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| Spence Rehabilitation Center |
| 9305 Calumet Ave. Suite C-1 |
| Munster, IN 46321 |
| Phone |
: (219) 513-2267 |
| Fax |
: (219) 836-1276 |
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What are potential causes of numbness affecting |
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part of one extremity? |
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| 1. |
Mononeuropathies: |
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Typically caused by compression of a single nerve in |
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the extremity. For example, carpal tunnel syndrome |
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is compression of the median nerve at the wrist. |
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| 2. |
Radiculopathies: |
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Pinched nerve roots at the spine due to herniated discs |
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or arthritis of the spine. |
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What are potential causes of numbness affecting |
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both sides of the body? |
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| 1. |
Polyneuropathy: |
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Disease that affects most nerves in extremities. |
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Polyneuropathies can be caused by systemic diseases, |
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drugs, or toxins. It typically affects the hands and feet |
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first in a Stocking-Glove distribution. |
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| 2. |
Spinal cord disease: |
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Can cause sensory loss of everything below a certain |
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level of the body. |
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| 3. |
Disease of the Brain and Brainstem: |
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Typically causes sensory loss affecting one side of the |
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body. |
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Why are Nerve Conduction Studies and EMG useful |
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to assess numbness? |
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| 1. |
Does the disease affect the peripheral nervous |
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system: |
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If so, the EMG and Nerve Conduction Studies Should |
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show abnormalities. If the EMG and NCS are normal, |
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the brain and spinal cord should be the suspected |
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culprit. |
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| 2. |
Where in the peripheral nervous system is the |
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diseased nerve? |
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Is there a compressed nerve root at the spine or is |
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there compression lower at the wrist or shoulder? |
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Different nerves will be affected depending on the |
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location of the compression. |
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| 3. |
How severe is the damage? |
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Mild disease may only affect the insulation around |
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the nerves (myelin) resulting in slowing of the nerve |
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impulse while more severe disease can result in |
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nerve death. |
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| 4. |
How long has the nerve disease been present? |
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The duration of disease can be determined by looking |
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for characteristic waveforms on the EMG. |
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What tests can be used to determine the cause of |
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numbness? |
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| 1. |
History and physical exam: |
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To look for family history of numbness, exposure to |
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toxins, and look for signs of disease. |
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| 2. |
Laboratory studies: |
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To look for inflammatory disorders, hormone |
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deficiencies, or vitamin deficiencies. |
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| 3. |
MRI of the brain and/or spinal cord: |
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To look for tumors, infections, strokes. |
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| 4. |
Electrodiagnostic studies( EMG and NCS): |
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If the disease originates in the peripheral nervous |
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system, the EMG and/or NCS studies are usually |
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abnormal. However, if the disease is affecting the |
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central nervous system (brain and spinal cord), the |
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EMG/NCS studies are usually normal. |
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| 5. |
Nerve biopsy: |
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A small portion of a nerve is removed and sent to a |
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pathologist who looks for abnormalities. |
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What are some important laboratory studies used |
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to evaluate numbness? |
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| 1. |
Complete blood count, erythrocyte |
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sedimentation rate (ESR), antinuclear antibody |
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(ANA): |
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Can be used to look for inflammatory disorders and |
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infection. |
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| 2. |
Thyroid stimulating hormone (TSH): |
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A test used to look for thyroid disorders. |
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| 3. |
Serum protein electrophoresis (SPEP): |
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Looks for a rare cancer that can lead to numbness. |
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| 4. |
Blood glucose: |
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Checks for diabetes which is a common cause of |
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peripheral neuropathy. |
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| 5. |
Vitamin B12 concentration: |
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Deficiencies can result in neuropathy. |
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| 6. |
Urinalysis |
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How is numbness treated? |
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| 1. |
Treatment of the underlying process: |
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Limit the exposure to alcohol or toxins, provide thyroid |
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hormone and vitamin deficiency supplementation if |
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indicated. If diabetes is the culprit, ensure tight |
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glucose control keeping your HgBA1C less than 7 is |
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ideal to maintain nerve function. |
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| 2. |
In patients with idiopathic CIDP or CIDP secondary |
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to
a monoclonal gammopathy of undetermined |
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significance, corticosteroids, intravenous immune |
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globulin, plasmapheresis, and other |
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immunosuppressant drugs are all effective. |
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What are some effective treatments for pain |
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resulting from Neuropathy? |
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| 1. |
Gabapentin: |
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Also known as neurontin is typically used at 100 to |
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300mg three times a day and gradually increased |
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up to a total daily dose of 4000mg. |
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| 2. |
Tricyclic antidepressants and SNRIs: |
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Examples include amitriptylene, cymbalta, and effexor. |
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| 3. |
Other medication that can be tried: |
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Carbamazepine, phenytoin, topiramate, baclofen, |
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mexiletine, and dextromethorphan. |
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| 4. |
Tramadol, NSAIDs, or low-dose narcotics: |
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May be necessary in some patients for occasional |
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"breakthrough pain." |
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| 5. |
Physical therapy: |
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Should be used if the patient has difficulty walking due |
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to poor balance or weakness. ankle-foot orthoses, |
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splints, and walking assistance devices can also help. |
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