What is restless arm syndrome?

Restless arm syndrome refers to a specific and peculiar problem in the central nervous system that causes abnormal movements and sensations in the arms.

Patients typically complain of strange sensations in the arms such as

• crawling sensations
• tingling sensations
• involuntary jerky arm movements
• an urge to move the arms
• disturbed sleep.

Symptoms may be limited to the arms, or in some cases, other parts of the body may also be affected.

Restless arm syndrome is related to the more commonly known condition "restless leg syndrome". A more accurate description could be “restless limbs”, because it's not just the legs that can be affected, but also other part of the limbs such as the arms, shoulders, and elbows.

CAUSES OF RESTLESS ARM SYNDROME

In many cases, there is no known direct or specific cause of restless arm syndrome. Researchers and the medical community think it may be due to:

1) Genetics

It is theorized that there is a familial link or relation in over 50% of cases of restless limbs.

It is an autosomal dominant condition meaning that if you suffer from it, there is a 50% chance that you will pass it on to any child you have (depending on which condition is more dominant).

2) Dopamine Imbalance

Dopamine is a chemical neurotransmitter that relays and passes messages between the brain and the nervous system, which helps to control and co-ordinate movement. If our natural dopamine levels drop, it may cause muscle spasms or the arms to move involuntarily (to which we'd need to start on dopamine supplements to help with dopaminergic levels).

3) Underlying Health Condition

There are a number of medical conditions associated with restless arm syndrome including:

• Parkinson’s Disease
• Chronic kidney disease
• Vitamin 12 deficiency
• Fibromyalgia.

4) Iron Deficiency Anaemia

Low levels of red blood cells result in reduced iron levels, which leads to a drop in dopamine levels

5) Pregnancy

Statistics show that around 40% of pregnant women experience symptoms of restless leg syndrome, which may also cause or lead to restless symptoms in the arms.

It is most common in the third trimester, but unfortunately the reason for this is unknown. Symptoms typically resolve naturally within a few days or weeks of giving birth.

POTENTIAL TRIGGERS

Triggers are things that do not cause restless arm syndrome directly, but can make symptoms worse. Triggers for restless arm and leg syndrome include:

1) Medications: Such as anti-depressants, anti-histamines, antipsychotics and calcium channel blockers.

2) Caffeine: People often find that consuming caffeinated drinks such as tea, coffee or Coca Cola make their symptoms worse or more frequent.

3) Lack of Exercise: Being inactive and living a sedentary lifestyle may contribute to restless arm syndrome (it is reported moreso in sedentary patients moreso than active patients).

4) Stress: Stress and anxiety can trigger an attack of restless arm syndrome.

CLASSIFICATION TYPES

Restless arm / leg syndrome can be categorised into two different types:

Primary:

Also known as idiopathic restless limb syndrome, which has no clear or known direct or indirect causes.

Typically, the condition develops slowly, with symptoms appearing before the age of 40 – 45 years.

There is usually a familial or genetic history.

Patients typically experience and report that their symptoms come and go. The symptoms may last a few months at a time, and the condition tends to get gradually worse (e.g. symptoms are more frequent and last longer) with age and time.

Secondary:

This type is known as "secondary" restless limb syndrome. It usually develops suddenly, and often is associated with another medical condition or certain medications.

Symptoms tends to first appear over the age of 45 but do not worsen with time.

Restless leg syndrome affects approximately 10% of the population, and approximately one quarter of those sufferers (2.5% of the population as a whole) will also be affected by restless arm syndrome symptoms.

SYMPTOMS OF RESTLESS ARM SYNDROME

Restless arm syndrome can have a variety of symptoms and can differ a lot amongst patients in terms of severity, frequency and duration.

Symptoms may include:

1) Involuntary Arm Movements

Patients tend to experience sudden, jerky, uncontrollable movements in the arms, and in some cases other body parts as well, most commonly the legs.

2) Odd Sensations

Patients with restless arm syndrome often report feeling strange sensations in their arms such as:

• tingling
• burning
• numbness
• tickling
• buzzing
• itching
• sensations described as "like a creepy crawly crawling over you".

The strange sensations associated with restless limbs can also give you a strong intense desire and urge to want to move the affected arm or leg as quickly as you can.

3) Daily Pattern

Symptoms of restless limbs can be worse in the evenings and overnight, or when resting or relaxing.

As a result, sleep is often affected. Some patients may experience symptoms throughout the day, but symptoms tend to be less severe in the mornings.

4) Sleep Disturbance

Restless limb syndrome will often affect sleep duration and quality.

The strange sensations and involuntary arm movements can make it difficult to get to sleep, difficult to reach deep sleep and may wake you up.

Then a vicious cycle starts to form - symptoms are often worse when you are tired, but as a result it is harder to get a good night's sleep, so you get even more tired and the cycle continues.

4) Difficulty Sitting Still

People often find that their symptoms happen or are triggered when they rest or sit still for long periods, e.g. on a car/train journey or when watching television.

5) Relief With Movement

Patients typically find that moving their arms, doing some simple exercises or rubbing/massaging their affected arms can help to reduce symptoms of restless arm syndrome.

