Hand and Foot Numbness: Neurological Insights and Concerns

Numbness in both hands and weakness in the legs?

After experiencing numbness in the first phalanx of both hands, the second phalanx also became completely numb.
Continuous examinations have ruled out carpal tunnel syndrome, and both cervical and peripheral nerves are intact.
There is no history of diabetes.
Over the past six months, the numbness has progressed to the palms, significantly affecting daily activities such as buttoning clothes and grasping objects.
Recently, there has also been weakness in the right foot, making it difficult to walk and requiring assistance from both hands to climb stairs.
The right foot cannot be lifted high.
The cause has not yet been identified, and I am currently seeing a neurosurgeon, who does not rule out issues related to the cervical spine or brain.
The cervical spine has undergone two surgeries in the past.

Tsai Tsai, 60~69 year old female. Ask Date: 2023/11/01

Dr. Jiang Junyi reply Neurology

Dear Ms.
Tsai,
You mentioned that "recently my right leg has been weak while walking, and I need to use both hands to pull myself up the stairs.
I also cannot lift my right leg high and have not yet found the cause.
I am currently continuing to see a neurosurgeon and do not rule out issues with my neck or brain, as I have undergone two surgeries on my neck." It may be necessary to consider muscle diseases or spinal cord compression.

Examinations for peripheral nerve issues typically involve electrophysiological studies to assist in diagnosis.
Nerve conduction studies assess the conduction velocity and waveform of large fiber nerves.
Electromyography (EMG) evaluates the muscle response in the areas innervated by the nerves.
I recommend using EMG for diagnosis to rule out muscle pathology.
You may want to visit a neurology clinic for follow-up, specifically seeking a physician with expertise in peripheral nerves, as they have more experience with EMG testing.
Thank you for your inquiry.
If you have any related questions, feel free to discuss further!
Wishing you good health and peace,
Dr.
Jiang Junyi
Department of Neurology, Taoyuan Hospital

Reply Date: 2023/11/01

More Info

Understanding hand and foot numbness can be quite complex, especially when it involves multiple symptoms and potential neurological implications. Based on the symptoms you've described—numbness in the fingers progressing to the palms, and now weakness in the right foot—there are several possible explanations that could be explored.

Firstly, it's important to consider the anatomy and function of the nervous system. Numbness and weakness can arise from various sources, including peripheral nerve issues, spinal cord problems, or even central nervous system conditions. Given that you've already ruled out carpal tunnel syndrome and diabetes, and considering your history of neck surgeries, it may be prudent to investigate further into cervical spine issues.

Cervical Radiculopathy: This condition occurs when a nerve root in the cervical spine is compressed or irritated. Symptoms can include pain, numbness, and weakness that radiates down the arm into the hand. If the compression affects the nerves that innervate the hands, it could explain the numbness you're experiencing. The fact that you have had surgeries on your neck raises the possibility of scar tissue or other complications affecting nerve function.

Cervical Myelopathy: This is a more serious condition that occurs when the spinal cord itself is compressed, often due to degenerative changes in the cervical spine. Symptoms can include not only numbness and weakness in the hands and feet but also balance issues, coordination problems, and difficulty with fine motor skills. Given that you are experiencing weakness in your right foot, this could be a potential concern that warrants further investigation.

Peripheral Neuropathy: While you mentioned that diabetes has been ruled out, other causes of peripheral neuropathy should be considered. This can include vitamin deficiencies (such as B12), exposure to toxins, or autoimmune conditions. A thorough evaluation of your nutritional status and any potential environmental exposures may be beneficial.

Multiple Sclerosis (MS): Although less common, MS is a neurological condition that can cause a wide range of symptoms, including numbness and weakness in various parts of the body. It is characterized by demyelination of the nerves in the central nervous system, which can lead to the symptoms you are experiencing. If other causes are ruled out, this may be something to discuss with your neurologist.

Diagnostic Steps: Given your ongoing symptoms and the impact on your daily life, it is crucial to continue working closely with your neurologist. Additional diagnostic tests may include:
1. MRI of the Cervical Spine: This can help visualize any structural issues that may be compressing the spinal cord or nerve roots.

2. Electromyography (EMG) and Nerve Conduction Studies: These tests can assess the electrical activity of your muscles and the speed of nerve conduction, helping to pinpoint the location and cause of nerve damage.

3. Blood Tests: To check for vitamin deficiencies, autoimmune markers, and other potential causes of neuropathy.

Management: Treatment will depend on the underlying cause of your symptoms. If a cervical issue is identified, options may include physical therapy, medications for pain and inflammation, or potentially further surgical intervention. If peripheral neuropathy is diagnosed, addressing the underlying cause (such as vitamin supplementation) and managing symptoms will be key.

In conclusion, the progression of your symptoms from the hands to the feet suggests a need for a comprehensive neurological evaluation. It is essential to communicate openly with your healthcare providers about your symptoms and concerns, as this will aid in arriving at an accurate diagnosis and effective treatment plan. Your quality of life is paramount, and addressing these neurological issues is crucial for restoring function and comfort in your daily activities.

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