Persistent Hand Numbness: Seeking Answers After 4 Months of Symptoms

Numbness in both hands for the past four months?

Hello doctor, I have been experiencing numbness in my hands since the beginning of September.
Initially, it was only in my right hand, but within a week, my left hand started to feel numb as well.
The numbness has not ceased, causing significant inconvenience in my daily life.
I have recently undergone nerve conduction studies and a brain CT scan, both of which returned normal results.
I am currently awaiting the results of an EEG.
The numbness has worsened, accompanied by a strange sensation like electric currents, difficulty buttoning clothes, inability to grasp small objects, and frequent dropping of items.
Many fine motor skills are affected, and the more I move my hands, the more numb they become, especially when raised.
I also have trouble aligning my fingers.
What additional tests can I undergo to identify the underlying cause? Thank you.

Yan, 20~29 year old female. Ask Date: 2015/12/10

Dr. Gao Chunde reply Neurology

When experiencing hand numbness, it is important to determine whether the distribution of symptoms falls within the peripheral nerve range, nerve roots, or central nervous system.
Particularly, if nerve conduction studies are normal, carpal tunnel syndrome is almost ruled out.
Symptoms occurring in both hands generally suggest a spinal issue, especially in the cervical spine, while involvement of the brain is less common, though possible, and the cerebellum may also be implicated.
If the cerebellum is involved, diagnostic imaging may be less effective.
The physician who is directly evaluating you will have the clearest understanding of your situation, so it is essential to attend follow-up appointments regularly to identify the problem and pursue treatment.

Reply Date: 2015/12/10

More Info

Persistent hand numbness can be a frustrating and debilitating condition, especially when it affects your daily activities and quality of life. Given that you have experienced these symptoms for over four months, it is essential to explore various potential causes and diagnostic avenues to identify the underlying issue.

Based on your description, the numbness began in your right hand and subsequently affected your left hand. The symptoms you report, including a sensation of electric shocks, difficulty with fine motor skills, and increased numbness with movement (especially when raising your hands), suggest that there may be a neurological component to your condition. The fact that you have already undergone nerve conduction studies and a CT scan of the brain, both of which returned normal results, is a good start, but further investigation may be necessary.

Here are some potential avenues for further evaluation:
1. MRI of the Cervical Spine: Given that your symptoms are bilateral and involve numbness and motor difficulties, it is crucial to assess the cervical spine for any signs of nerve compression, such as herniated discs or spinal stenosis. An MRI can provide detailed images of the spinal cord and surrounding structures, helping to identify any potential sources of nerve irritation.

2. Electromyography (EMG): While nerve conduction studies assess the speed and strength of electrical signals in the nerves, an EMG can evaluate the electrical activity of muscles. This test can help determine if there is any muscle damage or nerve dysfunction that may not have been evident in the initial tests.

3. Ultrasound of the Peripheral Nerves: This imaging technique can help visualize the peripheral nerves in your arms and hands, allowing for the detection of any abnormalities such as nerve entrapments (e.g., carpal tunnel syndrome or cubital tunnel syndrome).

4. Blood Tests: Certain systemic conditions, such as diabetes, vitamin deficiencies (especially B12), thyroid disorders, and autoimmune diseases, can lead to peripheral neuropathy and numbness. Comprehensive blood work can help rule out these conditions.

5. Consultation with a Neurologist: If you haven't already, consider seeking a second opinion from a neurologist who specializes in peripheral nerve disorders. They may have additional insights or recommend further specialized tests based on your symptoms.

6. Physical Therapy: While this may not directly diagnose the issue, engaging in physical therapy can help improve your hand function and potentially alleviate some symptoms. A physical therapist can provide exercises to enhance strength and coordination, which may help with your fine motor skills.

7. Lifestyle Modifications: In the meantime, consider modifying activities that exacerbate your symptoms. For instance, if certain positions or movements worsen the numbness, try to avoid them or find alternative ways to perform tasks.

8. Follow-Up on Brain Wave Testing: Once you receive the results from your EEG (electroencephalogram), it may provide additional information about any neurological issues that could be contributing to your symptoms.

In conclusion, persistent hand numbness can arise from various causes, including nerve compression, systemic conditions, or even central nervous system issues. Given the complexity of your symptoms and the duration of your condition, it is crucial to continue working closely with your healthcare providers to explore these diagnostic options. Early identification of the underlying cause can lead to more effective treatment strategies and ultimately improve your quality of life.

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