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.[1,2]
Severe pain in the affected limbs Burning type of pain which may awake the patient at night from sleep.[2]
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.[1,2]
Gender of the patient Found mainly in middle aged women.[1,2]
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.[3]
References
  1. 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
  2. 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
  3. 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

Examination

Fact Explanation
Marked tenderness of the forearm Particularly in the extensor muscles and sometimes in the thenar and adductor muscles of the hand.[1,2]
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.[2,3]
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.[2]
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.[2,3]
Cyanosis of the digits with coldness Found only in few patients, as a result of compression of the subclavian artery compromising the blood flow.[2]
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.[3]
References
  1. 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
  2. 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
  3. 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

Differential Diagnoses

Fact Explanation
Vitamin D deficiency Known to cause numbness, tingling sensations in the fingers.[1,3]
Polyneuritis Paraesthesiae in the fingers can occur in polyneuritis due to variety of causes.[2,3]
Protrusion of cervical disks Paraesthesiae in the fingers are common with a lateral disk protrusion compressing an emerging nerve root, but in the early stages there are often pain and stiffness of the neck aggravation of the pain by certain movements of the neck, and impairment of one or more of the arm jerks.[2]
Cervical spondylosis In cervical spondylosis, with encroachment by osteophytes on the intervertebral foramina and fibrosis of the root sleeves, pain in the arms and paraesthesiae in the fingers may also occur.[2]
Diseases of the spinal cord Such as disseminated sclerosis or subacute combined degeneration of the cord, but in these disorders they are usuallypresent by day as well as by night and are accompanied by abnormal physical signs.[2]
References
  1. GLERUP H, ERIKSEN EF. Acroparaesthesia--a typical finding in vitamin D deficiency. Rheumatology (Oxford) [online] 1999 May, 38(5):482 [viewed 31 August 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/10371298
  2. 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
  3. 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

Investigations - for 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.[1]
Electrodiagnostic studies (nerve conduction studies and electromyography) Should be done only if clinically indicated and when there is diagnostic uncertinity.[2]
References
  1. 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
  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

Management - Specific Treatments

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.[1,2,3]
0.5% procaine injection Inject into the tender areas found in the extensor muscles.[1]
Massage with regional exercises Massage to the shoulder girdles and general tonic treatment tend to prevent recurrence.[2]
Analgesics Analgesics also have their uses in some cases as an adjuvant to relieve associated pain.[2]
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.[3]
References
  1. 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
  2. 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
  3. 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