Tingling in the Arm - Thoracic Outlet Syndrome

If you have numbness or tingling, or radiating pain in the arm, chances are there is a nerve that is either being compressed or is irritated. This can happen in numerous places such as the cervical spine, a muscle in the forearm, or it can be thoracic outlet syndrome.

The thoracic outlet is a triangle from your jaw, to your clavicle, to your shoulder. The brachial plexus, a network of nerves, exit the spine in this triangle and feed all of the muscles of your arm. If you get compression in this triangle, you have thoracic outlet syndrome.

There are 3 main areas that can compress the nerves; the scalenes, the pec, or from the first rib. Here is how I test for it:

If it’s from the scalenes, the most common reason is from weakness in the front of the neck. For that, I’d stretch the scalenes and strengthen the front of the neck:

If it’s coming from the pec, I’d do a pec release like this:

The rib can be trickier and you’d definitely want to see a physical therapist for this. Either way, you should have it properly assessed, and this is just meant to be a quick overview. 

Oftentimes, I see someone with these symptoms and they have had an image of their neck. Of course, something was found on the image, a disc bulge, stenosis, degeneration, etc. This does not always mean it’s an issue. Most asymptomatic people will have these findings also. The clinical presentation matters more than the image. So don’t rush to surgery, because it may not solve the issue. See a physical therapist first. The good news is that it can often be solved in 4-6 visits.