We are all familiar with falling asleep with an arm in an awkward position and waking with an intense “pins-and-needles” feeling. Once you get into a better position, it slowly resolves.
But for some people, it is a nightly event, even if they sleep in a normal position. In severe cases, it prevents them from sleeping more than a few hours at a time. Sometimes it occurs with use of the hand or arm, and with others it can be a constant problem.
A common misconception is that it is because of reduced blood flow. This is not the case. It is more accurate to say it is because of reduced nerve flow. Similar to when you hit your “funny bone” in the elbow and the last two fingers go numb, when a nerve is compressed or irritated the “pins and needles” can be the result.
So what’s the cause of this sensation — technically caused paresthesia — in the arms? While the nerves can be pinched at the wrist, causing carpal tunnel, or at the elbow, affecting the last two fingers, I have yet to see a case where the neck and upper back were not involved. A very common cause is trigger points — muscular “knots” in the neck and shoulders that cause pain and tingling that radiates down the arm. Often, the patient does not feel any pain at the muscle itself; this is why it is important to know these patterns of referred pain. Once you know which muscles tend to send tingling to the hands and arms, it is relatively easy to check the muscles for trigger points.
Another common cause of arm tingling is the joints of the neck. The pattern here is similar to muscle trigger points. Once you know the patterns of referred pain, it leads you to the problem area. Joint problems often coexist with trigger points, especially in chronic cases. There may be a history of injury, such as a whiplash, or the problem can build up slowly over time. This is especially the case in people who work at a computer all day. Even when the joints are affected by arthritis, they still can respond to care.
Disc problems in the neck are less common causes of tingling and can be more difficult to treat. They often do respond to conservative care, including manipulation. Surgery is needed only in a minority of cases.
There are other causes of paresthesia. A few diseases can cause it, such as multiple sclerosis, and it can be a side effect of medications, such as the popular purple pills for heartburn or chemotherapy. But by far, most cases are caused by joint and muscle problems in the neck and upper back, and they respond well to a combination of joint manipulation and muscle treatments.
In the beginning of care, treatment is focused on easing the symptoms, allowing the patient to sleep through the night or work without discomfort. Once the symptoms are controlled, we begin to address the underlying causes of the problem. Typically the patient is shown stretches for the tight muscles. There also are postural exercises that help reduce the “forward head posture” that is so common and leads to joint and muscle problems.
If patients are willing to follow through with their care and do their self-care, pins-and-needles sensations can be a thing of the past — or at least reduced to a tolerable level.
Dr. Michael Noonan practices chiropractic, chiropractic acupuncture and other wellness therapies in Old Town. He can be reached at noonanchiropractic@gmail.com.