In around one in ten people, prolonged inactivity can trigger an uncomfortable need for exercise. Long bus rides, chilling out in bed or even an afternoon in the cinema trigger unpleasant sensations in the lower limbs, which can only be alleviated by repositioning the legs.
Without a clear cause or objective diagnostic options, restless legs syndrome (RLS) could affect more people than we are aware of, which makes it one of the most common neurological disorders worldwide.
For all its secrets, our knowledge of RLS is light years ahead of a similar syndrome that affects the arms and shoulders.
With so few cases in the literature, it is easy to assume that restless arm syndrome (RAS) is comparatively rare. However, case studies of the few examples we know of show that people tend to suffer in silence long before diagnosis.
Pain therapists Ulrich Moser and Jasmin Schwab from the Bavarian State Medical Association in Germany now suspect that reports of RAS may not reflect the true prevalence, especially in mild and less chronic forms.
Her most recent report focuses on the case of a 66-year-old male patient who had back pain and discomfort in his right shoulder for more than 20 years.
Visits to radiologists, neurologists, and rheumatologists did not bring long-term relief. He was given anti-inflammatory drugs. I gave acupuncture an injection. Massage, transcutaneous electrical nerve stimulation, and even a visit to the chiropractor did not correct his condition.
In March 2017, the patient visited Moser and reported his symptoms of pressing, stabbing and deep pain.
His back pain subsided with treatment, but a follow-up appointment in 2020 brought reports of new symptoms – severe pain and a feeling of restlessness in both hands and forearms that had steadily worsened over the past two years.
An orthopedic surgeon ordered surgery and non-steroidal anti-inflammatory drug treatment, thinking it might be a case of “snap” or “trigger finger” and maybe some arthritis. Unfortunately, the patient’s complaints persisted.
The symptoms were scary like restless legs syndrome. During the day, when you were moving and exercising, everything seemed fine. Only in relaxation phases did the sharp, tingling, burning sensations intensify.
Interestingly, the discomfort was only in his arms. He had never experienced such sensations in his legs before, not even the slightest. Although we know little about the mechanisms behind restless legs syndrome, we have some ideas on how to relieve its symptoms.
After other possible causes had been ruled out and essentially all boxes for severe RLS had been ticked – albeit in the arms – Moser prescribed medication typical of restless legs, which provided an additional dopamine kick in the brain.
The result for our patient is good, she has continued the treatment since then without any side effects.
But the case required some investigation, which raised the question of how many people with similar experiences might be out there.
“The patient reported here had symptoms for many years that could indicate restless arm syndrome,” report Moser and his colleague Schwab.
“In the past two years these symptoms had worsened massively and the major diagnostic criteria of the International Restless Legs Syndrome Study Group were met in full, except that the symptoms only occurred in the upper extremities.”
If what doctors learn about RLS could be applied to the upper limbs, it could provide plenty of relief to patients whose diagnosis is being tested for a range of unrelated conditions, from arthritis to the trigger finger.
Conversely, there could be subtle differences that help improve therapies or even lead to a better understanding of restlessness in general.
It is an area of research that we should definitely pursue.
This research was published in BMJ Case Reports.