Numbness and Tingling in Both Arms and Legs

Numbness and tingling are paresthesias. These are abnormal sensations or in the case of numbness, it is a lack of sensation. Both numbness and tingling can affect any part of the body. The limbs – arms (upper limbs) and legs (lower limbs) – are frequently affected with paresthesias like numbness and tingling. Other abnormal sensations like prickling or a burning sensation may also occur.

Paresthesias may occur only one arm or one leg. This usually indicates a problem with a nerve of that affected limb. However, when it affects both arms or both legs at the same time then it is most likely a problem with the nerve root or a systemic problem that can affect multiple nerves simultaneously. Some of these conditions may also cause numbness and tingling in both arms as well as both legs at the same time.

Peripheral Neuropathies

Peripheral neuropathy (Gk. peripheria = outer surface; neuropathy = nerve disease) is a group of disorders affecting nerves outside the brain and spinal cord. Sensory, motor and autonomic fibres of the spinal nerves and vagal nerve, can be affected and cause:

• Numbness, tingling, burning, pain or weakness in limbs
• Problems with coordination, muscle weakness, partial paralysis, falling from leg buckling or tripping over toes, problem with fine finger movements
• Difficulty breathing or swallowing
• Heat intolerance
• Dizziness at standing up
• Early satiety, diarrhea, constipation, unintentional weight loss
• Problems with urination
• Male impotence

Causes Due to Peripheral Neuropathies

Some of the possible causes of peripheral neuropathies resulting in arm or leg numbness or tingling as common symptoms:

1. Diabetic peripheral neuropathy (in type 1 or 2 diabetes mellitus) causes a “stocking-glove” (feet-hands) pattern of numbness.
2. Alcoholic neuropathy: long term excessive alcohol drinking, burning feet, wide-based gait
3. Rheumatoid arthritis: symmetrically swollen and warm joints in hands and/or feet, morning stiffness, numbness.
4. Vitamin B 12 deficiency: weakness due to anemia, paleness, sore mouth and tongue, loss of appetite, numb feet and hands.
5. Uremia (from kidney failure): weakness, uremic frost, itchy skin (throughout body), edema (puffy face in the morning), numbness in limbs, urine-like odor to the breath.
6. Lyme disease (disseminated form): severe fatigue and headache, behavioral changes, numbness in the limbs, problems with the eyes, heart or joints.
7. Hepatitis C: history of a drug abuse, numbness in limbs, and often NO jaundice or other liver-related symptoms.
8. Chronic inflammatory demyelinating polyneuropathy (CIDP) is an inflammation of peripheral nerves due to abnormal immune response; numbness or tingling usually starts in toes or fingers; arms and legs weakness, and fatigue are common.
9. Leprosy is largely confined to certain South Asian and African countries. Symptoms include rounded pigmentation on the limbs, numbness in hands (fingers) or feet (toes) and limbs deformities.
10. Amyloidosis: enlarged tongue, right upper abdominal fullness, numbness in hands/feet.
11. Friedreich’s ataxia: clumsiness, staggering or lurching gait, trembling when standing still, impaired speech, arm/legs numbness.
12. Colorado tick fever, transmitted by a tick bite, occurring in Colorado/US: fever, sensitivity to light, headache, severe muscle aches, difficulty walking and breathing and limb numbness.
13. POEMS syndrome includes polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy, and skin changes. The cause is uncertain; unusual skin sensation and weakness can appear in the limbs on both sides.

Brain and Spinal Disorders

Various disorders of the central nervous system (CNS), which includes the brain and spinal cord, can cause numbness and tingling in both arms and both legs.

1. Multiple sclerosis can cause numbness and tingling in various parts of the body, but rarely in a symmetrical pattern.
2. Stroke can cause sudden numbness on one side of the body, for example in the left arm and leg.

SPINAL DISORDERS

Disorders of the spinal cord or spine (vertebra), causing numbness and tingling in arms and/or legs:

1. Spinal cord injury. Injuries of the cervical spine result in symmetrical arm and leg paralysis and numbness. Injuries at the thoracic level affect trunk and legs, and lumbar and sacral injuries affect hips and legs. In most spinal cord injuries, urine and fecal incontinence appear.
2. Spinal tumors are rare, symptoms depend on their location and include back pain, arm or leg pain, weakness, numbness, partial paralysis, clumsiness, muscle spasms, bowel or bladder problems, or spinal deformity. Symptoms can develop gradually or suddenly.
3. Syringomyelia refers to a cyst (syrinx) in the spinal cord. Symptoms include pain, numbness, stiffness in the back, upper trunk, arms and legs.
4. Spinal arachnoid cysts are cysts around the spinal cord, which contain cerebrospinal fluid. Symptoms: back and leg pain and tingling or numbness in the legs or arms that worsen with time.

Circulation Disorders

Causes of impaired circulation resulting in arm/leg numbness or tingling:

1. Peripheral arterial disease is narrowing of arteries due to their calcification (arteriosclerosis). Affected legs (or arms) can be pale, with blue/red discoloration, cold, painful, tingling or numb.
2. Buerger’s disease usually develops in heavy smokers and causes pain, numbness and tingling in the feet and/or hands triggered by exercise and relieved by rest; ulcers on fingers/toes may appear.
3. Raynaud disease is where the arteries at the tips of the hands and feet suddenly narrows and restricts blood supply. It may be triggered by cold or stress but the exact cause is unknown.
4. Frostbite: pale, bluish, numb skin on fingers, toes, nose and ears due to prolonged exposure to low temperatures. This may be seen in frostnip and chillblains prior to frostbite arising.
5. Polyarteritis nodosa is a type of vasculitis, affecting medium-sized arteries: painful skin changes on the legs, partial limb paralysis, numbness in arms/legs, fever and weight loss.
6. Chronic necrotizing vasculitis is a rare vasculitis affecting arterial walls and causing fever, red spots on limbs, numbness and tingling in the toes, fingers, feet and hands

Toxins and Poisoning

There are various naturally occurring and synthetic toxins that can cause various symptoms, including tingling and numbness in both arms and legs. Some of these toxins may not cause any significant symptoms in small quantities.

1. Fish or shellfish poisoning:
   • Ciguatera poisoning: Certain big tropical fish, like tuna or barracuda, accumulate ciguatoxin from reef algae and can, usually few minutes to 30 hours after ingestion, cause tingling or itching in and around the lips, both arms and legs, or elsewhere on the body, reversal of hot/cold sensations, nausea, diarrhea, excessive sweating, headache, and muscle aches. Symptoms may last from few days to several months.
   • Paralytic shellfish poisoning: Shellfish like mussels, cockles, clams, scallops, oysters, crabs and lobsters can, usually 15 minutes to 10 hours after eating, cause numbness or tingling of the face, arms, and legs, followed by headache, dizziness, nausea, and muscular incoordination or floating sensation. In severe poisoning, muscle paralysis and death may occur in 2 to 25 hours.
   • Neurotoxic shellfish poisoning: Caused by a toxin accumulated in oysters, clams and mussels. Within 1 to 3 hours after eating, numbness, tingling in the mouth, arms and legs, incoordination, and gastrointestinal upset and reversal of hot/cold sensations can appear; spontaneous recovery usually occurs within 2-3 days.
2. Arsenic poisoning symptoms include discoloration of the skin, numbness in hands and feet partial paralysis and sometimes blindness.
3. Lead poisoning symptoms include headaches, abdominal pain, joint and muscle aches, numbness and tingling in the limbs, high blood pressure (hypertension) and constipation.

References

1. Peripheral neuropathy: common causes. Right Diagnosis

Last updated on September 8, 2018.