ANKLE PAIN
CARPAL TUNNEL SYNDROME
CHRONIC PAIN
ELBOW PAIN
HIP PAIN
IMPAIRMENT & DISABILITY
KNEE PAIN
MUSCLE WEAKNESS
MYOFASCIAL PAIN
NECK & LOW BACK PAIN
NUMBNESS
SHOULDER PAIN
WRIST PAIN
BIOGRAPHY
REFERALS
Spence Rehabilitation Center
1650 45th Ave. Suite 2C
Munster, IN 46321
Visit our Porter County location!
1620 Country Club Rd. Ste E
Valparaiso, IN 46383
Phone : (219) 513-2267
 
     
 
What are potential causes of numbness affecting
part of one extremity?
 
1. Mononeuropathies:
Typically caused by compression of a single nerve in
the extremity. For example, carpal tunnel syndrome
is compression of the median nerve at the wrist.
2. Radiculopathies:
Pinched nerve roots at the spine due to herniated discs
or arthritis of the spine.
 
What are potential causes of numbness affecting
both sides of the body?
 
1. Polyneuropathy:
Disease that affects most nerves in extremities.
Polyneuropathies can be caused by systemic diseases,
drugs, or toxins. It typically affects the hands and feet
first in a Stocking-Glove distribution.
2. Spinal cord disease:
Can cause sensory loss of everything below a certain
level of the body.
3. Disease of the Brain and Brainstem:
Typically causes sensory loss affecting one side of the
body.
 
 
Why are Nerve Conduction Studies and EMG useful
to assess numbness?
 
1. Does the disease affect the peripheral nervous
system:
If so, the EMG and Nerve Conduction Studies Should
show abnormalities. If the EMG and NCS are normal,
the brain and spinal cord should be the suspected
culprit.
2. Where in the peripheral nervous system is the
diseased nerve?
Is there a compressed nerve root at the spine or is
there compression lower at the wrist or shoulder?
Different nerves will be affected depending on the
location of the compression.
3. How severe is the damage?
Mild disease may only affect the insulation around
the nerves (myelin) resulting in slowing of the nerve
impulse while more severe disease can result in
nerve death.
4. How long has the nerve disease been present?
The duration of disease can be determined by looking
for characteristic waveforms on the EMG.
 
 
What tests can be used to determine the cause of
numbness?
 
1. History and physical exam:
To look for family history of numbness, exposure to
toxins, and look for signs of disease.
2. Laboratory studies:
To look for inflammatory disorders, hormone
deficiencies, or vitamin deficiencies.
3. MRI of the brain and/or spinal cord:
To look for tumors, infections, strokes.
4. Electrodiagnostic studies( EMG and NCS):
If the disease originates in the peripheral nervous
system, the EMG and/or NCS studies are usually
abnormal. However, if the disease is affecting the
central nervous system (brain and spinal cord), the
EMG/NCS studies are usually normal.
5. Nerve biopsy:
A small portion of a nerve is removed and sent to a
pathologist who looks for abnormalities.
 
What are some important laboratory studies used
to evaluate numbness?
 
1. Complete blood count, erythrocyte
sedimentation rate (ESR), antinuclear antibody
(ANA):
Can be used to look for inflammatory disorders and
infection.
2. Thyroid stimulating hormone (TSH):
A test used to look for thyroid disorders.
3. Serum protein electrophoresis (SPEP):
Looks for a rare cancer that can lead to numbness.
4. Blood glucose:
Checks for diabetes which is a common cause of
peripheral neuropathy.
5. Vitamin B12 concentration:
Deficiencies can result in neuropathy.
6. Urinalysis
 
 
How is numbness treated?
 
1. Treatment of the underlying process:
Limit the exposure to alcohol or toxins, provide thyroid
hormone and vitamin deficiency supplementation if
indicated. If diabetes is the culprit, ensure tight
glucose control keeping your HgBA1C less than 7 is
ideal to maintain nerve function.
2. In patients with idiopathic CIDP or CIDP secondary
to a monoclonal gammopathy of undetermined
significance, corticosteroids, intravenous immune
globulin, plasmapheresis, and other
immunosuppressant drugs are all effective.
 
What are some effective treatments for pain
resulting from Neuropathy?
 
1. Gabapentin:
Also known as neurontin is typically used at 100 to
300mg three times a day and gradually increased
up to a total daily dose of 4000mg.
2. Tricyclic antidepressants and SNRIs:
Examples include amitriptylene, cymbalta, and effexor.
3. Other medication that can be tried:
Carbamazepine, phenytoin, topiramate, baclofen,
mexiletine, and dextromethorphan.
4. Tramadol, NSAIDs, or low-dose narcotics:
May be necessary in some patients for occasional
"breakthrough pain."
5. Physical therapy:
Should be used if the patient has difficulty walking due
to poor balance or weakness. ankle-foot orthoses,
splints, and walking assistance devices can also help.
 
     
     
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