| Paresthesia is a symptom that refers to abnormal sensations occurring without any apparent cause (spontaneously), although it may also occur in response to a stimuli, e.g., hitting the "funny bone." Paresthesias are often described as tingling, "pins and needles," prickling, electric, burning, vibrating, buzzing, or crawling. Paresthesias have also been described as "the limb falling asleep" (due to brief compression of the sciatic, common peroneal, or ulnar nerves). They often occur due to compression of peripheral nerves or an abnormality along the peripheral or central nervous systems.
Paresthesias can occur with many different diseases including carpal tunnel syndrome, cervical and lumbosacral radiculopathy, restless leg syndrome, diabetic neuropathy, vitamin B12 deficiency, kidney disease, toxicologic conditions, and alcoholic polyneuropathy. Less common causes of paresthesias include cancer, human immunodeficiency virus (HIV), hypocalcemia, malabsorption, multiple sclerosis, Guillain-Barré syndrome, and use of certain medications (isoniazid, vincristine, diuretics, and nonsteroidal anti-inflammatory drugs [NSAIDs]).
Nonspecific numbness and tingling of the hands, feet, and face are commonly seen in hyperventilation syndrome and panic attacks.Risk: Because paresthesia is a symptom of other conditions, there are no specific risk factors. These vary according to the causative condition. Incidence and Prevalence: Because paresthesia is a symptom rather than a diagnosis, there are no incidence statistics available for paresthesia itself. Incidence statistics vary according to the causative condition. |
Source: Medical Disability Advisor
| History: Individuals complain of sensations of tingling, "pins and needles," prickling, electric, burning, vibrating, buzzing, crawling, or of "a limb falling asleep." Individuals may report the presence of other symptoms such as pain, numbness, weakness, stiffness, or clumsiness. Important information obtained from the history includes location of the paresthesia, how long paresthesia has been present, and if the paresthesia worsens in any one position or when engaged in a specific activity. Physical exam: The exam may reveal decreased sensation over the involved area. Tinel's sign is elicited by tapping an entrapped nerve that increases distal paresthesias, and is simply a sign of irritability of a nerve at the location stimulated by the tap. Tinel's sign may be present with carpal tunnel and cubital tunnel syndromes. Phalen's sign is elicited by flexion of the wrist that increases median nerve paresthesia. Phalen's sign may be present with carpal tunnel syndrome. Physical examination may also reveal presence of nerve root pain (radiculopathy) that is due to narrowing of the spinal canal or nerve root opening (foramen), with decreased strength, sensation, and reflexes relating to the affected nerve root. Individuals with diabetic neuropathy may reveal bilateral loss of sensation to pain, touch, temperature, vibration, and proprioception. Many paresthesia manifestations occur with multiple sclerosis. Physical examination of individuals with Guillain-Barré syndrome may reveal increasing paralysis and hyporeflexia. Tests: Electromyography (EMG) and nerve conduction tests can rule out nerve dysfunction. Specific laboratory blood testing is indicated. A vitamin B12 blood level below 200 pg/ml indicates vitamin B12 deficiency. The blood calcium level may also be abnormal. Abnormally elevated liver function tests and an elevated mean corpuscular volume may reveal alcohol abuse. Blood screening for heavy metals may also be appropriate.
