank you! 😊

Pingguo, 30~39 year old female. Ask Date: 2022/10/31

Dr. Jiang Junyi reply Neurology

Dear Ms.
Apple,
You mentioned that "blood tests, nerve conduction studies, and spinal tap examinations all reported normal results, and the cerebrospinal fluid analysis was also normal, with only a noted slowing of nerve conduction." You pointed out abnormal sensory nerves, which can occur in conditions such as diabetes, nerve root compression due to herniated discs, renal failure, stroke patients, those undergoing chemotherapy, or individuals with vitamin B12 deficiency.
Peripheral nerve issues caused by systemic diseases (such as diabetes, chemotherapy, or vitamin deficiencies) are often symmetrical, resulting in sensations of numbness or insensitivity on both sides of the body.
Peripheral nerve examinations are categorized into three types:
1.
Nerve Conduction Studies: This traditional test primarily assesses large fiber nerves.
2.
Quantitative Sensory Testing (QST): This test focuses on small fiber nerves and measures sensations such as cold, heat, and pain, which traditional nerve conduction studies cannot evaluate.
Both tests complement each other for a comprehensive assessment of sensory nerve abnormalities.
3.
Electromyography (EMG): This test evaluates muscle responses in the areas supplied by the nerves.
I recommend consulting a neurologist specializing in peripheral nerve disorders, as they have more experience with EMG diagnostics.
Thank you for your inquiry.
If you have further questions, feel free to discuss them!
Wishing you good health and peace,
Dr.
Cheng-Jun Yi, Tao Medical Center

Reply Date: 2022/10/31

More Info

Persistent numbness in the hands and feet can be a concerning symptom, and it’s understandable that you are seeking answers after experiencing this for over a month. Based on your description, it seems that you are dealing with a condition that could be related to nerve function or circulation, especially since you have already undergone various tests that returned normal results except for some slowing in nerve conduction.

Numbness, or paresthesia, can arise from several potential causes, including peripheral neuropathy, nerve compression, or systemic conditions. Given that your symptoms have persisted without significant change, it’s essential to consider the following possibilities:
1. Peripheral Neuropathy: This condition involves damage to the peripheral nerves and can result from various factors, including diabetes, vitamin deficiencies (especially B vitamins), alcohol use, and certain medications. Since you are already taking B1 and B12 supplements, it’s crucial to ensure that you are receiving adequate nutrition and to discuss with your doctor whether additional testing for other deficiencies or metabolic conditions is warranted.

2. Nerve Compression: Conditions such as carpal tunnel syndrome or tarsal tunnel syndrome can lead to numbness in the hands and feet, respectively. These conditions occur when nerves are compressed due to repetitive motions, inflammation, or anatomical abnormalities. If you have a history of repetitive hand or wrist movements, it may be worth exploring this possibility further.

3. Circulatory Issues: Poor circulation can lead to numbness and tingling sensations. Conditions like Raynaud's phenomenon or peripheral artery disease can affect blood flow to the extremities. If you notice that your symptoms worsen in cold conditions or with certain positions, this could be a contributing factor.

4. Systemic Conditions: Autoimmune diseases, thyroid disorders, and other systemic conditions can also manifest as numbness in the extremities. Given that your spinal fluid and other tests were normal, these may be less likely, but they should still be considered, especially if you have other symptoms.

5. Anxiety and Stress: Sometimes, psychological factors can contribute to physical symptoms. Anxiety can lead to hyperventilation and muscle tension, which may exacerbate feelings of numbness or tingling.

Since your symptoms have not improved with the current treatment, it may be beneficial to follow up with a neurologist or a specialist in peripheral nerve disorders. They may recommend additional diagnostic tests, such as an MRI to rule out structural issues or further nerve conduction studies to assess the extent of nerve involvement.

In the meantime, consider the following self-care strategies:
- Ergonomic Adjustments: Ensure that your workspace is set up to minimize strain on your hands and wrists. Use ergonomic tools and take regular breaks to stretch and move.

- Physical Therapy: A physical therapist can provide exercises to strengthen the muscles around the affected nerves and improve circulation.

- Stress Management: Engage in relaxation techniques such as yoga, meditation, or deep breathing exercises to help reduce overall tension in your body.

It’s essential to maintain open communication with your healthcare provider about your symptoms and any changes you experience. Persistent numbness should not be ignored, and further evaluation may be necessary to determine the underlying cause and appropriate treatment.

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