Can restless legs syndrome (RLS) affect the arms?

Can Restless Legs Syndrome Affect Your Arms?

Yes, while restless legs syndrome (RLS) primarily affects the legs, it can also involve the arms or other body parts in addition to the legs. 1

Understanding RLS and Its Distribution

Restless legs syndrome is characterized by:

1. An urge to move the legs usually accompanied by uncomfortable and unpleasant sensations
2. Symptoms that begin or worsen during periods of rest or inactivity
3. Relief of symptoms with movement
4. Worsening of symptoms in the evening or at night

According to the International Restless Legs Syndrome Study Group (IRLSSG) diagnostic criteria, while the condition is named for its most common presentation in the legs, the uncomfortable sensations and urge to move can extend beyond the legs. The official diagnostic criteria specifically note that "sometimes the urge to move the legs is present without the uncomfortable sensations and sometimes the arms or other parts of the body are involved in addition to the legs." 1

Clinical Presentation of Upper Limb Involvement

When RLS affects the arms, patients may experience:

• An uncomfortable urge to move the arms, particularly when at rest
• Sensations described as crawling, tingling, or deep-seated discomfort in the arms
• Relief of arm symptoms with movement
• Worsening of arm symptoms in the evening or at night

Progression and Spread of Symptoms

It's important to note that arm involvement in RLS often occurs as a progression of the disorder:

• Most patients initially experience symptoms only in their legs
• As the condition progresses or becomes more severe, symptoms may spread to the arms
• Arm involvement is particularly common in cases of augmentation, which is a worsening of RLS symptoms that can occur with dopaminergic medication treatment 2

The National Comprehensive Cancer Network (NCCN) guidelines specifically mention that RLS can affect the arms in their diagnostic criteria, stating that the essential diagnostic criteria include "an urge to move the legs usually accompanied by uncomfortable and unpleasant sensations in the legs and sometimes the arms or other body parts." 1

Clinical Significance

The spread of RLS symptoms to the arms may indicate:

• Disease progression
• More severe disease
• Possible augmentation in patients on dopaminergic medications

If a patient reports symptoms spreading from the legs to the arms, particularly if they are on dopaminergic medications like ropinirole, this should prompt evaluation for augmentation and potential medication adjustment 2, 3.

Management Considerations

When RLS affects both legs and arms:

• The same treatment principles apply as for leg-only RLS
• Medication adjustments may be needed if arm involvement represents augmentation
• For patients experiencing augmentation with dopamine agonists, consider:
  • Reducing the dose
  • Switching to a non-dopaminergic medication like gabapentin or pregabalin
  • In severe cases, considering opioids or intravenous iron therapy 3

In summary, while RLS is named for its predominant leg symptoms, arm involvement is a recognized feature of the condition, particularly in more advanced or severe cases.