6) Periodic Limb Movement Disorder (PLMD)

Many patients with restless arm syndrome will experience restless limb movements at night.

This is where the arm jerks or twitches uncontrollably, for short bursts of time with a repetitive pattern. This unfortunately tends to happen when you are asleep and may wake you and your partner up.

Patients can also get periodic limb movements when they are awake but this is less common.

DIAGNOSING RESTLESS LIMBS

There is no specific test for diagnosing restless limb syndrome and it can take a long time to get a definitive diagnosis.

Your doctor will usually run various tests to rule out other conditions such as vitamin deficiency or other neurological conditions.

They will want to get a clear picture of your symptoms including

• frequency
• duration
• daily pattern
• intensity.

The National Institute for Neurological Disorders & Stroke highlight four criteria for diagnosing restless limb syndrome:

1. Symptoms are worse at night with minimal or no symptoms in the morning
2. A strong, often overwhelming need to move the affected body parts and limb(s)
3. Sensory symptoms that are triggered by rest, relaxation or sleep
4. Sensory symptoms that ease with movement – symptom relief persists as long as the limb is kept moving.

If you are diagnosed with restless arm syndrome, you should have your iron levels checked.

WHAT ARE YOUR TREATMENT OPTIONS IF YOU HAVE RESTLESS ARM SYNDROME?

Treatment for restless arm syndrome looks to reduce the symptoms of the condition such as the intensity and/or frequency of symptoms, including how much sleep is affected.

Treatment may include:

1) Medication

Drugs to help increase the levels of dopamine (known as dopaminergic agents) can be very effective and tend to be tried first, however caution must be used, as long term medication use can actually make symptoms worse.

Other medications that may be prescribed include:

• levodopa (for occasional symptoms)
• opioids (such as codeine)
• anti-convulsants (such as gabapentin).

Some medications can make the symptoms of restless limbs worse in some individuals, including sedating anti-histamines, cold and flu remedies, anti-depressants, antacids and tricyclic medications.

2) Supplements

Supplements such as iron, magnesium and folate can help reduce symptoms, although they are only recommended if your levels are low. Please consult with your doctor before taking any supplements.

3) Sleep Pattern

Having a regular sleep pattern can help with restless arm syndrome.

• Adopt good habits – try to go to bed at around the same time each evening and also get up at a consistent time in the mornings.
• Allow yourself time to wind down in the evening.
• Make sure your bed is for sleep only, not working or looking at screens.
• Make sure the room is the right temperature – symptoms can be worse if you are too hot.
• Symptoms are often worse when you are tired.

Some people find it helpful to keep a sleep diary.

4) Watch Your Intake

Cutting down your intake of

• caffeine
• alcohol
• tobacco / nicotine

will help reduce the symptoms of restless arm syndrome - avoid them completely after 6pm.

5) Exercise

Exercising regularly, but not excessively, during the day, and some gentle yoga and stretching before you go to bed can help to reduce symptoms.

6) Movement

Moving the affected limb usually helps to relieve symptoms almost instantly, but symptoms may return quickly once you stop. We recommend that you instead:

• take a short walk
• do some gentle stretches.

7) Massage

Massaging or rubbing the arms when symptoms of restless arm syndrome develop can help reduce symptoms. Regular deep tissue massage may help.

8) Treatment of Underlying Disease

If another medical condition, such as diabetes, is contributing to your restless arm syndrome, then treating or keeping that condition under control will usually reduce symptoms of restless arm syndrome.

9) Use Hot or Cold

Some of our patients report that applying heat (e.g. electrical heat pack) or cold therapy (e.g. ice) to their arms, and in some cases, alternating between the two, helps to reduce their symptoms.

Ensure you do this safely - only apply for ten minutes at a time and do not use this treatment if your sensation is compromised (e.g. you can't feel cold or heat very well).

10) Bath/Shower

Some people find that having a gentle warm or cool bath or shower before bed helps to relax their bodies and themselves.

PROGNOSIS

Unfortunately, symptoms of restless arm syndrome may gradually get worse over time, although this is more common in the primary form (secondary forms can subside once the main causes or medications have been taken cared of).

Symptoms can often fluctuate and may disappear completely for periods, but in most cases they will return after a few weeks or months. Please note that it is very important to rule out any underlying medical conditions.

If you suspect that you may be suffering from restless limbs, please see your doctor.

How can physiotherapy and hand therapy assist with restless arm syndrome?

Patients may receive the following physiotherapy and hand therapy treatment modalities:

• cold therapy
• moist heat paraffin wax therapy
• radio-frequency Indiba physiotherapy to accelerate soft tissue healing
• joint mobilization
• stretching exercises
• strengthening exercises
• scar management
• hands-on manipulation and mobilization (manual therapy)
• computerized spinal decompression traction
• soft tissue management
• heat therapy, heat treatment and heat packs to relieve tight muscles and joints
• ultrasound therapy to accelerate soft tissue healing
• exercise therapy
• acupuncture and/or dry needling
• deep tissue release

Phoenix Rehab offers the best hand therapy in Singapore, so do not hesitate to book today!

References

• https://www.shoulder-pain-explained.com/restless-arm-syndrome.html