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Neurology (Expert Forum)
Pins and needles early mornings
Answered by
Joanna Fong, MD - Stroke/NICU, multiple sclerosis, sleep, EEG, General Neurology
Cleveland Clinic
Cleveland - OH
This forum is for questions and support regarding neurology issues such as: Alzheimer's Disease, ALS, Autism, Brain Cancer, Cerebral Palsy, Chronic Pain, Epilepsy, Fibromyalgia, Headaches, MS, Neuralgia, Neuropathy, Parkinson's Disease, RSD, Sleep Disorders, Stroke, Traumatic Brain Injury
Pins and needles early mornings
by KateG, Jun 15, 2007 12:00AM
Every morning at around 4.30am I am awoken by an unpleasant sensation of tingling/pins and needles. It starts in my hands and breasts and then I can't keep still, especially my legs. It passes after a couple of minutes though sometimes it can happen 2 or 3 times. I am always very tired and when I am overly warm my energy evaporates. I have had a couple of strange experiences with a severe buzzing through my body when I almost passed out. Initial searches on the web ( my GP doesn't seem to have any idea or interest) took me to a MS site. Any ideas most welcome. Thanks.
Doctor's Answer
by Joanna Fong, MD, Oct 17, 2007 08:15AM
, Oct 17, 2007 08:15AM
To: Kate G
Hi Kate. Your symptoms of tingling sensation in your arms and legs can be due to two categories of disease processes:
1) Peripheral nervous system (nerves outside your brain and spinal cord)
2) Central nervous system (brain and spinal cord)
**The tingling sensation in your arms in the morning sounds very much like carpal tunnel syndrome (CTS). The clinical features of CTS are variable, but usually include pain and numbness or tingling sensation in the thumb, first two fingers, and the radial-half of the ring finger (the distribution of the median nerve). These sensory changes may involve the entire palm area in some cases due to variable nerve innervation. In addition, pain may radiate proximally into the forearm, and occasionally to the shoulder.
Many patients experience pain at night and are awakened by abnormal sensations; they will typically report shaking their hand to return normal feeling. Activities associated with frequent or persistent flexion or extension of the wrist also often exacerbate the symptoms. Prolonged use, as in writing or working at a handcraft, may be followed by unbearable pain. Patients who are habitual clenchers (jaw, hand, rectum) and who drive long distances to work are more prone to work-related symptoms, particularly if the workplace is stressful.
Physical examination is usually normal early in the course of the disease. However, as the duration of nerve entrapment increases, flattening of the thenar eminence typically occurs. These patients may have thumb weakness and motor incoordination manifested by difficulty performing pinch-grasping, writing, or holding small utensils.
Current recommendations of the National Institute of Occupational Safety and Health (NIOSH) for work-related carpal tunnel syndrome are mainly clinical. A detail neurological examination is often sufficient. EMG/NCS (needle test for the nerve) can be done to confirm diagnosis and predict prognosis. This can be done through the neurology department.
**As for as your leg symptoms, it can be also due to similar mechanism as CTS (i.e. nerve compression). However, it can also be due to something called "Restless Leg Syndrome" (RLS). In patient with RLS, although the subjective symptoms of RLS are often difficult to describe, the clinical features are highly stereotyped. The hallmark of RLS is a marked discomfort in the legs that occurs only at rest and is immediately relieved by movement. The abnormal feelings are typically deep seated and localized below the knees. Distribution is usually both sides, but some asymmetry may occur and the arms can be affected in more severe cases.
Terms that patients use to describe the symptoms include crawling, creeping, pulling, itching, drawing, or stretching, all localized to deep structures rather than the skin. Pain and tingling paresthesia of the type that occurs in painful peripheral neuropathy is usually absent, and there is no sensitivity to touching of the skin.
Symptoms typically worsen towards the end of the day and are maximal at night, when they appear within 15 to 30 minutes of reclining in bed. In severe cases symptoms may occur earlier in the day while the patient is seated, thereby interfering with attending meetings, sitting in a movie theater, and similar activities. In milder cases patients will fidget, move in bed, and kick or massage their legs for relief. Patients with more severe symptoms feel forced to get out of bed and pace the floor to relieve symptoms.
**Other possible causes for your symptoms (although less likely) are central. MRI brain can be used to rule out diseases such as multiple sclerosis, stroke, tumor, vascular diseases, etc.
THIS INFORMATION IS PROVIDED FOR GENERAL MEDICAL EDUCATION PURPOSE ONLY. PLEASE CONTACT YOUR PHYSICIAN FOR DIAGNOSTIC AND TREATMENT OPTIONS OF YOUR SPECIFIC MEDICAL CONDITION.
