Differential Diagnosis for Bilateral Hand Numbness

Single Most Likely Diagnosis

• Carpal Tunnel Syndrome: This condition is the most common cause of bilateral hand numbness, especially if it affects the thumb, index, and middle fingers. It occurs due to compression of the median nerve at the wrist.

Other Likely Diagnoses

• Peripheral Neuropathy: Conditions such as diabetes, vitamin deficiencies, or alcohol abuse can lead to peripheral neuropathy, causing numbness in the hands.
• Cervical Radiculopathy: Compression or irritation of the nerve roots in the cervical spine can cause numbness in the hands, depending on which nerve roots are affected.
• Thoracic Outlet Syndrome: Compression of the nerves or blood vessels that pass into the thoracic outlet (the space between your collarbone and first rib) can cause numbness in the hands.

Do Not Miss Diagnoses

• Multiple Sclerosis: An autoimmune disease that affects the brain and spinal cord, leading to a wide range of neurological symptoms, including numbness in the hands.
• Spinal Cord Compression: Conditions such as a herniated disk, tumor, or abscess can compress the spinal cord, leading to numbness, weakness, or paralysis.
• Vitamin B12 Deficiency: A deficiency in vitamin B12 can cause neurological symptoms, including numbness or tingling in the hands and feet.

Rare Diagnoses

• Guillain-Barré Syndrome: A rare autoimmune disorder in which the body's immune system mistakenly attacks part of its peripheral nervous system, leading to numbness, weakness, and sometimes paralysis.
• Syringomyelia: A disorder in which a fluid-filled cavity forms within the spinal cord, leading to numbness, weakness, and loss of reflexes.
• Amyloidosis: A group of diseases in which abnormal proteins (amyloid) accumulate in organs and tissues, potentially causing numbness or tingling in the hands and feet.

Each of these diagnoses has a different set of causes and risk factors, and a thorough medical history, physical examination, and diagnostic tests are necessary to determine the underlying cause of bilateral hand numbness.