Questions Your Doctor May Ask - and Why!
During a consultation, your doctor will use various techniques in his assesment of the symptom: Hand paresthesia.
These may include a physical examination or other medical tests.
Your doctor may ask several questions when assessing
your condition. It is important to remember that your consultation is a two-way process and any extra information
you can share with your doctor may help them with their diagnosis.
Some of the questions your doctor may ask are listed below:
- How long have you noticed paresthesia in your hand?
Why: to establish if acute or chronic.
- What areas of the hand are affected by the paresthesia ?
Why: can help determine which nerves are affected e.g. carpal tunnel syndrome causes paresthesia of the pulps of the thumb, index, middle and half of the ring finger; peripheral neuropathy typically causes a glove and stocking sensory loss to hands and feet; C8 spinal cord or nerve root lesion causes paresthesia of the little finger; C7 spinal cord or nerve root lesion cause paresthesia of the middle finger; C6 spinal cord or nerve root lesion causes paresthesia of the outer side of the forearm and thumb.
- Are both hands affected and is it symmetrical?- helps determine which nerves are affected e.g. peripheral neuropathy is symmetrical compared with individual nerve or nerve root disease which should be suspected if sensory loss is asymmetrical or confined to one limb
- Is the arm also affected by the paresthesia?
Why: helps to determine which nerves may be affected.
- Is there a time of day when hand paresthesia is worse?
Why: can help determine the cause of hand paresthesia e.g. carpal tunnel syndrome is usually worse at night.
- Relieving factors?
Why: helps to determine the cause of arm paresthesia e.g. carpal tunnel syndrome symptoms may be relieved by dangling the arm over the side of the bed.
- History of trauma?
Why: e.g. whiplash injury, Brachial plexus injury, finger injury, hand injury.
- Past medical history?
Why: diabetes, chronic renal failure, leukemia, lymphoma, lupus and amyloidosis can be a cause of peripheral neuropathy; causes of carpal tunnel syndrome include hand trauma, rheumatoid arthritis, Acromegaly, amyloidosis, pregnancy, hypothyroidism, Paget's disease, diabetes mellitus and tophaceous gout.
- Dietary history?
Why: e.g. Vitamin B12 deficiency can be a cause of peripheral neuropathy.
- Medications?
Why: some medications can cause peripheral neuropathy e.g. amiodarone, phenytoin, nitrofurantoin, isoniazid, heavy metals.
- Occupational history?
Why: certain occupations requiring repetitive motions are at risk of causing work-induced overuse disorders e.g. process and meat workers are at risk of carpal tunnel syndrome due to rapid finger and wrist movement.
- Sexually transmitted disease history?
Why: Tabes dorsalis of syphilis may be a cause of peripheral neuropathy.
- Alcohol history?
Why: alcohol abuse (with or without vitamin B1 deficiency) can be a cause of peripheral neuropathy.
Questions your doctor may ask about related symptoms:
Sometimes, other symptoms may be present and may help your doctor analyse
your condition. These may include:
- Arm or hand pain?
Why: if also pain in the involved extremity this usually suggests herniated cervical disc , spinal cord tumor or cervical spondylosis. Other conditions to consider are brachial plexus neuropathy, thoracic outlet syndrome, cervical rib, Pancoast's tumor, Raynaud's disease, sympathetic dystrophy or various entrapment syndromes such as carpal tunnel syndrome and ulnar nerve entrapment at the elbow.
- Arm or hand weakness?
Why: may suggest a type of brachial plexus; compression of the C8 segment by cervical spondylosis or a disc herniation, median or ulnar nerve lesions; diabetes mellitus causing a peripheral neuropathy.
- Neck pain?
Why: may suggest a cervical spinal cord or nerve root lesion due to cervical spondylosis (degeneration) or herniated cervical disc.
- Are there any other areas of the body which also are affected by paresthesia ?
Why: e.g. paresthesia of the face may suggest a diagnosis of cerebrovascular disease, a mass in the brain, migraine or multiple sclerosis.
- Headaches?
Why: may suggest migraine or mass in brain.
- Symptoms of stroke?
Why: e.g. weakness of upper limb, increased muscular tone, increased reflexes, occasionally sensory loss.
- Symptoms of multiple sclerosis?
Why: e.g. blurry vision, double vision, dizziness, weakness, paresthesia or tingling in any limbs.
- Symptoms of carpal tunnel syndrome?
Why: e.g. paresthesia or "pins and needles" affecting the pulps of the thumb, index , middle and half of the ring finger. These symptoms are usually noticed after, rather than during, rapid use of the hands. There may also be pain, which may radiate up as far as the shoulder, from the inside of the wrist.
- Symptoms of peripheral neuropathy?
Why: e.g. distal loss of sensation and/or muscle power loss in the hands and feet. A typical sensory loss is a symmetrical glove and stocking loss to all sensation.
- Symptoms of hyperventilation?
Why: usually associated with anxiety e.g. lightheadedness, faintness, dizziness, breathlessness, palpitations, sweating, dry mouth, agitation, fatigue, paresthesia of the hands, feet or mouth.
» Next page: Types of Hand paresthesia
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