1) Peripheral nervous system (nerves outside your brain and spinal cord)
2) Central nervous system (brain and spinal cord)
**The tingling sensation in your arms in the morning sounds very much like carpal tunnel syndrome (CTS). The clinical features of CTS are variable, but usually include pain and numbness or tingling sensation in the thumb, first two fingers, and the radial-half of the ring finger (the distribution of the median nerve). These sensory changes may involve the entire palm area in some cases due to variable nerve innervation. In addition, pain may radiate proximally into the forearm, and occasionally to the shoulder.
Many patients experience pain at night and are awakened by abnormal sensations; they will typically report shaking their hand to return normal feeling. Activities associated with frequent or persistent flexion or extension of the wrist also often exacerbate the symptoms. Prolonged use, as in writing or working at a handcraft, may be followed by unbearable pain. Patients who are habitual clenchers (jaw, hand, rectum) and who drive long distances to work are more prone to work-related symptoms, particularly if the workplace is stressful.
Physical examination is usually normal early in the course of the disease. However, as the duration of nerve entrapment increases, flattening of the thenar eminence typically occurs. These patients may have thumb weakness and motor incoordination manifested by difficulty performing pinch-grasping, writing, or holding small utensils.
Current recommendations of the National Institute of Occupational Safety and Health (NIOSH) for work-related carpal tunnel syndrome are mainly clinical. A detail neurological examination is often sufficient. EMG/NCS (needle test for the nerve) can be done to confirm diagnosis and predict prognosis. This can be done through the neurology department.
**As for as your leg symptoms, it can be also due to similar mechanism as CTS (i.e. nerve compression). However, it can also be due to something called "Restless Leg Syndrome" (RLS). In patient with RLS, although the subjective symptoms of RLS are often difficult to describe, the clinical features are highly stereotyped. The hallmark of RLS is a marked discomfort in the legs that occurs only at rest and is immediately relieved by movement. The abnormal feelings are typically deep seated and localized below the knees. Distribution is usually both sides, but some asymmetry may occur and the arms can be affected in more severe cases.
Terms that patients use to describe the symptoms include crawling, creeping, pulling, itching, drawing, or stretching, all localized to deep structures rather than the skin. Pain and tingling paresthesia of the type that occurs in painful peripheral neuropathy is usually absent, and there is no sensitivity to touching of the skin.
Symptoms typically worsen towards the end of the day and are maximal at night, when they appear within 15 to 30 minutes of reclining in bed. In severe cases symptoms may occur earlier in the day while the patient is seated, thereby interfering with attending meetings, sitting in a movie theater, and similar activities. In milder cases patients will fidget, move in bed, and kick or massage their legs for relief. Patients with more severe symptoms feel forced to get out of bed and pace the floor to relieve symptoms.
**Other possible causes for your symptoms (although less likely) are central. MRI brain can be used to rule out diseases such as multiple sclerosis, stroke, tumor, vascular diseases, etc.
THIS INFORMATION IS PROVIDED FOR GENERAL MEDICAL EDUCATION PURPOSE ONLY. PLEASE CONTACT YOUR PHYSICIAN FOR DIAGNOSTIC AND TREATMENT OPTIONS OF YOUR SPECIFIC MEDICAL CONDITION.
I too get the same thing, I get pins and needles, buzzing sensations which are rythmic, among many other things. My doctor is not interested either, after my many visits to see him about this and other symptoms he referred me to a psychiatrist insisting my problem was of a psychiatrict nature. The psychiatrist whom I did see told me that my problem is neurological and luckily he specialised in M.E. etc... before he went into psychiatry. He has written a letter to my doctor to recommend I see a neurologist and get an MRI done.
The central nervous system causes these sensations. It can range from tension to MS. (Not meaning to scare you) I have suspected MS with all of my other symptoms.
But apparently anxiousness can cause it too and make CFS (ME) and MS symptoms feel worse.
Can you change GP?
If not, try what I did, I contacted Cloverleaf Advocacy to get a medical advocate to help with my case. They're a charity so they're free. Their website is www.cloverleaf-advocacy.co.uk
Your GP will probably want to do blood work on you if you are experiencing paresthesias (pins and needles, tingling etc...) to rule other things out. In the meantime, a suggestion for you, nerve damage and irritation causes paresthesias, try taking supplements like B12, the B Vitamins are good for energy but B12 also helps to repair the nerves. They do regenerate themselves, but B12 is a good start, and it lifts your mood.
Thank you for your reply. Have you been diagnosed with anything or are you still trying to sort out your symptoms? Do you still have the symptoms and are you still losing weight? Thanks for the advice about fluids. I know I don't drink as much as I should. Hope to hear from you again. Best wishes.