Tingling

Thoracic outlet syndrome is a combination of pain in the neck and shoulder, numbness and tingling of the fingers, and a weak grip. The thoracic outlet is the area between the rib cage and collar bone. Causes Blood vessels and nerves coming from the spine or major blood vessels of the body pass through a narrow space near the shoulder and collarbone on their way to the arms. As they pass by or through the collarbone (clavicle) and upper ribs, they may not have enough space.

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Touch localization is performed by light pressure for an instant with the examiner's fingertip or a wisp of cottonwool; the patient, whose eyes are closed, is required to identify the site of touch with the fingertip. Bilateral simultaneous stimulation at analogous sites (e.g., the dorsum of both hands) can be carried out to determine whether the perception of touch is extinguished consistently on one side or the other. The phenomenon is referred to as extinction.

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Spinal Cord (See also Chap. 372) If the spinal cord is transected, all sensation is lost below the level of transection. Bladder and bowel function are also lost, as is motor function. Hemisection of the spinal cord produces the Brown-Séquard syndrome, with absent pain and temperature sensation contralaterally and loss of proprioceptive sensation and power ipsilaterally below the lesion (see Figs. 25-1 and 372-1). Numbness or paresthesias in both feet may arise from a spinal cord lesion; this is especially likely when the upper level of the sensory loss extends to the trunk.

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Anterior view of dermatomes (left) and cutaneous areas (right) supplied by individual peripheral nerves. (Modified from MB Carpenter and J Sutin, in Human Neuroanatomy, 8th ed, Baltimore, Williams & Wilkins, 1983.) Figure 25-3 Posterior view of dermatomes (left) and cutaneous areas (right) supplied by individual peripheral nerves. (Modified from MB Carpenter and J Sutin, in Human Neuroanatomy, 8th ed, Baltimore, Williams & Wilkins, 1983.)Temperature sensation, to both hot and cold, is best tested with small containers filled with water of the desired temperature.

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Examination of Sensation The main components of the sensory examination are tests of primary sensation (pain, touch, vibration, joint position, and thermal sensation; Table 251).

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Anatomy of Sensation Cutaneous afferent innervation is conveyed by a rich variety of receptors, both naked nerve endings (nociceptors and thermoreceptors) and encapsulated terminals (mechanoreceptors). Each type of receptor has its own set of sensitivities to specific stimuli, size and distinctness of receptive fields, and adaptational qualities. Much of the knowledge about these receptors has come from the development of techniques to study single intact nerve fibers intraneurally in awake, unanesthetized human subjects.

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Harrison's Internal Medicine Chapter 25. Numbness, Tingling, and Sensory Loss Numbness, Tingling, and Sensory Loss: Introduction Normal somatic sensation reflects a continuous monitoring process, little of which reaches consciousness under ordinary conditions. By contrast, disordered sensation, particularly when experienced as painful, is alarming and dominates the sufferer's attention. Physicians should be able to recognize abnormal sensations by how they are described, know their type and likely site of origin, and understand their implications. Pain is considered separately in Chap.

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Harrison's Internal Medicine Chapter 22. Dizziness and Vertigo Dizziness and Vertigo: Introduction Dizziness is a common and often vexing symptom. Patients use the term to encompass a variety of sensations, including those that seem semantically appropriate (e.g., lightheadedness, faintness, spinning, giddiness) and those that are misleadingly inappropriate, such as mental confusion, blurred vision, headache, or tingling.

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