Numbness in my hands - what can I expect at the doctor?
July 20, 2014 4:40 PM   Subscribe

YANMD. I am experiencing my second episode of numbness in my fingers/hands. What kind of tests can I expect when I go to the doctor?

You are not my doctor and I am not looking for medical advice. I am absolutely going to the doctor tomorrow. I have huge anxiety around going to the doctor and I just want to know what kinds of tests I can expect. I don't have a regular doctor so I will be going to an urgent care type of place. They will probably refer me to a neurologist, right?

From roughly the beginning of March to the end of May, the fingertips of my right hand were numb. It started with just the ring and pinky finger and then slowly progressed into the middle and index finger. During this time, I was studying at my desk for 5+ hours every day, so I thought the constant writing/typing and bad posture was screwing with the nerves in my arm. I also had some balance problems and would trip.

It stopped at the end of May and then started up again about a week ago, except now it is the fingers on both of my hands, the side of my left hand and occasionally my abdomen/chest. I have the balance problems again.

I just want to reiterate that I am going to the doctor tomorrow. I am even more terrified now after Google told me all of the horrible diseases I might have. I just want to know what kinds of tests I can expect! Thank you for any advice.
posted by dangerbird to Health & Fitness (15 answers total) 1 user marked this as a favorite
You will no doubt have an electromyograph and nerve conduction velocity study. It may be that a referral to a neurologist will come first, followed by the study.

You will want to ask the neurologist what it might be. You are not likely to get an answer at that point. He or she will tell you you need to have the testing done and then the results can be discussed. This is the hardest part of being a patient. Doctors tend to keep their working diagnoses to themselves until they get some objective data. That is how they work. You will need to accept it.
posted by yclipse at 4:53 PM on July 20, 2014

An urgent care doctor is going to check the basics first: your blood pressure, your reflexes (rubber mallet time !), your inner ears, your pupil and eye reactions.

But of course MS and brain tumors and a dozen other awful things are going to occur to her as well, so that's why you'll probably get a referral to a specialist.

Anecdata: a couple of years ago I started having numbness in my hands and feet, and my doctor started pursuing an MS diagnosis. But while checking my blood pressure he mumbled "mmm, normal" and I objected: "No, Doctor, my blood pressure is dangerously high and has been for years." He checked again. Normal.

Turns out quitting my job had reduced the caffeine and adrenaline my body was accustomed to affecting my blood pressure, and it hadn't adjusted to the new normal yet. Symptoms cleared up in a couple of months.
posted by Kakkerlak at 4:56 PM on July 20, 2014

My assumption is that they will do blood work (if not ask them to) to check things like your blood sugar and vitamin B12 level.
posted by gudrun at 5:01 PM on July 20, 2014

My husband has had similar symptoms for a few years and was referred to a neurologist, he got an MRI. This is particularly relevant for him as both his parents had MS which greatly increases his likelihood of getting it too. Thankfully at this point, the scan is clear. He also has a broken collarbone from an old rugby injury, spends hours at a computer (possible RSI) and fell four (yes, four) floors from a balcony years ago, sustaining multiple injuries, any one of these which could be causing this issue years later. It's a case of just working through it all. He has shoulder surgery coming up. Hopefully it may get to the bottom of it.

Good luck, if you're lucky, it could be something as simple as getting an ergonomic chair. Your doctor will probably start with getting your medical history, do bloodwork, blood pressure etc and take it from there as to what specialist to send you to.
posted by Jubey at 5:03 PM on July 20, 2014

You may only get referred to specialist doctors, who order the actual tests...
posted by TheAdamist at 5:14 PM on July 20, 2014

Try not to worry and catastrophize the whole thing- let your doctor be the expert and help you figure out the issue.

I hope this will help- I had the same symptoms you're having, roughly- fingertip numbness that started in ring fingers and progressed to all fingers, facial numbness (cheeks and lips), and numbness in my neck. With a few changes the symptoms are almost completely gone.

My doctor started by thinking about dietary deficiencies that could be causing numbness, and he did a series of x-rays. His determination was that it was probably just an ergonomic issue as nothing seemed out of the ordinary after the x-rays and blood tests. He had me take Vitamin B supplements anyway and told me to work with the ergonomics of my desk in my office. He also gave me a pain medication in the short term to try to reduce any inflammation in my wrists (I'd been dealing with some tendinitis there too).

I lowered the desk, bought a new chair, and got a new keyboard and mouse. I asked to work from home a bit more often so I would be more free to stand and work, and I asked to take a few more breaks throughout the day to spend less time sitting in front of a screen. The numbness and tingling went away after a little while and have never been back to that degree... in fact, it's been months since I've noticed it.

Yes, you may have a more severe issue, but try to remember that your doctor will help you figure it out. The odds are strongly in favor of you handling this simply by fixing your ergonomics, maybe spending a little less time at the keyboard and more time up on your feet, and maybe taking a medication or supplement to help.

Best wishes with your visit!
posted by Old Man McKay at 5:41 PM on July 20, 2014

A lot of strange responses above. Electromyography is a pretty last-line test and is only used if the diagnosis is not apparent after all the preliminary testing is done. It's the gold standard, but I highly suspect that your doc is going to start out with a simple history and physical, checking for signs of ulnar or median nerve compression using such exam techniques as Tinel's Sign and Phalen's Maneuver. Bloodwork, if any, might focus on electrolyte and nutrient imbalances that might cause neuropathy. Imaging, like electromyography, is usually reserved for cases that can't be definitively diagnosed clinically.

From the Washington Manual of Outpatient Medicine:
Radiographs of the hands and wrists may provide diagnostic information, particularly if arthritis is suspected.
However, definitive changes may not be apparent until the disease has been present for an extended period of time.
In cases of significant trauma, plain films are usually mandatory.

