The parenthesis is a medical condition characterized by burning sensations, numbness, picot tingling or itching, usually felt in the upper (arms and hands) and lower extremities (legs and feet) (National Institute of Neurological Disorders and Stroke, 2015).
It usually occurs on a hand or foot and does not usually cause pain. Patients frequently report sensations of numbness, tingling, and numbness in the hands, legs, arms, face, feet, or other parts of the body (National Institute of Neurological Disorders and Stroke, 2015).
These types of sensations may be transient or permanent. In most cases, it is a temporary pathology that is usually caused by the existence of pressure on one of the nerves. However, it can also be a symptom of acquired injury or a wide variety of diseases or disorders that cause damage to the nervous system.
These sensitive symptoms, especially in the upper limbs, are often a frequent reason for consultation in primary care services. In most cases, it is due to the development of a degenerative pathology or nerve entrapment neuropathies.
Due to the fact that they deal with mild and not very explicit symptoms, in many cases, an incomplete evaluation tends to be performed, underestimating some of the symptoms that may be alarm signals of other more severe pathologies (Barrio Ruiz and Mendoza Linguine, 2013).
What is paraesthesia?
At different times, many of us after sitting cross-legged for a while or if we lean for a long time on an arm, we feel a tingling sensation or say that we “fall asleep” a foot or an arm. We experience parenthesis, i.e., feeling pricked, numb or burning, by the foot or arm, annoying without causing pain.
The stimulation and sensations of the different parts of our body are transported by the peripheral nerves to the spinal cord. From the spinal nerves, the signals are conveyed to the brain through the brain stem. Thus, some interruption in this signaling pathway may result in the development of parenthesis (Sharif-Alhoseini et al., 2012).
Therefore, this type of nuisance sensations occurs as a result of pressure on certain nerves.
In addition, they can occur as a result of different conditions, diseases, or disorders that are going to cause nerve damage. Some of the causes may be: brain tumor, stroke, anemia, encephalitis, diabetes, multiple sclerosis, peripheral neuropathy, among others.
Symptoms of parenthesis
People with parenthesis often describe the symptoms and signs they feel through multiple terms. Among them we can highlight: burning, numbness, itching and / or tingling.
Many patients refer to symptoms such as:
- “Abnormal sensations such as itching, pricking as with pins and needles”.
- “I feel like burning and stinging by the hands and feet.”
- “I feel the padded hands and I find it difficult to move them.”
Symptoms usually occur more often in the arms, legs, hands and feet, but may also occur in other parts of the body.
Parenthesis is usually a symptom of other diseases, conditions or neurological disorders, so that parenthesis can also lead to some of the following symptoms:
- Fallen foot.
- Muscular atrophy.
- Ocular dysmetria.
- Restless leg syndrome.
- Difficulty getting to sleep.
- Tingling sensation in the skin.
In spite of this symptomatic description, these will vary depending on the nerves that are involved and the severity of the alteration. For example, the pressure of the lunar nerve can cause parenthesis in the little finger and in various areas of the hand.
How long does parenthesis last?
It is normal for parenthesis to occur temporarily due to some activity or position that exerts prolonged pressure on one or more nerves. It is frequent that it appears when crossing the legs, when sitting for a long time, to sleep supported on one of the upper extremities, etc. Therefore, annoying sensations often disappear when the pressure is relieved.
However it can also present more severely and even permanent / chronic due to orthopedic disorders or neurological conditions that cause permanent damage to the nervous system. In addition, in more than one case, parenthesis is a primary manifestation of some type of serious pathology.
Causes of Parenthesis
Causes of transient par aesthesia
The temporary condition will cause a tingling and / or numbness that disappear quickly. Some causes are described below (Sharif-Alhoseini et al., 2012):
- “Obdormition”: this term refers to the numbness that occurs as a result of prolonged pressure on a nerve. The recovery is immediate.
- Cervical whiplash: After presenting this type of pathologies, lesions in the soft tissue of the cervix can causeparestheticsensations. Recovery is usually gradual over a period of six months.
- Hyperventilation syndrome: sensations of parenthesis may appear in approximately 35% of patients, only three minutes after
- Hyperventilation begins.
- Panic attacks: parenthesis in the mouth, hands, and feet are often associated with panic attacks and hyperventilation.
- Transient ischemic attack: Some conditions such as thrombosis or embolism can interrupt the normal flow of oxygen to the nervous system and therefore temporarily (or permanently) affect the nerve pathways.
- Seizures: There may be feelings of numbness and numbness both during and after a partial seizure. The vague nerve stimulation in anticonvulsant therapy can also cause any of these symptoms.
- Dehydration: Significant loss of body water can also lead to parenthesis.
