What is Numbness in the Limbs?
Numbness in the limbs is a symptom caused by abnormalities in sensory nerves, and can manifest in various ways such as tingling, buzzing, reduced sensation, or loss of sensation. The causes are diverse, including peripheral nerves, spinal cord, brain, and systemic diseases, some of which, such as stroke and acute neurological disorders, require urgent medical attention.
At our clinic, as an internal medicine department, we evaluate numbness stemming from systemic diseases such as diabetic neuropathy, vitamin deficiency, and thyroid dysfunction, and refer patients to orthopedics or neurology as needed.
Numbness requiring urgent medical attention
Sudden numbness and weakness on one side of the face or limbs, slurred speech, or visual disturbances may indicate a stroke. Do not hesitate to call for emergency services (#7119 or 119). The speed of initiating treatment greatly affects the prognosis.
Types of Numbness
| Type | Characteristics |
|---|---|
| Paresthesia (tingling, buzzing) | Tingling sensation upon touch, nerve hypersensitivity |
| Hypoesthesia | Dull sensation to touch, like after sitting cross-legged |
| Anesthesia | Complete loss of sensation |
| Accompanied by motor dysfunction | Paralysis/weakness (high urgency) |
| Accompanied by pain | Burning or electric shock-like pain |
Diseases Suspected by Location
Numbness in Both Hands and Feet / Systemic Numbness
| Disease | Characteristics |
|---|---|
| Diabetic Peripheral Neuropathy | Ascends from both feet, stocking-glove distribution |
| Vitamin B12 / Folate Deficiency | Numbness in limbs + megaloblastic anemia |
| Alcoholic Neuropathy | Chronic drinkers, predominantly in both lower limbs |
| Drug-induced Neuropathy | Side effects of anticancer drugs, tuberculosis medications, etc. |
| Guillain-Barré Syndrome | Acute progression, ascends from both lower limbs, urgent |
| Hypothyroidism | Generalized swelling, fatigue, numbness |
| Uremic Neuropathy | End-stage chronic kidney disease |
Unilateral Numbness
| Disease | Characteristics |
|---|---|
| Stroke (Cerebral Infarction / Hemorrhage) | Acute onset, unilateral paralysis, speech disorder, urgent |
| Transient Ischemic Attack (TIA) | Temporary, resolves within 24 hours, requires detailed examination |
| Aura of Hemiplegic Migraine | Visual disturbance + numbness, before headache attack |
| Cervical Spondylotic Radiculopathy | Worsens with neck movement, arm numbness |
| Lumbar Herniated Disc / Spinal Stenosis | Radiating leg pain, sciatica |
| Thoracic Outlet Syndrome | Numbness when raising the arm |
Numbness Only in the Hands
| Disease | Characteristics |
|---|---|
| Carpal Tunnel Syndrome | Numbness in thumb to middle finger at night/morning, common in pregnant women/menopausal women |
| Cubital Tunnel Syndrome | Numbness on the little finger side, worsens with elbow flexion |
| Cervical Spondylotic Radiculopathy | Worsens with neck movement, dermatomal distribution |
| Raynaud's Syndrome | Color change in fingers + numbness in cold conditions |
Numbness Only in the Feet
| Disease | Characteristics |
|---|---|
| Lumbar Spinal Stenosis | Intermittent claudication, worsens with walking, improves with leaning forward |
| Lumbar Disc Herniation | Sciatica, worsens with coughing/sneezing |
| Peripheral Artery Disease (PAD) | Calf pain/cold sensation when walking |
| Restless Legs Syndrome | Unpleasant leg sensations/urge to move legs at bedtime |
| Tarsal Tunnel Syndrome | Numbness in the sole of the foot |
About Diabetic Neuropathy
This is the most frequent complication of diabetes, characterized by numbness and reduced sensation starting from both feet. If left untreated, it can lead to foot ulcers and gangrene.
Characteristics
- Stocking-glove distribution: Starts from both feet and gradually ascends
- Symmetrical
- Often worsens at night
- Reduced sensation makes it difficult to notice burns/cuts (cause of foot lesions)
- May also be complicated by autonomic neuropathy
Treatment
- Blood sugar control is paramount (HbA1c target below 7.0%)
- Neuropathic pain medications: Pregabalin, Mirogabalin, Duloxetine
- Vitamin B12 (Mecobalamin)
- Aldose reductase inhibitor (Epalrestat)
- Foot care (daily foot observation)
Vitamin B12 Deficiency
- Deficiency common in elderly, post-gastrectomy patients, vegetarians, H. pylori infection, autoimmune gastritis (pernicious anemia)
- Numbness in limbs + anemia symptoms, glossitis, gait disturbance
- Confirmed by blood tests
- Treatment: Oral/injectable Mecobalamin
- Early treatment improves symptoms, but irreversible changes can occur if left untreated
Carpal Tunnel Syndrome
Characteristics
- Median nerve is compressed in the wrist canal
- Numbness in the thumb to middle finger at night/morning is characteristic
- Shaking hands provides relief
- Severe cases lead to thenar muscle atrophy and difficulty with pincer grasp
- Common in pregnant women, menopausal women, and dialysis patients
Treatment
- Wrist rest and nocturnal splinting
- Vitamin B12
- Local steroid injection (orthopedics)
- Surgery for severe cases (carpal tunnel release)
Numbness Suggesting Stroke
FAST assessment for early detection
Face (facial asymmetry), Arm (inability to raise one arm), Speech (slurred speech), Time (record onset time) – if even one applies, call for emergency services immediately. tPA treatment is possible within 4.5 hours of onset.