Electrodiagnostic testing (median nerve conduction) is generally thought to be the gold standard for CTS, but false positives and false negatives do occur. Such testing should be considered only when the diagnosis is uncertain or surgical treatment is being considered or in cases of work-related compensation.
Now, Urgent Care may do things differently. You may get a Nurse Practitioner or Physician's Assistant, both of whom are more likely to order imaging and EMG testing than diagnose clinically.
posted by The White Hat at 6:02 PM on July 20, 2014 [1 favorite]

I had EMG for this, but I'm not disagreeing with The White Hat, because in my case surgical treatment was being considered (and indeed, I did have surgery, an ulnar transposition, and it was completely successful.) In my case, the problem was fallout from a years-old elbow injury. (And it was more localized than yours, so it was much clearer what nerve was creating the issue.)

Is there any chance of your seeing a physical therapist, especially an occupational and/or hand therapist? I found those guys extremely useful. And when they said "we can't help you, you probably need surgery," it gave me much more confidence and less fear about going under the knife.
posted by escabeche at 6:15 PM on July 20, 2014

The White Hat - both diabetes and pernicious anemia can cause neuropathy (and pernicious anemia can affect balance), hence blood work to test blood sugar and B12 levels would be indicated to at least rule them out.
posted by gudrun at 6:53 PM on July 20, 2014

I did have surgery, an ulnar transposition, and it was completely successful

This happened to both my sister and my father who were both presenting very similar symptoms to yours as far as the numbness. My sister will still, even post-surgery, get the same weird symptoms if she sits in a funny way or overuses the computer. She has balance problems but they are unrelated to this. So did my father, oddly enough.

Do not be terrified because it will not help. You will likely get some general tests for inner ear problems, nerve problem (pinpricks and strength tests and "can you feel when I touch your hand/arm in this place?" sorts of things) and some questions about stress and anxiety. I trust The White Hat's answer and it does not contradict anything that I've experienced. Come back and tell us how it goes. There is much more of a chance than it is nothing than it is something terrible. The numbers are with you.
posted by jessamyn at 6:58 PM on July 20, 2014

Coming back in to say that yes, now that Jessamyn reminds me, I had

* pinprick (you close your eyes, the doctor touches your finger with a tool that has either one or two pins in it, you try to say whether it's one pin or two, there are tools with successively smaller spacing between the pins so as to give a general measure of your level of sensitivity at the skin surface)

* strength test -- basically a thing with a spring on it that you squeeze in your fist so they can test the strength of your grip.

I definitely did these before going to the EMG. I think it was even a completely different doctor's visit, now that I think of it, because the EMG is administered by a specialist, while the two tests above were done by my GP.

I'm not sure what particular aspects of the doctor visit you have anxiety about, but let me just say that there's no pain involved in either the pinprick test or the strength test. The EMG, they'll warn you, involves some pain, and it does, but I would say it's about the same as somebody socking you in the arm kind of hard. Enough so that you wince and maybe say "Ow" out loud, but not as bad as a bad cramp, not enough to make you cry, etc.

Hope this helps you get ready!
posted by escabeche at 7:23 PM on July 20, 2014

This is a symptom I started having more than a year before my pernicious anemia was diagnosed, and it went away completely after about a month of treatment.

If it'd been caught then I would have avoided a world of misery, so I second gudrun's suggestion of appropriate blood testing.

Your primary care physician might be able to do the necessary test, too; as my partner and I were getting in the car after the appointment everyone in my life had ganged up and forced me to make, we were startled when a side door in the medical building burst open and my diminutive Thai-born physician ran toward us across the parking lot waving a sheaf of papers and shouting "Blood! Blood! You have no blood!" Then when she got to the car she jerked the door out of my hand, knocked me backward into the passenger seat, and demanded we proceed instantly to the ER of the hospital a few blocks away.

I can't promise you that level of concern from your doctor, but if you do have pernicious anemia you'll start feeling better almost immediately.
posted by jamjam at 8:36 PM on July 20, 2014 [3 favorites]

I work in an ER/urgent care setting, and I typically just get basic blood work (electrolytes and blood counts) on people with numbness and tingling.

My guess is that you will either get this basic blood work or no testing whatsoever beyond history and physical exam, and then a referral. If you're getting a referral to a neurologist, don't forget to ask for a referral for a primary care doctor too. You need a primary care doctor who can help you work through this issue, along with a neurologist, and to be able to help you with any other health problems you may develop in the future, to advise you on disease prevention and perform necessary health maintenance like keeping you up to date with your vaccines and screening tests.

Urgent cares don't do tests like EMGs, NCVs, and MRIs. They don't have the capability to do the tests nor to interpret the results. Best of luck getting through tomorrow - try to do something to distract yourself til bedtime.
posted by treehorn+bunny at 9:22 PM on July 20, 2014 [1 favorite]

One thing I would add is that you should get a neurologic exam as part of your regular physical exam - if anything out of the ordinary is found, or if there is anything of further concern in the history, you could get a CT scan of your head - some urgent cares can do these, or they can refer you to an emergency department to have them done.
posted by treehorn+bunny at 9:24 PM on July 20, 2014

I had a situation where I had numbness in my finger, then my hand, and then my entire arm started losing muscle mass. I freaked out.

My doctor, when I first visited him, was pretty concerned, but said, "Usually it's the simplest explanation."

Anyway, it turned out I had carpal tunnel syndrome, and not ALS (like I thought I had). I changed to a standing desk and I recovered.

Now, I have no idea what is causing your problem, but what could be the simplest explanation?
posted by KokuRyu at 7:27 PM on July 30, 2014

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