Weakness in Hands and Feet: Causes and Solutions

Weakness in the limbs?

Hello, I have been troubled by a long-standing issue where my hands and feet often feel weak.
Sometimes, I even struggle to lift my hands to brush my teeth, and when I walk up stairs, it can get so severe that I end up kneeling down.
I have low blood pressure and previously underwent nerve conduction studies at the hospital, which showed normal results.
I also consulted a traditional Chinese medicine practitioner who mentioned that my pulse was weak, and I have been drinking Si Wu Tang for over two weeks, but it doesn't seem to have any effect.
Last week, I had my blood pressure measured, and it was reported to be quite low.
I would like to know which specialty I should consult to determine what the problem might be.
Thank you!

Hei Gua, 20~29 year old female. Ask Date: 2005/05/21

Dr. Xiao Yongxun reply Internal Medicine

Hello, in response to your question.
The complaint of "weakness in the limbs" is common in clinical practice; however, due to the subjective nature of the experience, which varies from person to person, and the multitude of potential causes that lack specificity, it can be challenging to diagnose.
Here are some differential diagnoses to consider:
1.
Mental health disorders: such as depression and chronic anxiety disorder.

2.
Endocrine disorders: such as hyperthyroidism, adrenal insufficiency, pituitary dysfunction, diabetes, and hypercalcemia.

3.
Metabolic issues: such as chronic kidney failure and liver failure.

4.
Infectious diseases: such as tuberculosis, HIV/AIDS, Lyme disease, viral infections, and endocarditis.

5.
Cardiopulmonary diseases: such as congestive heart failure and sleep apnea.

6.
Hematological malignancies: such as anemia and tumors.

7.
Neuromuscular disorders: such as myasthenia gravis and multiple sclerosis.

8.
Autoimmune diseases: such as rheumatoid arthritis and systemic lupus erythematosus.

Given the numerous factors to consider, please discuss this with your family physician or internist before making any decisions.

Reply Date: 2005/05/21

More Info

The symptoms you are experiencing, such as weakness in your hands and feet, difficulty lifting your arms, and feeling like your legs give out when walking up stairs, can be quite concerning. Given your history of low blood pressure and previous normal nerve conduction studies, it is essential to explore several potential causes for your symptoms.

1. Neuromuscular Disorders: Conditions like myasthenia gravis or muscular dystrophy can lead to muscle weakness. Myasthenia gravis, for instance, is an autoimmune disorder that affects the communication between nerves and muscles, leading to weakness that worsens with activity and improves with rest. A neurologist can perform specific tests, including antibody tests and possibly a CT scan of the chest, to rule out these conditions.

2. Peripheral Neuropathy: Although your nerve conduction studies were normal, peripheral neuropathy can still occur due to various reasons, including diabetes, vitamin deficiencies (especially B12), or thyroid dysfunction. A thorough evaluation of your nutritional status and thyroid function may be warranted.

3. Circulatory Issues: Given your low blood pressure, it’s possible that inadequate blood flow could be contributing to your symptoms. Orthostatic hypotension, where blood pressure drops significantly upon standing, can lead to weakness and dizziness. A cardiologist can evaluate your heart function and circulation to rule out any underlying cardiovascular issues.

4. Muscle Fatigue: Chronic fatigue syndrome or fibromyalgia could also be considered, especially if you experience widespread pain or fatigue. These conditions often require a multidisciplinary approach for management, including physical therapy, lifestyle changes, and sometimes medications.

5. Psychological Factors: Anxiety and stress can manifest physically, leading to feelings of weakness and fatigue. If you find yourself feeling anxious about your health, it may be beneficial to speak with a mental health professional who can help you manage these feelings.

6. Consultation Recommendations: Given your symptoms and history, I recommend starting with a visit to a neurologist to rule out any neuromuscular disorders. If they find no issues, a referral to a cardiologist to assess your blood pressure and circulation would be the next step. Additionally, consider discussing your symptoms with a primary care physician who can coordinate care and possibly refer you to other specialists as needed.

7. Lifestyle Modifications: In the meantime, consider lifestyle changes that may help manage your symptoms. Staying hydrated, eating a balanced diet rich in vitamins and minerals, and incorporating gentle exercise can improve overall muscle strength and circulation. Physical therapy may also be beneficial in developing a tailored exercise program that focuses on strengthening your muscles without overexerting them.

8. Monitoring Symptoms: Keep a detailed log of your symptoms, including when they occur, their severity, and any potential triggers. This information can be invaluable for your healthcare providers in diagnosing and managing your condition effectively.

In conclusion, while your symptoms are concerning, there are multiple avenues to explore for diagnosis and treatment. A multidisciplinary approach involving neurologists, cardiologists, and possibly other specialists will provide the best chance of identifying the underlying cause of your weakness and developing an effective treatment plan. Remember, it’s essential to advocate for your health and seek the care you need to improve your quality of life.

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