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Pins and needles, swollen ankles after fall. DVT?

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Problem: swollen outer ankles for one week, pins and needles in bed as well as prickly sensation in legs. Veins in hand large and painful when waking up but go away once up. Vein under ring finger has turned black and blue and sensitive to touch.

History: 41 year old female
134 lbs 5'5"
Cholesterol fine, blood sugar fine, blood pressure on lower normal range. Take no medication other than vitamin D 1,000 mg. Do not smoke and literally never drink.

Started 10 days with pain in right thigh but then stopped and went into left thigh. Pain in left thigh only for four days. Pain went away but that evening outer ankles swelled up. Went to ER to check for DVT as had been on 8 hour flight four weeks earlier. No explanation for swelling but no DVT. Swelling continues and left wrist swelled on one side for a few hours but went down. Went to see GP, couldn't figure out and all blood tests have come back normal. Three nights ago hands and feet felt like ice water was going through them but has since stopped. Pins and needles at night and prickly sensation in legs but only at night. Feels like vein pain, if that is possible, wake up with veins bulging on top of hands but goes away after I get up.

Last four weeks I've done a lot of hiking but lyme test came back negative. I've had lyme before and did not feel like these symptoms. I did fall while hiking on my right ankle but got up after a few minutes and it was fine. Just did three mile walk at good pace, never felt out of breath.

Yearly physical is mid October. Any ideas? Becoming anxious, so that may be making it worse.

Category: Internal Medicine Specialist

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Category: HIV- AIDS Specialist
 24 Doctors Online

Hello.
Thank you for your query at DoctorSpring.com
I understand your concern.
You do have isolated symptoms and hence making a diagnosis has become difficult.
Its a good thing that DVT has been ruled out, since it is one of the serious possibilities.
Now the pins and needles sensation can indicate a vitamin deficiency. But you also have swelling of the ankles. Now that can be due to constant hiking and it should settle down on its own once you rest adequately. The other possibilities are lymphedema, but in absence of other symptoms it does not look probable.
All your symptoms together point towards something called Raynaud's Syndrome. It is more common in women and is triggered by cold temperatures and stress. Have you been exposed to cold temperatures recently? Mostly it is a self limiting disease and should recover on its own. In most cases where Primary Raynaud's is said to be identified, the patient is advised to reduce the exposure to cold temperatures and avoid stress. In some cases though with persistent exposure, it can lead to severe vasospasm, which is severe reduction in blood flow to the peripheries ( hands and legs ) and can lead to ulcer/ gangrene.
Now we need to carefulle evaluate you. Most patients with Raynaud's present with pins and needles and pricky sensation mostly all along the limbs, can feel ice cold even if the temperature is normal, and observe bulging veins. If possible you can get a Doppler of your lower limbs just to rule out insufficiency of blood supply. It will give us a better picture of whether you actually have Raynaud's.
Please do not worry,as most attacks are self limiting. Only when you keep getting persistent episodes it needs to be evaluated. However it is advised to avoid too cold temperatures and stress, which are the predisposing factors.
So if possible get a doppler and also upload the results os the tests that have been carried out.
One distant possibility apart from the vitamin insufficiency and Raynaud's is a pinched nerve syndrome, where due to compression of the nerve such pins and needles sensation is felt through out the limbs. But that doesn't explain the ankle swelling and the swelling in the wrist. Hence it can be ruled out. The swelling that you have experienced can be due to stasis in the blood supply leading to localized edema.
So kindly get a doppler of the lower limbs for a clearer picture.
Hope this was helpful,
Regards.


Dr. Jaydeep Tripathy
Category: HIV- AIDS Specialist
Experience: 
MBBS from Sri Ramachandra University in December 2011
M.Med (Family Medicine) - TNMGR University, Chennai
MBA-MPH in Public Health in March 2016, SRM University
Finished AFIH in March 2016, SRM University
MRCP ( UK ), Internal Medicine, Royal College of Physicians, June 2016
Fellowship in Diabetology from Martin Luther University in January 2017

Currently Resident Physician, in MD Radiodiagnosis - Kamakshi Memorial Hospital, Chennai
Dr. Jaydeep Tripathy and 4 other Medical Specialists are ready to help you

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