pins n needles

noticed about month ago my left fingers and palm feel like their pins and needles and sometimes I notice that both hands and sometimes left foot get this also.I am 48 social cigarettes ,use to work the wrenches ,now I just monitor people,and go to college no repetative use of computer or twisting ,it just like out of blue .I never get colds or sick ?No female change or anything out of the ordinary? Can you possible have any ideas ?Thankyou.

[Christopher R Newey, DO]

Thanks for using the forum. I am happy to address your questions, and my answer will be based on the information you provided here. Please make sure you recognize that this forum is for educational purposes only, and it does not substitute for a formal office visit with a doctor.

Without the ability to examine and obtain a history, I can not tell you what the exact cause of the symptoms is. However I will try to provide you with some useful information.

I am not sure what you mean by left fingers. If the sensation occurs on the medial fingers (pinky and half of the ring finger) and medial aspect of palm, it may be a neuropathy from the ulnar nerve. This nerve is also known as your “funny bone” when tapped or hit. It has several sites of compression along its course – one site being at the elbow. Classically, it may be a truck driver who rests elbow on window/door. It should also be mentioned that with rapid weight gain or weight loss, the ulnar nerve or median nerve (which causes carpal tunnel syndrome) can be compressed and cause their neuropathies.  The foot sensory changes (or neuropathy) may or may not be related to the sensory changes in the hand. Neuropathies can be caused by many mechanisms including microtrauma (overuse), hypothyroidism, weight changes, amyloidsosis, and diabetes, to name a few.

I recommend that you follow up with your local neurologist. He/she will perform a specific neurological examination focused on the ulnar and median nerves. The neurologist may also elect to perform an EMG/NCS to evaluate the motor and sensory components of the median and ulnar nerves as they travel to the wrist. An MRI of the neck may be necessary to examine the discs in your back more closely to ensure no herniation of the discs and also ensure that there is no dilatation of the central canal of the spinal cord, which can cause cape-like numbness of the arms. An MRI of the cervical spine would also evaluate further if the pain in the feet is connected to the bilateral hands/arms numbness. Other labs, such as vitamins and autoimmune panels, may be ordered based on the history that the neurologist may obtain.

Treatment options for the ulnar and median neuropathies (if diagnosed) include surgical release/correction. However, less invasive procedure such as splinting should be tried first, as you have done. Medications are usually directed at the underlying cause and include NSAIDs such as ibuprofen. If you are found to have a neuropathy, medications such as gabapentin and/or pregabalin may be used (as well as other medications).

Thank you for this opportunity to answer your questions, I hope you find the information I have provided useful, good luck.