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DIFFERENTIAL DIAGNOSIS:
NUMBNESS & TINGLING
SOME EXAMPLES OF DIFFERENTIAL DX
ALONG WITH QUESTIONS TO ASK THE PATIENT
-
Peripheral Neuropathy:
- Do you have a history of diabetes?
- If YES, what and when was your last A1c?
- Is it bilateral? (this is usually bilateral)
- Do you have a history of diabetes?
-
B12 deficiency:
- Do you eat a vegan diet?
- Do you have a history of gastric bypass?
- Do you ever have any confusion?
-
Radiculopathy:
- Do you have any history of upper or lower back pain?
- If YES, history of bulging discs or spinal stenosis?
- Do you have pain from back down the lateral aspect of your leg? (L5)
- Have you had a back injury?
- Does sitting make worse?
- Are the symptoms sudden or intermittent? (often acute)
- Does it radiate on anterior or posterior of thigh (most often anterior)
- Do you have leg weakness?
- Do you have any history of upper or lower back pain?
-
Carpel Tunnel:
- Do you type for many hours a day?
- Is it unilateral?
- If YES, is it more in dominant hand? (typically yes with this Dx)
- If YES, was the dominant had first to show symptoms? (typically yes in this Dx)
- Do you wake up in middle of night with paresthesias in your hands & wrist?
- If YES, Do you shake them to help release the pain? (Classic sign)
- Are the symptoms constant or intermittent? (CTS is usually intermittent)
- Is it gradual or sudden? (CTS usually gradual)
-
PAD
- Do you smoke?
- Have you lost hair on your lower extremities?
- Does it hurt when you walk? (intermittent claudication)
- If YES, does it resolve when you stop walking? (classic sign)
- How far & how long can you walk without having to stop from pain?
- Is it unilateral or bilateral? (can be either)
- Is it in your thigh, hip, butt area? (can also be in these areas-calf is most common though)
- Do you wakeup in the night time because of pain in your legs?
- Does elevating your leg cause pain and gravity relieve the pain?
- Do you have any wounds on your legs or feet?
-
Chronic Alcohol Abuse
- How much do you drink every day?
-
Fibromyalgia
- Any muscle tenderness?
- If YES, which muscles?
- Any joint pain?
- Does stress seem to make your symptoms worse?
- Do you have fatigue that does not go away even after resting?
- Any issues with insomnia?
- Do you feel stiff often?
- Do you have headaches?
- Do you have fluid retention?
- Do you have sensitivity to odors, bright light, wearing tight clothing?
- Any muscle tenderness?
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