Expert: Dr. J. Shawn Leatherman - 12/11/2006

Question
For a little over a week I have been having pain in my left leg and my left foot nearly falling asleep. It never quite falls all the way asleep, so I always have at least some feeling. For the first few days the achiness in my leg and the numbness and tingling in my foot were constant. Now it seems to come and go, but it mostly happens when I'm laying in bed at night, or when I'm sitting. I'm 24 years old and would say that I've always had fairly poor circulation, my feet fall alseep very quickly but not just from sitting or laying down. I was just wondering what could be causing this. I don't have any sharp pains, just an over all ache. When I'm sitting, the most pain is right at the top of my leg. And the last couple of days my left arm is feeling the same as my leg, a little achey with somewhat tingly fingers. But my arm is not nearly as bad as my legs. Could it be a pinched nerve? Or bad circulation? I also don't know what sort of doctor I need to see, or if I need to see one at all. Thanks for any help you can give.

Answer
Dear Marie,

Pinched nerve is not the best description, and I really don't like what it implies, but people generally understand that concept.  Yes you can pinch a nerve, but not how most people think.  Usually there is some encroachment of the surrounding tissue which causes a local irritation and swelling around the nerve which can cause symptoms of tingling or numbness.  It is really more about inflammation of the nerve rather than a true compressive force pinching it.  Now when you get older and degeneration has set in, then pincing of the nerve by a mechanical means is more likely.

The problem is that poor circulation can cause the same symptoms.  I would also look for the hands/feet being cold to the touch, or you having a sensation of cold in the fingers or toes before i would blame it on circulatory problems.  To Test, press the fingernail/toenail beds and then release...if they quickly turn from white to pink, then your circulation is likely normal.  Obviously there are more sophisticated tests, but this one is quick and easy.

There is the possibility of nerve root encrochment in the low back causing these symptoms, but being 24, I wouldn't expect this unless something more was found on clinical examination.  Fibromyalgia should be considered, but there is specific criteria for that diagnosis including tender points on both sides, and the upper and lower body.  To have this more thoroughly checked any doctor will do...chiropractic or medical. Both are effectively trained to evaluate all of the above, and it would be a good idea to have normal blood testing as well to look for and rule out any abnormalities. Make sure that whatever doctor you chose, they actually perform a functional evaluation of the low back to include orthopedic tests to stress the anatomy.  

Respectfully,
Dr. J. Shawn Leatherman