Friday, July 20, 2007


Tingling: “Funny bone” or a neurological disorder?

We have all experienced the sensation of tingling in our limbs. Most commonly, this occurs when we strike our elbow and have a strange feeling extending to our hand that lasts for a few seconds.

People often downplay this and may rationalize it by saying they hit their “funny bone.” The terms “pins and needles” and “my foot fell asleep” might be used to describe this phenomenon. When such a pattern persists day and night, it is known as peripheral neuropathy and can be very disabling.

I see many patients who complain of persistent tingling, numbness, and burning pain in all extremities, worsening at night. I typically perform a detailed neurological examination with particular attention to any loss of sensation to pin prick, temperature and vibration. Blood work and a diagnostic test known as electroneuromyography will help in reaching a diagnosis and appropriate treatment.

The complex human nervous system is divided into two parts. The brain and spinal cord make up the central nervous system. The second part, the peripheral nervous system, consists of the nerves in our limbs. These nerves carry impulses to and from the central nervous system. When peripheral nerves are injured, they transmit paresthesias, which are perversions of actual sensations such as tingling, burning or an impression of crawling insects. These uncomfortable sensations are not only distracting, but they can become very painful and significantly interfere with daily routines.

Peripheral neuropathies are fairly common and their causes are many and varied. Worldwide, leprosy is the number one cause of peripheral neuropathy. Despite available treatment, thousands of new cases of leprosy appear each year in the poorest countries.

In the United States and other industrialized nations, the leading causes of peripheral neuropathy are alcohol use and diabetes. Interestingly, in 10 percent of all diabetics, peripheral neuropathy is the first symptom. Increased thirst and frequent urination are more commonly known symptoms of diabetes.

Other treatable causes of neuropathy include vitamin B12 and folic acid deficiencies, Lyme disease, thyroid disease, and excess intake of vitamin B6. Some peripheral neuropathies are inherited while certain forms of cancer cause others.

Treatments include removing or correcting the underlying reason, applying medicated creams, or taking oral medications to control discomfort. Prevention is an important key in reducing the risk of neuropathy. Eating a balanced diet and moderating alcohol consumption are as essential as treating contributory medical conditions.

Here is my advice for people who experience any of these symptoms: don’t always make excuses for a few seconds of discomfort. When tingling becomes a persistent debilitating problem, it’s time to have a detailed medical evaluation.

Anthony G. Alessi, MD, is a neurologist on The William W. Backus Hospital Medical Staff with a private practice at NeuroDiagnostics, LLC in Norwich. This column should not replace advice or instruction from your personal physician. E-mail Dr. Alessi and all of the Healthy Living columnists at

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