Circulation Issues Can Mask Nerve Issues

Important: When circulation is reduced, is it is easier to miss important warning signs of other issues. A common result of this is nerve damage.

For example, loss of sensation could be due to loss of blood flow or it could be the result of a compressed nerve. If it is due to circulation, it will not normally cause any long-term issues as long as it is addressed within 20 minutes or so. But if it was really a nerve issue — or there was both a circulation and a nerve issue at the same time — the nerve part of the problem could result in a long-term injury in just a few minutes, or even less depending on the specific circumstances.

Bottoms: Learn how to do sensory checks and make it a habit to do them.

Tops: If your bottom alerts you to a change in sensation, you need to check for nerve compression and resolve any you find. If you determine that the issue was circulatory and you both jointly decide to continue with the scene, you can choose to do that, but the burden is then on you, the Top, to closely and continually monitor for additional/new nerve compression.

Bottoms: If you agree to allow the scene to continue in such a circumstance, you need to recognize the additional risk you are taking.

How can you tell the difference between circulation loss and nerve compression?

Here are some tests that both Tops and bottoms can do to help distinguish between circulation loss and nerve compression. But understand that these tests are not 100% reliable!

Each body is different and so it’s possible so you might do these tests and completely believe that the issue is circulatory and still end up with some type of nerve damage. That said, they’re the best we have, and are worth doing regularly.

Circulation lossNerve compressionSpeed of sensation lossGradualGradual or suddenArea of sensation lossWhole limbPartial limb/fingersMobilityNo loss of mobilityLoss of mobilityCapillary nail refillSlow refillNormal refill

• Speed of the sensation loss: With circulation issues, loss of sensation usually appears gradually and in stages (slight tingling, fat fingers, more intense pain, complete numbness) but this may vary from person to person. With nerve compression, loss of sensation can be gradual or sudden. Therefore, if there is a sudden loss of sensation (“my left thumb just went numb”), assume nerve compression. If it was gradual, look to other indicators to determine which it is.
• Area of sensation loss: With circulation issues, loss of sensation tends to affect the entire limb or entire hand/foot. Loss of sensation due to nerve compression tends to affect the specific areas that are provided sensation by that nerve. It is important for the bottom to do sensory tests from time to time and report any issues. For example, sensation on the top of the thumb and forefinger is supplied by the radial nerve, so if most of a person’s hand feels normal, but they suddenly have numbness in just their thumb and forefinger, there is nerve compression somewhere along the path of the radial nerve. See below for more details on this and other nerves.
• Loss of mobility: Certain nerves are responsible for enabling the body to move in certain ways. Sudden inability to move the hands or feet in particular ways when a person can normally do so can indicate severe nerve compression. See below for details. It is important to do motor/mobility tests before the scene so that you know if there are any pre-existing issues. (If a person cannot twist their wrist like they are opening a doorknob under normal circumstances, you cannot use that as a test during the scene.)
• Capillary nail refill: Press on the nail of a finger or toe until it turns white. Release pressure and see how quickly color returns to the nail. If it takes longer than a second or two, the issue is more likely to be circulation loss. Again, it is important to do this test before your scene with someone so you know what is normal for them on that day. If a person already has circulation issues, this test is not going to be helpful.