From the Guidelines
Paresthesia in both upper limbs should be promptly evaluated by a healthcare provider to determine the underlying cause and appropriate treatment, as it may indicate neurological issues that can impact morbidity, mortality, and quality of life. The symptoms of paresthesia, such as tingling, numbness, or burning, can be caused by various factors, including nerve compression, cervical spine issues, peripheral neuropathy, vitamin deficiencies (particularly B12), or systemic conditions like diabetes or autoimmune disorders 1.
Common Causes and Treatment
Some common causes of paresthesia in both upper limbs include:
- Nerve compression (like carpal tunnel syndrome)
- Cervical spine issues
- Peripheral neuropathy
- Vitamin deficiencies (particularly B12)
- Systemic conditions like diabetes or autoimmune disorders
Treatment depends on the underlying cause and may include:
- Physical therapy
- Wrist splints for carpal tunnel syndrome
- Medication for pain management (such as gabapentin 300-900 mg daily or amitriptyline 10-25 mg at bedtime)
- Vitamin supplementation if deficient
- Addressing any underlying medical condition
Importance of Prompt Evaluation
It is essential to consult a healthcare provider promptly for proper evaluation, as self-diagnosis or treatment is not advisable for this condition. The physician will likely perform a neurological examination and may order tests such as nerve conduction studies, MRI, or blood work to determine the cause. While awaiting medical attention, it is recommended to avoid prolonged positions that worsen symptoms, take breaks from repetitive hand movements, and maintain good posture.
Potential Consequences of Delayed Treatment
Delayed treatment or misdiagnosis can lead to further complications, such as increased morbidity, mortality, and decreased quality of life. Therefore, it is crucial to prioritize prompt evaluation and treatment to address the underlying cause of paresthesia in both upper limbs. According to recent studies, early intervention can significantly improve outcomes and reduce the risk of long-term damage 1.
Recent Studies and Guidelines
Recent studies and guidelines emphasize the importance of prompt evaluation and treatment of paresthesia, particularly in patients with underlying medical conditions or those who are at risk of developing peripheral neuropathy 1. By prioritizing prompt evaluation and treatment, healthcare providers can help improve outcomes and reduce the risk of complications associated with paresthesia in both upper limbs.
From the Research
Causes of Paresthesia in Upper Limbs
- Paresthesias may be caused by central or peripheral nervous system abnormalities 2
- Peripherally induced paresthesias can be caused by entrapment syndromes, metabolic disturbances, trauma, inflammation, connective tissue diseases, toxins, hereditary conditions, malignancies, nutritional deficiencies and miscellaneous conditions 2
- Entrapment of peripheral nerves can occur as they travel through restrictive spaces, resulting in a constellation of signs and symptoms, including pain, paraesthesia and numbness 3
Diagnosis of Paresthesia in Upper Limbs
- Diagnosis is mainly based on history and examination 3
- Further investigations are available for atypical presentations 3
- Accurate and appropriate treatment depends on differential assessment based on sound clinical reasoning 4
- Nerve conduction studies may be necessary to diagnose peripheral neuropathy, but they may also be normal with small fibre neuropathy 5
Treatment of Paresthesia in Upper Limbs
- Treatment is based on the relevant diagnosis and mechanism to address the cause 5
- This includes better glycaemic control for diabetes, night splint for CTS or elbow padding for ulnar neuropathy, modifying lifestyle with reduced alcohol consumption or replacing dietary deficiencies or changing medications where appropriate and practical 5
- Pregabalin has beneficial effects on some symptoms of neuropathic pain, but its use significantly increases the risk of a number of adverse events and discontinuation due to adverse events 6
- Activity modification followed by steroid injection and finally surgical decompression for ongoing persistent symptoms or severe initial presentation may be used to treat peripheral nerve entrapments 3