Check out the T4 syndrome that was published as a case study in the Chartered Physiotherapy Journal awhile back.

It was described as bilateral tingling in the hands when PA T4 and the symptoms often wakes patient up at night with tingling.

I have seen a couple of these T4 syndrome patients. Noted that some have bilateral tingling while others are unilateral. Their T4 is hypo ++ and symptomatic+. I have learnt to be conservative with them. I used to manip T4 but found that their symptoms worsen. I have found Grade II T4 PA or less in 4-6 sesisons seems to work well with these patients.

$0.02