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Claudication

Nov 22nd 2018

Why we shouldn't always ignore the feeling of pins and needles

Pins and needles are a warning to tell us to move our limbs about, because long-term nerve entrapment can cause permanent damage

veryone has experienced it: that tingling, prickling feeling you get in your limbs when you’ve been sitting or lying in one position for too long. Medical people call it paresthesia, but to the rest of us it’s “pins and needles”. And here’s how it works.

Our bodies contain miles of nerves and blood vessels. Most people know that nerves carry messages as electrical impulses to and from our brain, and blood carries oxygen and nutrients to our organs. What people are less familiar with is the fact that nerves also need blood vessels and blood vessels need nerves.

Nerves are made of living cells and there are special blood vessels called vasa nervorum that deliver oxygen and other nutrients to them. Blood vessels also need nerves to ensure the body is kept at the right temperature and the right amount of blood gets to where it needs to be. Nerves help change the diameter of blood vessels. For example, when we run, nerves widen blood vessels so that more blood can get to the muscles in our arms and legs.

Any compression of nerves or the blood vessels supplying them interferes with the ability of the nerves to transmit impulses back to the spinal cord and brain, so the brain interprets the lack of signals or abnormal signals as pins and needles in the affected area. Long-term compression can progress from pins and needles to more permanent nerve damage or dysfunction.

When pins and needles gets serious

Some forms of pins and needles are caused by occupation or lifestyle, such as carpal tunnel syndrome (CTS). This occurs when the median nerve, which passes through the carpal tunnel (formed by the carpal bones in the hand and a fibrous band of tissue forming a bridge across the bones), becomes compressed by inflamed tendons that also pass through this “tunnel”.

People who use equipment that vibrates, such as pneumatic drills or orbital sanders, are at increased risk of CTS, as are people who play musical instruments or use computer keyboards for long periods of time. These kinds of activities cause stresses and strains through the wrist and carpal tunnel that can pinch the median nerve.

Carpal tunnel syndrome symptoms can be temporarily relieved by shaking the affected hand. But in the longer term it can disappear on its own through ceasing the aggravating activity or by wearing a wrist splint to keep the wrist straight. In some cases, surgery is needed.

Lifestyle induced

While CTS is usually caused by hard work, Saturday night palsy, as the name suggests, usually results from letting your hair down. People get Saturday night palsy when they “fall asleep” with their arm hanging over something, like a chair, bar stool or edge of the bed. Initial pressure causes pins and needles, but this can progress quickly to longer-term damage in the form of palsy.

Saturday night palsy affects the radial nerve in the arm (see diagram above). It is usually damaged at its location next to the biceps muscle and is the most commonly injured nerve in the arm. One study showed more than 70 per cent of reported injuries involved alcohol in some form, and over 75 per cent of people with the condition compressed the nerve for more than two hours, resulting in recovery that took weeks. Evidence shows that this type of alcohol-induced injury is also on the rise.

The same nerve can be injured in another type of palsy. This one is called “honeymoon palsy”. It happens when your partner lays or sleeps on your arm or leg for so long that it causes palsy.

Tight jeans

“Tingling thigh syndrome” and “tight jean syndrome” are terms for a medical condition known as meralgia paresthetica. It is experienced as pins and needles in the outer part of the thigh. These result from compression of a nerve called the “lateral cutaneous nerve of the thigh” – meaning the nerve supplying the skin of the lateral thigh.

There are many causes, most widely seen are those associated with trousers that are too tight around the waist; carrying a wallet, keys or phones in pockets; as well as impact to the thigh during sports, such as the asymmetric bars.

While many of the examples listed above are temporary, there are some instances where pins and needles shouldn’t be ignored. For example, tingling in the lips can indicate a food allergy or a stroke. Tingling in the hands and feet can also indicate mineral or vitamin deficiency. So pins and needles is a way of telling you that something is wrong, although most of the time, the cause is benign.

 

 What is claudication

Claudication is a common condition in which pain occurs in the legs with exercise. The pain is the result of a reduction in the bloodflow to the muscles of the legs. 

What causes claudication?

The cause of claudication is hardening of the arteries (called atherosclerosis). Arteries are the blood vessels that supply oxygen and nutrients to the tissues, including muscles. When you walk, the leg muscles need more oxygen than when you are at rest. Muscles become painful if they can't get enough oxygen. After you rest your muscles, the oxygen levels in them return to normal and it is possible to walk again for about the same distance before the pain returns. 

How will I know if I have claudication?

The most common symptom is a cramp-like pain developing in the calf muscles when you walk. The thigh and buttock muscles can also be painful. If you rest briefly, the pain goes away and you will find it comfortable to walk again. 

Tests for claudication

Doctors use the distance that you can walk along flat ground (not uphill) before the pain starts as a rough guide to the severity of your condition. Doctors will examine the pulses in the leg to see if they are weaker than normal or absent. To confirm their diagnosis, they can measure the blood pressure in your legs when you are at rest, and after you have walked on a treadmill. 

Treatment of claudication

The most important part of the treatment for claudication is to make sure your arteries do not get any worse. 

Atherosclerosis affects not only the arteries in your leg, but also those to your heart (which can cause heart attacks), and to your brain (which can cause strokes). Claudication can, therefore, be a warning of more serious disease.

·       If you smoke, it is vital that you stop smoking completely. 

·       You will also be tested for diabetes, high blood pressure (called hypertension) and raised cholesterol. If these are thought to be contributing to the atherosclerosis, you might need to go on a special diet or take some medication. 

·       If you are overweight, losing weight will help your arteries and enable you to walk further. 

·       To help your arteries, your doctor might advise you to take a small dose of aspirin once a day. 

·       Regular exercise is also good for the legs.

Walking will help

When you have claudication, walking can be frustrating because of the frequent stops that are necessary when the legs become painful. However, it is important to persist and try to walk each day, increasing the distance as the legs improve. 

Do not try to 'walk through the pain'. 

Over a period of three to six months, the muscles in the legs will become more efficient, enabling you to walk further on the limited blood supply. In addition, the bloodflow in the leg(s) will increase as smaller non-diseased arteries increase in size. 

It is actually uncommon for the legs to get worse. Many patients are worried that they might have to have part of their leg removed. If you receive appropriate treatment and look after yourself, this is extremely unlikely and not a cause for concern. 

If the claudication remains troublesome, then you will need an ultrasound scan of the leg (which uses sound waves to see the bloodflow) or an angiogram (a type of X-ray with contrast medium injected) to see exactly where the narrowings or blockages in the arteries are. 

Angiograms

Angiograms are performed on an X-ray table and take approx. 20 to 30 min. Using a local anaesthetic, a needle is placed in the artery in your groin and a wire and catheter are passed into the artery so that dye can be injected. Using an X-ray to detect the dye, doctors can see where arteries are blocked or narrowed. 

Angioplasty

Doctors can treat some narrowings and blockages in your arteries using a special balloon to stretch the artery open again. This operation is called an angioplasty. It is similar to having an angiogram, except you will feel a little discomfort while the artery is actually being stretched. 

If there is a long or very hard blockage in the artery, it might not be possible to do an angioplasty. In these circumstances, if the claudication is bad, a bypass operation will be considered and discussed with you. This provides a parallel blood supply to the tissues but means taking a vessel from another part of your body.

In some cases, the risks of angioplasty or bypass surgery are too high, and a longer period spent exercising, losing weight etc is needed before the surgery can be considered.

These operations are all highly advanced, and discussion about them (including their risks and benefits) should always be between the patient and a specialist surgeon. Referrals can only be accepted from general practitioners or other specialists.

 

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