Numbness and Tingling Health Article

Definition

Numbness and tingling are decreased or abnormal sensations caused by altered sensory nerve function.

Description

The feeling of having a foot "fall asleep" is a familiar one. This same combination of numbness and tingling can occur in any region of the body and may be caused by a wide variety of disorders. Sensations such as these, which occur without any associated stimulus, are called paresthesias. Other types of paresthesias include feelings of cold, warmth, burning, itching, and skin crawling.

Causes

Sensation is carried to the brain by neurons (nerve cells) running from the outer parts of the body to the spinal cord in bundles called nerves. In the spinal cord, these neurons make connections with other neurons that run up to the brain. Paresthesias are caused by disturbances in the function of neurons in the sensory pathway. This disturbance can occur in the central nervous system (the brain and spinal cord), the nerve roots that are attached to the spinal cord, or the peripheral nervous system (nerves outside the brain and spinal cord).

Peripheral disturbances are the most common cause of paresthesias. "Falling asleep" occurs when the blood supply to a nerve is cut off—a condition called ischemia. Ischemia usually occurs when an artery is compressed as it passes through a tightly flexed joint. Sleeping with the arms above the head or sitting with the legs tightly crossed frequently cause numbness and tingling.

Direct compression of the nerve also causes paresthesias. Compression can be short-lived, as when a heavy backpack compresses the nerves passing across the shoulders. Compression may also be chronic. Chronic nerve compression occurs in entrapment syndromes. The most common example is carpal tunnel syndrome. Carpal tunnel syndrome occurs when the median nerve is compressed as it passes through a narrow channel in the wrist. Repetitive motion or prolonged vibration can cause the lining of the channel to swell and press on the nerve. Chronic nerve root compression, or radiculopathy, can occur in disk disease or spinal arthritis.

Other causes of paresthesias related to disorders of the peripheral nerves include:

• Metabolic or nutritional disturbances. These disturbances include diabetes, hypothyroidism (a condition caused by too little activity of the thyroid gland), alcoholism, malnutrition, and vitamin B₁₂ deficiency.
• Trauma. Trauma includes injuries that crush, sever, or pull on nerves.
• Inflammation.
• Connective tissue disease. These diseases include arthritis, systemic lupus erythematosus (a chronic inflammatory disease that affects many systems of the body, including the nervous system), polyarteritis nodosa (a vascular disease that causes widespread inflammation and ischemia of small and medium-size arteries), and Sjögren's syndrome (a disorder marked by insufficient moisture in the tear ducts, salivary glands, and other glands).
• Toxins. Toxins include heavy metals (metallic elements such as arsenic, lead, and mercury which can, in large amounts, cause poisoning), certain antibiotics and chemotherapy agents, solvents, and overdose of pyridoxine (vitamin B₆).
• Malignancy.
• Infections. Infections include Lyme disease, human immunodeficiency virus (HIV), and leprosy.
• Hereditary disease. These diseases include Charcot-Marie-Tooth disease (a hereditary disorder that causes wasting of the leg muscles, resulting in malformation of the foot), porphyria (a group of inherited disorders in which there is abnormally increased production of substances called porphyrins), and Denny-Brown's syndrome (a hereditary disorder of the nerve root).

Paresthesias can also be caused by central nervous system disturbances, including stroke, TIA (transient ischemic attack), tumor, trauma, multiple sclerosis, or infection.

Symptoms

Sensory nerves supply or innervate particular regions of the body. Determining the distribution of symptoms is an important way to identify the nerves involved. For instance, the median nerve innervates the thumb, the first two fingers, half of the ring finger, and the part of the hand to which they connect. The ulnar nerve innervates the other half of the ring finger, the little finger, and the remainder of the hand. Distribution of symptoms may also aid diagnosis of the underlying disease. Diabetes usually causes a symmetrical "glove and stocking" distribution in the hands and feet. Multiple sclerosis may cause symptoms in several, widely separated areas.

Other symptoms may accompany paresthesias, depending on the type and severity of the nerve disturbance. For instance, weakness may accompany damage to nerves that carry both sensory and motor neurons. (Motor neurons are those that carry messages outward from the brain.)