Reporter : Wu Yingxiang / Editor: Lin Xiaohui
Email: feature@mingpao.com / Direct translation
There are many reasons behind numbness, pain, and weakness in the hands and feet. They can be caused by muscle, joint, and tendon problems, or compression of the cervical and lumbar spine, or central nerve problems or nerve inflammation. Should I look for a family doctor, orthopedics, or neurology? Should I get X-ray or MRI? Rehabilitation specialists are trained in different specialties such as orthopedics, internal medicine, cranial neurology, etc., to uncover the source of arthralgia.
◆Cen: Cen Jian (Specialist in Emergency Department of Sanatorium and Hospital)
◆Zhou: Zhou Zhiping (Rehabilitation specialist)
■Many middle-aged patients are most afraid of stroke?
Question: What should family doctors do if they encounter patients with pain in the hands and feet from time to time?
Cen: Most of the patients seeking medical care due to pain in the hands and feet, especially middle-aged people, are most worried about stroke. As a first-line family doctor, he will make detailed consultations and grasp more clinical symptoms, such as: Does arthralgia appear suddenly, or has it lasted for several months? Is it gradually getting worse? In order to determine the severity of the disease, whether there is a possibility of stroke. Secondly, you will understand the medical history, such as: Has there been a similar situation before? Are there any chronic diseases? Has there been an accidental fall or surgery recently? Then, a basic examination will be done to check whether the muscles, nerves, muscle strength, and painful areas affect mobility, so that it is estimated that there is a problem with muscles, joints, bones or nerves.
■Acupuncture = neuralgia? Rash = Snake?
Q: What will the family doctor do? Under what circumstances need to be referred to a specialist?
Cen: First, check the location and nature of the pain. Take neuralgia as an example. The patient will experience sharp pain like acupuncture and lightning; if the skin also has rash, the more common case is "snakes" (shingles), and the doctor will prescribe antibiotics and painkillers to relieve the condition , Let the patient rest and sleep well, improve immunity, follow up after 1 week to see if the condition has improved.
If there is no rash, it is not a snake. Neuralgia that appears for no reason may not be immediately terminated.
Take a single limb pain as an example. There are many causes, such as carpal tunnel syndrome, neuroma squeezing, or neuralgia caused by vascular inflammation or diabetes. You must be referred to other specialists for further evaluation, and through blood tests, ultrasound, Computer scan or MRI can help diagnose the disease.
In the case of more complicated cases, which may involve different specialties such as orthopedics and internal medicine, the family doctor will refer them to the rehabilitation department. Because orthopedic surgeons mainly focus on bone and tendon problems, if the patient has immune system problems or neuropathy, the orthopedics department may not detect it. The Rehabilitation Department can evaluate various aspects to detect whether it is a problem with the nervous system or limbs or spine.
■First divide the pain like a fire and get an electric shock?
Question: The patient came to the rehabilitation department due to numbness of hands and feet, fatigue, how to diagnose?
Zhou: Rehabilitation doctors must first grasp the patient's detailed medical history, and then perform detailed examinations of muscles, joints, and nervous system. In terms of medical records, we must first distinguish the nature of the pain, whether it is a dull pain, or a sudden appearance or disappearance, like a fire or electric shock. If the pain originates from muscles, joints, or tendons, it will get better when stationary, and increase pain when it is moved; also pay attention to whether the location of arthralgia is a single or multiple parts, so it is estimated to be a local problem or a whole disease . For example, carpal tunnel syndrome mostly only has hand paralysis. If the patient's hands and feet are paralyzed at the same time, it may be a comprehensive disease, such as diabetic neuropathy.
Based on symptoms and clinical examination results, infer the root cause of the problem. For muscle and joint problems, imaging examinations such as computer scans or magnetic resonance imaging are usually done. If it is suspected to be a nervous system problem, nerve function must be checked. Common electrophysiological tests such as electromyography and nerve conduction tests are common.
■The pain continues after recovery?
Question: Painkillers can cure the symptoms but not the root cause?
Zhou: The medicine must be used with care. If the patient buys the medicine without a doctor's prescription, or throws the medicine indiscriminately, the wrong use may be toxic and affect health. To deal with pain, doctors will prescribe suitable medicines according to different degrees of pain, which are roughly divided into three categories:
‧General muscle and joint pain: For less severe pain, common analgesics such as paracetamol can solve the problem.
‧Inflammation of muscles, joints or tendons: Paracetamol is not effective or requires prescription of non-steroidal anti-inflammatory analgesics (NSAIDs).
‧Severe pain: For severe pain such as broken bones, surgery, wounds, etc., morphine pain relievers such as tramadol and morphine may be required.
If the pain is determined to be a nervous system problem, it is called neuralgia, and anti-brain drugs such as pregabalin can be used. In addition, antidepressants such as nortriptyline, which have been used in the medical profession for decades, are also effective in relieving neuralgia.
To deal with pain, the medical community recommends to detect the root cause of pain as soon as possible, and to control the pain with appropriate drugs as soon as possible, so as not to continuously transmit pain information from the hands and feet to the spinal nerves, which will cause permanent changes to the nervous system. Chronic pain develops due to excessive nervous system sensitivity.
■Rehabilitation department checks pain more comprehensively?
Q: What is the difference between rehabilitation and orthopedics?
Zhou: Rehabilitation training includes orthopedics, internal medicine, neurology, pain, and electro-diagnosis (electrophysiological diagnosis). There are many overlaps with orthopedics, but rehabilitation doctors do not perform operations. Rehabilitation doctors can comprehensively evaluate the patient's condition. In addition to muscle and joint problems, they can also evaluate problems caused by the nervous system. Many orthopedic diseases and neurological diseases affect each other. After World War II, many soldiers were injured by explosions and gunshots in battle. In addition to muscles, joints, hands, feet, and spinal nerves were also damaged. Many soldiers were injured at that time. There are both orthopedics and neurological diseases, and the situation is complicated, so the rehabilitation department was developed.
Recently, a construction worker came to see a doctor with numbness in his hands, low back pain, weakness in his left foot, and drooping feet (the soles of the feet could not be lifted). He had consulted a family doctor and found herniated disc and spinal canal stenosis after undergoing MRI. He was referred to the orthopedics department for a loosening operation, but his foot drop did not improve after the operation, and his hands became more and more paralyzed. Later, she was referred to the Rehabilitation Department for neurological examination and found that there were problems with the peripheral nerves of the limbs. The left foot was not caused by the nerves pressed by the intervertebral disc, but the peripheral nerves were inflamed. It all stems from the patient's immune system problems, suffering from eosinophilic granulomatous polyangiitis, only need to take steroids to control the inflammation of the blood vessels, but did a unnecessary operation in vain.
Ref : https://news.mingpao.com/pns/%e5%89%af%e5%88%8a/article/20200907/s00005/1599416359011/%e6%89%8b%e8%85%b3%e7%97%b9%e7%97%9b-%e5%82%b7%e8%82%8c%e5%82%b7%e9%aa%a8%e5%ae%9a%e8%85%a6%e7%97%85-%e5%be%a9%e5%ba%b7%e7%a7%91%e5%85%a8%e9%9d%a2%e6%aa%a2%e6%b8%ac-%e6%8f%aa%e5%87%ba%e5%85%83%e5%85%87
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