In restless legs syndrome, polysomnography can demonstrate periodic movements during sleep. An MRI may be used for diagnosis of multiple sclerosis. A spinal tap is used to obtain cerebrospinal fluid samples for diagnosis of Guillain-Barré and multiple sclerosis. |
Source: Medical Disability Advisor
| Treatment for paresthesia is based on the underlying cause of the symptom. For example, carpal tunnel syndrome is treated with wrist splints, anti-inflammatory medications, or surgical decompression. Cubital tunnel syndrome is treated with splinting or surgical decompression. Compression of a nerve in the lower leg (the common peroneal nerve) may be relieved by not crossing the legs. Radiculopathies are treated by avoiding activities that increase pain, following physical therapy, taking NSAIDs, limited bed rest, injections, and surgery when relief is not obtained through previous therapies. Diabetic neuropathy is treated by tighter control of blood sugar levels, topical analgesic medications, and oral medications including NSAIDs, antidepressants, and anticonvulsants. Vitamin B12 deficiency is treated with vitamin supplementation. Guillain-Barré syndrome is treated with plasmapheresis. Multiple sclerosis is treated with corticosteroid medications, interferon beta-1a and beta-1b, and glatiramer acetate. |
Source: Medical Disability Advisor
| Outcome is based on the underlying condition. Many individuals with mild carpal tunnel syndrome do well with conservative treatment. It may take several weeks to months for improvement to become apparent. There is marked improvement following surgical treatment for carpal tunnel. Some individuals may continue to have symptoms of carpal tunnel following surgery. The outcome of peroneal nerve compression in the lower leg is generally good. Time of recovery may vary from days to months. Outcome of radiculopathies may vary. Diabetic neuropathy may be disabling. Neuropathy due to vitamin B12 deficiency is treatable with vitamin B12 supplementation. The outcome following Guillain-Barré syndrome is variable and recovery slow. Multiple sclerosis may become progressively disabling. |
Source: Medical Disability Advisor
| Paresthesia is complicated by the primary or underlying disease causing its occurrence. For example, individuals with paresthesias can have difficulty with ambulation or grasping items in their hands when a particular extremity is affected. |
Source: Medical Disability Advisor
| Accommodations may include work environment design to avoid self-injury. Individuals with carpal tunnel syndrome and other nerve entrapment syndromes may need to avoid activities that exacerbate symptoms. Ergonomic keyboards and reconfiguring the work area may be necessary to help keep the wrist in proper alignment. Individuals with cervical or lumbar radiculopathy may also require work restrictions and accommodations to prevent exacerbation of symptoms and underlying condition. These individuals are often unable to lift and bear weight. Individuals with paresthesias due to diabetic neuropathy may need to regularly monitor their blood sugar and take insulin. Workplace and avocational exposures to potential toxins may need to be modified using appropriate industrial hygiene techniques. |
Source: Medical Disability Advisor
| If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case. Regarding diagnosis:
- Does individual have a history of carpal tunnel syndrome, neck (cervical) or lower back (lumbosacral) problems, restless leg syndrome, diabetic neuropathy, vitamin B12 deficiency (pernicious anemia), or alcoholism?
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Does individual have a history of cancer, human immunodeficiency virus (HIV), hypocalcemia, malabsorption, multiple sclerosis, or Guillain-Barré syndrome?
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Does individual have a history of workplace or avocational exposure to toxins that may cause paresthesias (heavy metal, solvents, etc.)?
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Are there sensations of a limb falling asleep, tingling, pins and needles, prickling, electric, burning, vibrating, buzzing, or crawling?
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Does individual report pain, numbness, weakness, stiffness, or clumsiness?
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Where are these sensations located and how long have they been present?
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Does the paresthesia worsen or improve with position change or with a specific activity?
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Was electromyography (EMG) done to rule out nerve dysfunction?
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Were vitamin B12 and calcium levels obtained? Any abnormalities?
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If restless leg syndrome was suspected, was polysomnography done?
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If suspicion of multiple sclerosis, was MRI taken?
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Did a spinal tap (lumbar puncture) rule out Guillain-Barré syndrome and multiple sclerosis?
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Was blood tested to determine if liver function levels were elevated? Is there alcohol abuse?
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Was the underlying cause for the paresthesia diagnosed?
Regarding treatment:
- Has the underlying cause been identified and confirmed?
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If carpal tunnel syndrome is the cause, have wrist splints, anti-inflammatory medications, or surgical decompression been used? Did this relieve the paresthesia?
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If vitamin B12 or calcium deficiency is the cause, has individual received vitamin B12 and calcium supplementation?
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If individual has Guillain-Barré syndrome, has plasmapheresis been done?
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Has multiple sclerosis been treated with corticosteroid medications, interferon beta-1a and beta-1b, and glatiramer acetate?
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If individual has diabetes, is blood sugar adequately controlled?
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Would individual benefit from an alcohol cessation program, as appropriate?
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Have appropriate industrial hygiene measures been undertaken to control toxic exposures?
Regarding prognosis:
- What is the underlying condition causing the paresthesia? Is underlying condition under control? If not, what other treatments are available? Is individual compliant with all medication and treatment regimens for the underlying condition?
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Could there be another condition or reason for the paresthesia?
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Given enough time to heal, is it likely the paresthesia will resolve?
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Have any complications occurred as a result of the underlying disorder? If so, what are they and what is expected outcome with treatment?
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Source: Medical Disability Advisor
| Rowland, Lewis P. "Diagnosis of Pain and Paresthesias." Merritt's Neurology. Ed. Lewis P. Rowland. 10th ed. Philadelphia: Lippincott, Williams & Wilkins, 2000. 22-26. |
Source: Medical Disability Advisor
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