From the Guidelines
The workup for numbness and tingling should begin with a thorough history and physical examination, including assessment of pinprick sensation, vibration threshold, light touch perception, and ankle reflexes, as recommended by the most recent guidelines 1.
Initial Evaluation
The initial evaluation should focus on determining the pattern, distribution, and associated symptoms of numbness and tingling.
- A thorough medical history should be taken to identify potential causes such as diabetes, vitamin deficiencies, and thyroid disorders.
- Physical examination should include assessment of sensory function, motor strength, and reflexes.
Laboratory Tests
Initial laboratory tests may include:
- Complete blood count
- Comprehensive metabolic panel
- Vitamin B12 and folate levels
- Thyroid function tests
- Hemoglobin A1c to evaluate for diabetes
Additional Tests
Depending on the clinical presentation, additional tests may be considered, such as:
- Erythrocyte sedimentation rate and C-reactive protein to assess for inflammatory conditions
- Antinuclear antibodies, rheumatoid factor, and serum protein electrophoresis to evaluate for autoimmune disorders
- Nerve conduction studies and electromyography to distinguish between peripheral neuropathy, radiculopathy, and other neuromuscular disorders
Imaging Studies
Imaging studies such as MRI of the brain or spine may be necessary if central nervous system pathology is suspected, as recommended by the guidelines 1.
Referral to Neurology
In cases where the etiology remains unclear after initial testing, referral to neurology is appropriate for further evaluation, as suggested by the guidelines 1.
Consideration of Other Causes
Other potential causes of numbness and tingling, such as neurotoxic medications, heavy metal poisoning, and vitamin deficiencies, should also be considered, as noted in the guidelines 1.
From the Research
Workup for Numbness and Tingling
- The workup for numbness and tingling involves a comprehensive history, physical examination, and judicious laboratory testing 2
- A thorough history should include an assessment of medical history, social, economic, and psychological background, as well as an evaluation of current functional state 3
- The physical examination should include a comprehensive neurologic and musculoskeletal evaluation, with special attention to changes that occur with normal aging 3
- Laboratory tests should be selected specifically according to the suspected type of neuropathy to avoid unnecessary tests and expenses 4
- Basic screening tests for neuropathies should include a blood cell count, thyroid, renal and liver function tests, blood glucose levels, HbA1c, vitamin-B12, and immunofixation 4
Diagnostic Considerations
- The differential diagnosis for upper-extremity pain associated with paresthesias can be narrowed with a thorough history, including an assessment of sport-specific risk factors, along with a comprehensive physical examination and functional assessment 5
- Localizing the pathology starts with a comprehensive understanding of neuromuscular anatomy and function 5
- Electrodiagnostics, magnetic resonance imaging, and ultrasound can be used as needed for confirmation and more specific localization 5
- Nonneurologic structures also may be causative or contributory to the patient's symptoms and should be considered 5
Examination Techniques
- The neurological examination in older adults may need to be modified to circumvent disabilities such as hearing and visual impairment 3
- Evaluation of neuropathy includes determining modality (numbness, tingling, pain, and weakness) and the distribution of symptoms in order to localize the site of nerve injury 3
- Nerve conduction studies/electromyography can be used to guide further diagnostic workup and treatment 3