- Circulatory insufficiency: Some circulatory disorders may temporarily (or permanently) affect the nerves and therefore cause parenthesis.
Causes of prolonged or chronic parenthesis
When the symptoms of parenthesis begin to appear regularly or intermittently it could be indicative of a more serious problem. It is usually a sign of neurological disease or traumatic injury (Sharif-Alhoseini et al., 2012).
Usually, it often appears due to an infection, inflammation, trauma or abnormal process that affects the nerves. It is less frequent to appear associated with disorders that endanger the life of the individual; however, it can occur due to the suffering of cerebrovascular disorders and / or tumors (Sharif-Alhoseini et al., 2012).
Disorders of the nervous system: this pathology is often present associated with alterations in both the central and peripheral nervous system.
CNS: stroke, intracerebral hemorrhages, lacunars infarcts, brain tumors, cranioencephalic trauma, encephalitis / meningitis, abscesses, lumbar stenos is systemic lupus erythematosus, multiple sclerosis, transverse mellitus, lumbar puncture, vitamin b12 deficiency, etc.
– Neuropathy, peripheral neuropathy, treatment neuropathy, carpal tunnel syndrome, lateral femoral coetaneous syndrome, femoral neuropathy, tarsal tunnel syndrome , sciatica, disc hernia ion, cervical spondylosis, pressure paralysis, Charcot-Marie-Tooth disorder, amyloidal neuropathy, neuralgia, etc.
- Circulatory Disorders: Insufficient blood supply can lead to both transient and permanent par aesthesia. These may be due to arterial, venous or neurogenic syndromes.
- Metabolic disorders: diabetes, alcoholism, hypoglycemia, hypothyroidism, hyperparathyroidism, menopause, abnormal levels of calcium / potassium / sodium, uremia, amyloidosis, etc.
- Infectious diseases: herpes simplex, herpes zoster, canker sores, disorder Lyme, human immunodeficiency virus, leprosy, syphilis, Guillain-Barre syndrome, rabies, etc.
- Autoimmune disorders: rheumatoid arthritis, lupus, Jorgen’s syndrome, anemia, diabetes, arthritis, fibromyalgia, nutritional deficiency.
- Vitamin deities: b12, b1, b5, b6.
- Other factors: alcoholism, tobacco use, drugs of abuse, heavy metals, nitrous oxide, carbon monoxide, etc.
Prognosis of people with parenthesis
The transient processes usually disappear when the pressure is reversed however; the treatment of the chronic processes involves the treatment of the etiological pathologies that will be different for each one of them.
In addition, par aesthesia may in turn cause different complications in the underlying disease or disorder. Many people with parenthesis may show bruising, wandering, or difficulty gripping.
Because it is a pathology that affects the nervous system there is a risk of suffering from chronic pain, disability, breathing difficulties, paralysis and therefore a poor quality of life?
On the other hand, when the sensitivity is significantly affected, some individuals may be unable to perceive some injuries as a wound or burn, putting their lives at risk in some cases. In addition, numbness of the legs and feet, and especially loss of sensation can greatly increase the risk of falls.
The therapeutic intervention will focus mainly on the identification of the condition that causes parenthesis. The use of medical history, physical examination and different laboratory tests, will be essential for your determination.
In addition, it will also be important to determine whether it is a transient or chronic process because of the implications that the latter may have for the integrity of the individual’s nervous system.
Some of the questions that must be answered are:
– Where do you notice annoying or numb sensations?
– At what moment did you start to perceive them?
– How long do you feel them?
– Do you do some kind of activity that causes it?
Treatment for parenthesis
The choice of treatment for this condition will depend to a large extent on the cause that is causing it.
If par aesthesia is of a transient type, it will be useful to use pediatrics that try to restore circulation through exercise, massage, or stretching of the limb that is affected. These actions will make the sensation of tingling and numbness gradually disappears.
In the case of the prolonged presence of parenthesis, when due to secondary pathological causes, the treatment will be directed to the treatment of etiological diseases and the relief of symptoms. Some professionals recommend the use of anti-inflammatory such as ibuprofen or aspirin under medical prescription when symptoms are mild.
Apart from these, non-pharmacological interventions are being developed that include nutritional regulation, exercise, avoiding the consumption of alcohol or tobacco, which can help the patient to control the discomfort derived from their symptoms.
Parenthesis is a condition that can affect thousands of people daily, especially those who perform their work sitting or limiting their mobility significantly.
In addition, in many cases the adoption of abnormal postures during sleep can cause an alteration of the sleep and therefore cause sensations of lack of sleep or episodes of poor sleep.
When sensations of numbness and / or numbness occur on a prolonged basis it is essential that a medical examination be requested as it may be suggestive of the presence of a neurological pathology that endangers the life of the person.