Diagnosis and Management of Bilateral Hand Numbness and Tingling

Patient Evaluation

The American College of Physicians recommends documenting specific symptom characteristics, including distribution pattern, temporal pattern, progression, associated symptoms, and red flags, to guide the diagnosis of bilateral hand numbness and tingling 1
A thorough physical examination, including sensory testing, motor examination, reflexes, and gait assessment, is essential for evaluating patients with bilateral hand numbness and tingling 1
The American Academy of Neurology suggests that patients with bilateral hand numbness and tingling should be screened for burning sensations in forearms, weakness, pain severity, and lower extremity symptoms 2

The American Diabetes Association recommends considering diabetic peripheral neuropathy in patients with diabetes and symmetric stocking-glove distribution of symptoms 1, 3, 2
The American College of Radiology suggests that cervical myelopathy/central cord syndrome should be considered in patients with bilateral hand numbness and burning forearm dysesthesias or lower extremity involvement 2
The National Comprehensive Cancer Network recommends considering chemotherapy-induced peripheral neuropathy in patients with recent chemotherapy exposure 4, 3

The American Academy of Neurology recommends ordering fasting glucose and HbA1c, complete blood count, vitamin B12 level, and thyroid-stimulating hormone (TSH) for all patients with bilateral hand numbness and tingling 1, 3
The American College of Physicians suggests considering additional testing, such as hepatitis B, C, and HIV, if risk factors are present 3

The American Academy of Neurology recommends duloxetine 60 mg once daily as first-line pharmacologic treatment for neuropathic pain in patients with peripheral neuropathy 3, 2
The American Diabetes Association suggests optimizing glucose control to prevent progression of diabetic neuropathy 3, 2
The American College of Radiology recommends considering ultrasound or MRI without contrast for suspected carpal tunnel syndrome with normal or indeterminate examination 5

The American Society of Clinical Oncology recommends reassessing symptoms before every treatment cycle if chemotherapy-related 4
The American Diabetes Association suggests monitoring for development of foot ulcers in diabetic patients 3
The American Academy of Neurology recommends referring to neurology if diagnosis remains uncertain after initial workup or if symptoms progress despite treatment 1