- Sudden numbness on one side of the limbs or face
- Slurred speech or difficulty speaking
- Loss of vision in one eye
- Dizziness, unsteadiness, difficulty walking
- Accompanied by severe headache
- Clouding or loss of consciousness
- Dysphagia, difficulty swallowing
Examination and Tests
Key Points for Interview
- Onset time, duration, progression speed
- Location, extent, and distribution of numbness
- Associated symptoms (weakness, pain, headache, visual disturbance)
- Provoking/aggravating factors (posture, time of day, movement)
- Medical history (diabetes, hypertension, heart disease)
- Current medications/supplements
- Alcohol/smoking history
Tests Available at Our Clinic
| Test | Purpose |
|---|---|
| Neurological Examination | Assessment of sensation, motor function, reflexes |
| Blood Test (Blood Glucose, HbA1c) | Assessment of diabetic neuropathy |
| Vitamin B12, Folate | Nutritional deficiency neuropathy |
| Thyroid Function (TSH, FT4) | Exclusion of thyroid disorders |
| Liver and Kidney Function | Metabolic neuropathy |
| Blood Pressure, ABI (Ankle-Brachial Index) | Peripheral artery disease |
| Electrocardiogram (ECG) | Arrhythmia (stroke risk) |
When Referral to a Specialist is Necessary
- Acute unilateral numbness: Neurology/Neurosurgery (urgent)
- Cervical/lumbar origin: Orthopedics (MRI, nerve conduction studies)
- Requires nerve conduction studies: Neurology
- Requires MRI/CT: Imaging diagnostic facility
- Carpal tunnel syndrome: Orthopedics/Hand surgery
Treatment Options
Treatment of Underlying Disease
- Diabetes: Blood sugar control is paramount
- Vitamin Deficiency: Supplementation therapy
- Thyroid Disease: Hormone replacement/Antithyroid drugs
- Herniated Disc/Spinal Stenosis: Conservative treatment/Surgery
- Carpal Tunnel Syndrome: Splinting/Steroid injections/Surgery
- Stroke: Acute phase treatment/Prevention of recurrence
Pharmacotherapy for Numbness
| Drug | Indication |
|---|---|
| Pregabalin (Lyrica) | Diabetic, postherpetic neuralgia, spinal origin |
| Mirogabalin (Tarlige) | Peripheral neuropathic pain |
| Duloxetine (Cymbalta) | Diabetic neuropathy, chronic pain |
| Mecobalamin (Methycobal) | Vitamin B12 deficiency, peripheral neuropathy |
| Tricyclic Antidepressants (Amitriptyline) | Chronic neuropathic pain |
| Herbal Medicine (Goshajinkigan, Shakuyakukanzoto) | Lower limb numbness, coldness, elderly |
Self-Care
Lifestyle Habits
- Appropriate management of diabetes, hypertension, dyslipidemia
- Smoking cessation (worsens peripheral circulation)
- Reduced alcohol consumption (neurotoxicity)
- Moderate exercise (improves peripheral circulation)
- Balanced diet (B vitamins)
- Adequate sleep
- Avoid prolonged static postures
Foot Care for Diabetics
- Daily foot observation (skin condition, wounds, athlete's foot)
- Avoid cutting nails too short
- Appropriate footwear (avoid pressure/chafing)
- Avoid going barefoot
- Beware of low-temperature burns from heating appliances
- Early treatment of athlete's foot
- Seek medical attention promptly if abnormalities are noticed
For Carpal Tunnel Syndrome Patients
- Nocturnal splinting (keep wrist straight and fixed)
- Avoid overuse of hands
- Wrist stretches
- Posture during computer work
Characteristics of Our Clinic's Numbness Treatment
- As an internal medicine department, exclusion of systemic diseases (diabetes, thyroid, vitamin deficiency, etc.)
- Blood tests, ECG, and ABI available on the same day
- Prescription of neuropathic pain medications (Pregabalin, Mirogabalin, Duloxetine)
- Oral/injectable Vitamin B12 available
- Blood sugar control for diabetic neuropathy + symptomatic treatment
- Referral to orthopedics for cervical/lumbar origins (MRI, nerve block)
- Prompt referral to neurology if stroke is suspected
- No appointment necessary, walk-ins welcome / Open daily from 9 AM to 9 PM / 1-minute walk from Jujo Station
Do Not Underestimate Numbness
Numbness is an important signal from your body. While some causes can be significantly improved with early treatment, other conditions may become difficult to recover from if left untreated. Please feel free to consult us if you have any concerning numbness.
