Acroparaesthesia

Cardiovascular

Clinicals - History

Fact Explanation
Weakness/stiffness in the forearm Particularly in the morning, when they start their work. Also they tend to drop things from the affected hand. Patients also complain clumsy movements of the fingers and hand. Weakness/stiffness in the forearm
Particularly in the morning, when they start their work. Also they tend to drop things from the affected hand. Patients also complain clumsy movements of the fingers and hand.
Severe pain in the affected limbs Burning type of pain which may awake the patient at night from sleep. Severe pain in the affected limbs
Burning type of pain which may awake the patient at night from sleep.
Numbness, pins and needles in the fingers and hand Acroparaesthesia is a mechanically produced syndrome, where there is compression on the lower components of the brachial plexus. These sensory symptoms usually found bilaterally, associated with pain and often occur at night causing sleep disturbances. Numbness, pins and needles in the fingers and hand
Acroparaesthesia is a mechanically produced syndrome, where there is compression on the lower components of the brachial plexus. These sensory symptoms usually found bilaterally, associated with pain and often occur at night causing sleep disturbances.
Gender of the patient Found mainly in middle aged women. Gender of the patient
Found mainly in middle aged women.
History of predisposing condition The disorder may be associated with a local lesion at the wrist such as tenosynovitis of the flexor tendons, rheumatoid arthritis, a malunited fracture of the scaphoid, or a
Colles's fracture in which there is some encroachment on the carpal tunnel. It may also occur in generalized diseases such as acromegaly or myxoedema, in which there may be a reduction in size of the carpal tunnel, and it is also seen in pregnancy and occasionally seems to be familial in that two or three siblings may be affected.
History of predisposing condition
The disorder may be associated with a local lesion at the wrist such as tenosynovitis of the flexor tendons, rheumatoid arthritis, a malunited fracture of the scaphoid, or a
Colles's fracture in which there is some encroachment on the carpal tunnel. It may also occur in generalized diseases such as acromegaly or myxoedema, in which there may be a reduction in size of the carpal tunnel, and it is also seen in pregnancy and occasionally seems to be familial in that two or three siblings may be affected.

Clinicals - Examination

Fact Explanation
Marked tenderness of the forearm Particularly in the extensor muscles and sometimes in the thenar and adductor muscles of the hand. Marked tenderness of the forearm
Particularly in the extensor muscles and sometimes in the thenar and adductor muscles of the hand.
Muscle wasting Underlying mechanism of acroparaesthesia is mechanical in origin and due to a minor degree of compression of the brachial plexus. Only in some patients there is slight wasting, sometimes more easily felt than seen, on the outer side of the thenar eminence. Muscle wasting
Underlying mechanism of acroparaesthesia is mechanical in origin and due to a minor degree of compression of the brachial plexus. Only in some patients there is slight wasting, sometimes more easily felt than seen, on the outer side of the thenar eminence.
Decreased muscle power Associated pain and discomfort and the muscle tenderness may lead to some apparent weakness of grasp and clumsiness of finger movements can be observed. Decreased muscle power
Associated pain and discomfort and the muscle tenderness may lead to some apparent weakness of grasp and clumsiness of finger movements can be observed.
Sensory loss Objective sensory loss is exceptional, though when pain and paraesthesiae are maximal there may be some blunting of cutaneous sensibility over the digits. Sensory loss
Objective sensory loss is exceptional, though when pain and paraesthesiae are maximal there may be some blunting of cutaneous sensibility over the digits.
Cyanosis of the digits with coldness Found only in few patients, as a result of compression of the subclavian artery compromising the blood flow. Cyanosis of the digits with coldness
Found only in few patients, as a result of compression of the subclavian artery compromising the blood flow.
Positive signs suggestive of carpal tunnel syndrome - Tinel sign Compression of the median nerve in the carpal tunnel has been confirmed as a cause of acroparaesthesia. Positive signs suggestive of carpal tunnel syndrome - Tinel sign
Compression of the median nerve in the carpal tunnel has been confirmed as a cause of acroparaesthesia.

Investigations - Diagnosis

Fact Explanation
Plain X-ray of the affected limb Radiography reveals no abnormality except the lowering of the outer end of the clavicle already alluded to, but of course an occasional case of cervical rib is revealed in this way. Plain X-ray of the affected limb
Radiography reveals no abnormality except the lowering of the outer end of the clavicle already alluded to, but of course an occasional case of cervical rib is revealed in this way.
Electrodiagnostic studies (nerve conduction studies and electromyography) Should be done only if clinically indicated and when there is diagnostic uncertinity. Electrodiagnostic studies (nerve conduction studies and electromyography)
Should be done only if clinically indicated and when there is diagnostic uncertinity.

Management - Specific

Fact Explanation
Resting with arm support The symptoms characteristically respond to rest (either rest in bed or the simple cessation of manual work), but not to any other treatment modality unless rest accompanies them.
Supporting of the arms in slings whenever
possible should be also done to relieve symptoms.
Resting with arm support
The symptoms characteristically respond to rest (either rest in bed or the simple cessation of manual work), but not to any other treatment modality unless rest accompanies them.
Supporting of the arms in slings whenever
possible should be also done to relieve symptoms.
0.5% procaine injection Inject into the tender areas found in the extensor muscles. 0.5% procaine injection
Inject into the tender areas found in the extensor muscles.
Massage with regional exercises Massage to the shoulder girdles and general
tonic treatment tend to prevent recurrence.
Massage with regional exercises
Massage to the shoulder girdles and general
tonic treatment tend to prevent recurrence.
Analgesics Analgesics also have their uses in some cases as an adjuvant to relieve associated pain. Analgesics
Analgesics also have their uses in some cases as an adjuvant to relieve associated pain.
Surgical management Surgical division of the volar retinaculum is curative, but is needed only in some patients, since many obtain complete relief
of the nocturnal paraesthesiae by putting a light plaster splint on the wrist when they go to bed.
Surgical management
Surgical division of the volar retinaculum is curative, but is needed only in some patients, since many obtain complete relief
of the nocturnal paraesthesiae by putting a light plaster splint on the wrist when they go to bed.

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  1. ACROPARAESTHESIA and the carpal tunnel. Br Med J [online] 1959 May 9, 1(5131):1230-1 [viewed 31 August 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/13651695
  2. AZHARY H, FAROOQ MU, BHANUSHALI M, MAJID A, KASSAB MY. Peripheral neuropathy: differential diagnosis and management. Am Fam Physician [online] 2010 Apr 1, 81(7):887-92 [viewed 31 August 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/20353146
  3. MAGONET AP. Acroparaesthesia and its treatment. Br Med J [online] 1947 Jan 18, 1(4489):111 [viewed 30 August 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/20342945
  4. WALSHE FM. "Acroparaesthesia" and so-called "Neuritis" of Women's Hands and Arms. Br Med J [online] 1945 Nov 3, 2(4426):596-8 [viewed 30 August 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/20786373