From the Guidelines
The initial evaluation of a patient with extremity numbness should begin with a thorough history and physical examination, including a comprehensive foot evaluation at least annually to identify risk factors for ulcers and amputations, as recommended by the most recent guidelines 1. The evaluation should assess the pattern of numbness (symmetric vs. asymmetric), onset (sudden vs. gradual), associated symptoms (weakness, pain), and risk factors (diabetes, alcohol use, medications). The neurological examination should include:
- Sensory testing
- Motor strength
- Deep tendon reflexes
- Coordination Basic laboratory tests are often warranted, including:
- Complete blood count
- Comprehensive metabolic panel
- Vitamin B12
- Folate
- Thyroid function
- HbA1c Depending on clinical suspicion, additional tests may include:
- Nerve conduction studies
- Electromyography
- MRI of the spine or brain
- Specialized blood tests for inflammatory or autoimmune conditions Treatment depends on the underlying cause, and for diabetic neuropathy, glycemic control and medications like gabapentin, pregabalin, or duloxetine may be used, as suggested by recent standards of care 1. While awaiting diagnosis, symptomatic treatment with neuropathic pain medications and physical therapy can help manage discomfort. Patients should be educated about:
- Protecting numb areas from injury
- Monitoring for worsening symptoms that might require urgent evaluation, such as rapidly ascending numbness or associated bladder/bowel dysfunction A multidisciplinary approach is recommended for individuals with foot ulcers and high-risk feet, and patients who smoke or have histories of prior lower-extremity complications, loss of protective sensation, structural abnormalities, or peripheral arterial disease should be referred to foot care specialists for ongoing preventive care and lifelong surveillance 1.
From the Research
Initial Evaluation
The initial evaluation for a patient presenting with numbness in the extremities involves a thorough medical history and physical examination to determine the underlying cause of the numbness.
- The patient's medical history should be reviewed to identify any pre-existing conditions that may be contributing to the numbness, such as multiple sclerosis (MS) or a previous stroke 2.
- A physical examination should be performed to assess the patient's neurological function, including sensation, strength, and reflexes.
- Imaging studies, such as MRI, may be ordered to rule out any structural abnormalities, such as spinal cord compression or lesions, that may be causing the numbness 3, 4.
Treatment Approach
The treatment approach for numbness in the extremities depends on the underlying cause of the numbness.
- If the numbness is due to MS, treatment may involve disease-modifying therapies, such as medications to reduce inflammation and slow disease progression 4.
- If the numbness is due to spinal cord compression, treatment may involve decompression surgery to relieve pressure on the spinal cord 5.
- If the numbness is due to vascular disease, treatment may involve medications to reduce the risk of further vascular events, such as antiplatelet agents or anticoagulants 6.
- A multidisciplinary approach, including pharmacological and non-pharmacological treatments, may be necessary to manage the patient's symptoms and improve functional outcomes 2.