How do you know if its a nerve or vascular issue?
 

My hands fall asleep very easily. And my toes are always cold. How do you distinguish between a nerve problem or circulation problem? I have normal blood pressure.

I have the cold toes and hands that fall asleep all the time as part of my symptoms as well. The last neuromuscular specialist I saw suggested that poor circulation due to my varicose veins could be causing (or at least contributing to) my problems.

I don't have an answer to your question at this time. But I do have an appointment with a vascular surgeon at the end of May to have this issue evaluated. I'll let you know what they do as far as testing, and any other info I find out.

I've done quite a bit of research online, and have found very few references to vascular issues causing the type of burning pain that I have - so I'm not very optimistic that this will lead anywhere. But at this point, the note is in my file that the NM specialist recommended a vascular evaluation - so the doctors won't want to pursue any other causes until I get the evaluation.

Sure would be nice if the doctor's would pursue more than one possibility at a time. I'd hate to find out what the cause of my problem is, only to find out that it's too late to do anything about it because the damage is done :mad:

I was thinking this too. I have varicose veins in my legs and arms (not face or back though...) and I keep seeing a commercial on tv that asks "if you have muscle spasms, burning etc. then we can help you treat your varicose veins and be rid of this"...
I keep asking my doc for a referral but he says no way this is due to vascular stuff... I guess it makes sense in my case cus I don't have varicose veins in my ears and scalp

Workup is the only way. Venous ultrasound and ABI (arterial brachial index) are noninvasive. Nerve conduction study would show a problem with large fiber nerves. That said there is a lot of neurovascular overlap that can get tricky to figure out or may not even be possible to if tests don't show anything glaring...

sorry, the point of my post was to say that apparently a varicose vein treatment center that advertises on tv reports these symptoms as being vascular.

Be careful of the "varicose vein treatment centers" that advertise on TV. If you may have something more serious than cosmetic issues related to varicose veins, be sure you are being treated by an actual vascular surgeon.

About 5 years ago, I had laser ablation of the greater saphenous vein in one leg, along with phlebectomy on numerous surface veins. That leg is now unfortunately getting bad again, and the other leg was already pretty bad 5 years ago but never treated. I have burning/pain in both feet, but worse on the leg that was never treated.

I did read a case study recently about a person who had a serious motor mononeuropathy that was causing intermittent weakness/foot drop due to a large varicose vein that was impinging on a nerve located behind the knee, so I guess it can happen.

My initial research into peripheral neuropathy came across vasculitis as a cause. My doctor told me I didn't have vasculitis so at this point I'm taking his word for it.

Vasculitis and arteritis are inflammation of the vessel walls due to a variety of reasons. This is totally different and nothing to do with venous or arterial flow or neurovascular issues.

Today I was laying down with my hands holding my head up from behind. Maybe 10 mins. Stood up and my hands had pins and needles. Took a good 20 seconds to go away.

Tunaboy that doesn't sound like anything out of the ordinary. Sounds like classic "falling asleep" sensation. Ahh the good ole days when the only tingling I ever had was from my hands or feet falling asleep.

It can be difficult--
 

--to distinguish symptoms of neuropathy from those of vascular insufficiency--especially since, technically, neuropathy can be caused by certain types of vascular insufficiency, either through the compressive effects from swelling putting pressure on nerves when blood flow is not normal and "pools", or through nerves being starved for nutrients and oxygen (and troubled in their removal of metabolic wastes) by lack of proper circulation. Diabetic neuropathy, for example, is though to be primarily an ischmeic/circulatory result; while high sugar levels can damage nerves directly they have a more widespread effect on capillaries, causing dysregulation of nitric oxide pathways and compromising blood flow to nerves. (And, of course, diabetes also leads to all sorts of things that start from compromised circulation--blindness, poor wound healing, coronary artery disease, kidney problems.)

I would think that if one's symptoms were PRIMARILY from peripheral artery disease, there would be more waxing and waning of symptoms, dependent on position and degree of exertion, whereas neuropathy symptoms would not be as dependent on these and be more constant.

A small percentage of population will have loss of blood flow with arms over head.

If you also have arm, elbow or hand pain /symptoms with it you may have a version of thoracic outlet syndrome. TOS for short. Previous whiplash, desk/computer/repetitive job are often factors..
for more info- post #1
http://neurotalk.psychcentral.com/thread84.html

I think they can analyze your punch biopsy for vasculitis. I'd have to recheck my results to confirm this.

So my symptoms in arms could result from TOS? just a possibility since my symptoms seem to fit. But would TOS cause burning feet? Or could I have two seperate conditions? Ugh...so tired of the guessing games. Counting down the days to my neuro appt. Hope I'm not completely disappointed.

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I thought I had TOS a few years back but according to the ortho doc I was seeing he said the pain would be rather significant which I wasn't having.

Many non TOS specialized drs , have only a basic & biased view of TOS.
Is it is not well understood and no imaging clearly proves it , unless there is a bony anomaly/ extra cervical rib, or if doppler shows compression on a blood supply.

Advanced PT's /chiropractors /bodyworkers often understand it better due to more intensive lessons on muscles, posture , function, fascia....

I did not have high pain which is usually nerve TOS, vascular TOS could be artery or vein related - it usually shows with swelling heaviness , possible clots, and veins showing, whit hands when up in air.. another TOS is called disputed - usually more related to long term chronic RSI's /forward head/forward/hunched shoulders postures.

Just mentioning it in case it may fit for someone.

I have always had poor posture including hunched shoulders. I'm wondering what issues this may cause down the road. I have improved my posture some but could be better.


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It shouldn't hurt to do some basic work on posture, here are some simple ideas that let gravity do most of the work..


http://neurotalk.psychcentral.com/pi...pictureid=5399

lay on foam roll or large towels rolled up tightly - pillow if needed for neck comfort - then just relax with arms at a comfortable position
http://neurotalk.psychcentral.com/pi...pictureid=5400


There are related videos on you tube also..if you want more details or how to do it.

Thanks Jomar...I like the exercise ball one especially. I will try it.