Nerve Pain: Causes of Numbness and Discomfort in Limbs

Q: Nerve Pain: Causes of Numbness and Discomfort in Limbs

Hello： You mentioned that "every night when I lie down, if my neck is compressed (by the bed or pillow), it gradually becomes numb and painful to the point of waking me up." This symptom may resemble cervical radiculopathy due to nerve root compression. <br>"After about five week

Numbness and stiffness in the hands and feet, pain in the shoulders and neck?

Hello, Doctor.
About a month ago, I started waking up at night to find my left hand completely numb and I couldn't feel my little finger.
After a few minutes of movement, I regained sensation, but I later discovered that every night, whenever I lay down and my neck was compressed (by the bed or pillow), I would gradually experience numbness and pain that would wake me up.
The numbness and pain sometimes extend to my fingers and palms, and at times to my arms, affecting both sides.
After about two weeks, I started waking up with stiffness in my fingers, making it difficult to straighten them.
Five weeks later, I also began to experience numbness in my toes and the soles of my feet.
The numbness, pain, and stiffness often persist with abnormal sensations throughout the day after waking up.
Additionally, I have shoulder and neck pain, pain in my left scapula and left anterior chest, immediate soreness and numbness when raising my arms, and my fingers and toes feel cold and are sensitive to temperature changes (I can feel numbness within 1-2 seconds of exposure to hot or cold).
I also hear a cracking sound when turning my head.
While lying on my side, I noticed a painful spot next to my left cervical spine, and pressing it causes an electric shock-like pain in my left hand.
Since I am currently abroad, the waiting time for consultations and examinations is extremely long.
I have had blood tests confirming that my blood sugar, blood count, thyroid function, and liver and kidney functions are all normal.
An X-ray indicated that my cervical spine is normal but did not provide further details, and I am waiting to see if I can get an MRI.
I have been taking non-steroidal anti-inflammatory drugs and doing rehabilitation exercises daily, but there has been no improvement.
I would like to ask what diseases these symptoms might indicate.
Why would cervical spine issues also cause numbness in the toes and soles of the feet? The emergence of new symptoms suggests that my condition is worsening, right? Currently, poor peripheral circulation and sensitivity to temperature changes—could this affect my heart? Additionally, what other tests could be done to identify the cause? Thank you.

Lulu, 30~39 year old female. Ask Date: 2021/05/08

Dr. Jiang Junyi reply Neurology

Hello: You mentioned that "every night when I lie down, if my neck is compressed (by the bed or pillow), it gradually becomes numb and painful to the point of waking me up." This symptom may resemble cervical radiculopathy due to nerve root compression.
"After about five weeks, my right toes and the ball of my foot also become numb.
The numbness, pain, and stiffness often persist throughout the day after waking up," which raises the possibility of polyneuropathy.
I would like to ask what diseases these symptoms might indicate? Why would cervical spine issues also cause numbness in the toes and the ball of the foot? The emergence of new symptoms indicates that the condition is worsening, correct?
A: If there is a significant decrease in reflex responses and the progression is rapid, acute inflammatory demyelinating polyradiculoneuropathy (AIDP) should be considered.
Currently, poor peripheral circulation and sensitivity to temperature changes may affect the heart.
Additionally, what other tests can be performed to identify the cause?
A: To diagnose AIDP, electrophysiological studies and cerebrospinal fluid analysis are necessary.
While abroad, you can supplement with B vitamins and remind yourself to get up every half hour to perform stretching exercises to avoid nerve compression and muscle tightness that could exacerbate symptoms.
It is advisable to consult a neurologist to discuss further examinations and treatment.
Wishing you good health and peace.
Dr.
Jiang Junyi, Neurology, Taoyuan Hospital, cares for you.

Reply Date: 2021/05/08

More Info

The symptoms you are experiencing, including numbness, tingling, and discomfort in your limbs, particularly in your hands and feet, can be indicative of several underlying conditions. Given the complexity of your symptoms, it is essential to consider a multifactorial approach to understanding the potential causes.

Possible Causes of Nerve Pain and Numbness
1. Cervical Radiculopathy: Your description of neck pain, shoulder discomfort, and the sensation of electric shock-like pain when pressing on certain areas suggests that you may be experiencing cervical radiculopathy. This condition occurs when a nerve in the neck is compressed or irritated, often due to herniated discs, bone spurs, or degenerative disc disease. The resulting nerve compression can lead to symptoms radiating down the arm, including numbness and tingling in the fingers.

2. Peripheral Neuropathy: The numbness and tingling in your toes and feet may indicate peripheral neuropathy, which can arise from various causes, including diabetes, vitamin deficiencies (especially B12), alcohol use, and certain medications. Even though your blood tests have ruled out diabetes and other metabolic issues, it’s essential to consider other potential causes of nerve damage.

3. Thoracic Outlet Syndrome: This condition occurs when the blood vessels or nerves in the space between your collarbone and your first rib become compressed. Symptoms can include pain, numbness, and tingling in the arms and hands, especially when lying down or in certain positions.

4. Multiple Sclerosis (MS): Although less common, MS can cause a wide range of neurological symptoms, including numbness and tingling in various parts of the body. The presence of new symptoms over time could suggest a demyelinating process, but this would typically be accompanied by other neurological signs.

5. Cervical Spondylosis: Age-related wear and tear on the cervical spine can lead to spondylosis, which may cause nerve compression and result in symptoms similar to those you are experiencing.

Why Neck Issues Affect the Feet
The nervous system is interconnected, and issues in the cervical spine can lead to symptoms in the lower extremities due to the complex pathways of nerve signals. Nerve roots that exit the cervical spine can influence sensations and motor functions in the arms and legs. If there is a significant issue in the cervical region, it can potentially lead to referred symptoms in the lower limbs.

Progression of Symptoms
The emergence of new symptoms can indicate that the underlying condition is worsening or that additional nerves are becoming affected. It is crucial to monitor these changes and communicate them to your healthcare provider.

Circulation and Sensitivity to Temperature
Your sensitivity to temperature changes and the feeling of poor peripheral circulation may not directly affect your heart but could indicate issues with blood flow or nerve function. Conditions like Raynaud's phenomenon can cause such symptoms, where blood vessels constrict excessively in response to cold or stress.

Recommended Next Steps
1. MRI of the Cervical Spine: An MRI can provide detailed images of the cervical spine and help identify any herniated discs, stenosis, or other structural issues that may be compressing the nerves.

2. Electromyography (EMG) and Nerve Conduction Studies (NCS): These tests can assess the electrical activity of your muscles and the speed of nerve conduction, helping to pinpoint areas of nerve damage.

3. Vitamin and Nutritional Assessment: Consider testing for vitamin deficiencies, particularly B12, folate, and other essential nutrients that support nerve health.

4. Referral to a Specialist: If symptoms persist or worsen, a referral to a neurologist or a pain specialist may be warranted for further evaluation and management.

In conclusion, while your symptoms are concerning, they can arise from various conditions. A thorough evaluation, including imaging and possibly nerve studies, will be essential in determining the exact cause and guiding appropriate treatment. Always keep your healthcare provider informed of any changes in your symptoms to ensure timely intervention.

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