[36F] With chronic numbness and pain in limbs and back

Patient Description

A 36-year-old female presents with chronic numbness and pain in her legs, feet, arms, and back. The numbness, described as burning, needles, and loss of sensation, has been present for two years and is exacerbated by sitting. The patient also experiences tingling in both hands and numbness in the left arm and hand, which worsens with activities such as driving or using a game controller. These symptoms started before her bariatric surgery. She reports weakness in her legs and feet, balance problems, difficulty walking, and muscle cramps or spasms. She has a history of PCOS, a metabolic disorder diagnosed two years ago, and migraines for the past 18 years. The patient is not currently on any medications and has not been tested for vitamin deficiencies, although she reports potential deficiencies and symptoms such as hair loss and fatigue. There are no changes in bowel or bladder function, no pain radiating down the leg, and no recent injuries or surgeries involving the back, legs, or feet. No known allergies or adverse reactions to medications.

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Arora's Assessment

What might be happening

Based on the symptoms you've described, several potential diagnoses could explain your condition. Here are the most likely ones:

Peripheral Neuropathy

Peripheral neuropathy is a condition resulting from damage to the peripheral nerves, which can cause numbness, tingling, and pain in the affected areas. This condition can be caused by various factors, including metabolic disorders, vitamin deficiencies, and chronic conditions like diabetes. Given your history of a metabolic disorder and potential vitamin deficiencies, this could be a significant factor.

Spinal Issues

Conditions such as herniated discs, spinal stenosis, or degenerative disc disease can cause nerve compression, leading to symptoms like numbness, tingling, and pain in the legs, arms, and back. The fact that your symptoms worsen with sitting and improve with walking suggests that spinal issues might be contributing to your condition.

Vitamin Deficiencies

Deficiencies in vitamins, particularly B vitamins, can lead to symptoms like numbness, tingling, fatigue, and hair loss. Given your history of bariatric surgery, which can affect nutrient absorption, this is a plausible cause.

Carpal Tunnel Syndrome

The numbness and tingling in your hands, especially when driving or using a controller, could be indicative of carpal tunnel syndrome. This condition occurs when the median nerve is compressed as it travels through the wrist.

What you can do

Peripheral Neuropathy

  • Consult a healthcare provider: It's essential to get a proper diagnosis and treatment plan. Your doctor may recommend blood tests to check for vitamin deficiencies and other underlying conditions.
  • Manage underlying conditions: If you have a metabolic disorder, work with your healthcare provider to manage it effectively.
  • Consider supplements: If vitamin deficiencies are identified, your doctor may recommend supplements to address them.

Spinal Issues

  • See a specialist: A neurologist or orthopedic specialist can help diagnose and treat spinal issues. Imaging studies like MRI or CT scans may be necessary.
  • Physical therapy: Engaging in physical therapy can help strengthen the muscles around your spine and improve your symptoms.
  • Posture and ergonomics: Ensure that your sitting posture is correct and consider ergonomic adjustments to your workspace.

Vitamin Deficiencies

  • Dietary changes: Incorporate foods rich in B vitamins, such as whole grains, meat, eggs, and dairy products, into your diet.
  • Supplements: If recommended by your doctor, take vitamin supplements to address any deficiencies.

Carpal Tunnel Syndrome

  • Wrist splints: Wearing wrist splints, especially at night, can help alleviate symptoms.
  • Ergonomic adjustments: Make ergonomic adjustments to your workspace and activities to reduce strain on your wrists.
  • Consult a specialist: A hand specialist or neurologist can provide further evaluation and treatment options.

What you should look out for

Given the complexity and duration of your symptoms, it's crucial to seek medical care to get a comprehensive evaluation. Here are some reasons to seek care more urgently:

  • Worsening weakness or numbness: If you notice a significant increase in weakness or numbness, seek medical attention promptly.
  • Loss of bowel or bladder control: This could indicate a serious spinal issue and requires immediate medical attention.
  • Severe pain: If your pain becomes severe and unmanageable, seek medical care.

Remember, while I can provide information and suggestions, it's essential to consult with a healthcare professional for a formal diagnosis and treatment plan. You can also use MDandMe to journal your symptoms, track progress, get insights, and share longitudinal medical notes with your provider.

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4 mo ago


People Also Ask


What are the common causes of peripheral neuropathy?

Peripheral neuropathy can be caused by a variety of factors including diabetes, metabolic disorders, vitamin deficiencies, infections, and exposure to toxins. It results from damage to the peripheral nerves, leading to symptoms like numbness, tingling, and pain.


How can vitamin deficiencies affect nerve function?

Vitamin deficiencies, particularly in B vitamins such as B12, B6, and folate, can impair nerve function and lead to symptoms like numbness, tingling, fatigue, and even hair loss. These vitamins are crucial for maintaining healthy nerve cells.


What are the symptoms of carpal tunnel syndrome?

Carpal tunnel syndrome is characterized by numbness, tingling, and weakness in the hand and arm. It occurs when the median nerve is compressed as it travels through the wrist. Symptoms often worsen with activities that involve wrist movement, such as driving or using a game controller.


How can spinal issues lead to numbness and pain in the limbs?

Spinal issues such as herniated discs, spinal stenosis, or degenerative disc disease can compress nerves in the spine, leading to symptoms like numbness, tingling, and pain in the limbs. These symptoms may worsen with certain positions or activities, such as sitting.

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