Numbness / tingling / altered sensation

Rationale

Patients will often present complaining only of altered sensation. There are varying underlying causes, some of which are serious.

Causal Conditions

(list not exhaustive)

1. Peripheral neuropathy (e.g., diabetic neuropathy, carpal tunnel syndrome, radiculopathy)
2. Central nervous system (e.g., multiple sclerosis)
3. Dermatological (e.g., herpes zoster, angioedema)
4. Mental disorders (e.g., panic attacks)

Key Objectives

Given a patient presenting with isolated numbness/tingling/altered sensation, the candidate will diagnose the cause, severity, and complications, and will initiate an appropriate management plan.

Enabling Objectives

Given a patient with numbness/tingling/altered sensation, the candidate will

1. list and interpret critical clinical findings, including
   1. history data relevant to potential underlying causes (e.g., diabetic risk factors, workplace risk factors, distribution of symptoms);
   2. results of a physical examination including a thorough neurological examination;
2. list and interpret appropriate investigations (e.g., fasting glucose, nerve conduction studies)
   1. recognize the fact that in many such cases investigations may not be required;
3. construct an effective initial management plan based on the working diagnosis, including
   1. providing appropriate continuing assessment and ongoing care;
   2. determining if the patient requires specialized care;
   3. advising the patient, if necessary, on work-related issues.