Is a Pinched Nerve Really the Problem? Understanding Brachial Plexus Syndrome and Thoracic Outlet Syndrome
Numbness, tingling, burning, or weakness in the arm or hand can be frustrating—and sometimes confusing.
Many people are told they have a “pinched nerve” in the neck when symptoms develop in the shoulder, arm, or hand. Sometimes that is correct. But the nerves traveling from the neck to the arm can also become irritated or compressed outside of the spine.
Two conditions that can cause these symptoms are brachial plexus disorders and thoracic outlet syndrome.
Understanding where the problem is occurring can be an important part of finding the right treatment.
What Is the Brachial Plexus?
The brachial plexus is a network of nerves that travels from the lower neck, through the shoulder region, and into the arm.
These nerves provide movement and sensation to much of the:
Shoulder
Upper arm
Forearm
Wrist
Hand and fingers
Think of the brachial plexus as a major electrical cable system connecting the spinal cord to the arm.
If those nerves become irritated, stretched, or compressed, symptoms can develop anywhere along their pathway.
What Does Brachial Plexus Syndrome Feel Like?
Symptoms can vary depending on which nerves are affected.
Common symptoms include:
Pain:
Pain may occur in the neck, shoulder, upper chest, arm, or hand.
Numbness or tingling:
A person may experience pins-and-needles sensations or numbness in part of the arm or hand.
Weakness:
Certain movements may become more difficult, and grip strength can sometimes be affected.
Burning or unusual sensations:
Some people describe the sensation as burning, electric, shooting, or crawling.
Symptoms may also change depending on arm position, shoulder position, activity, or posture.
What Is Thoracic Outlet Syndrome?
Thoracic outlet syndrome, often abbreviated TOS, occurs when nerves or blood vessels traveling between the neck and arm become compressed in the region known as the thoracic outlet.
The thoracic outlet is the area between the lower neck and upper chest, near structures such as the:
First rib
Collarbone
Scalene muscles
Pectoral muscles
The brachial plexus passes through this region, which is why thoracic outlet problems can produce many of the same symptoms associated with brachial plexus irritation.
There Are Different Types of Thoracic Outlet Syndrome
Thoracic outlet syndrome isn't always the same problem.
Neurogenic Thoracic Outlet Syndrome
This is the most common type.
The brachial plexus nerves are compressed or irritated.
Symptoms can include:
Arm or hand numbness
Tingling
Shoulder or arm pain
Weakness
Grip problems
Symptoms that worsen with certain arm positions
Venous Thoracic Outlet Syndrome
In this form, a vein is compressed.
The arm may develop:
Swelling
Heaviness
Bluish discoloration
A feeling of fullness or tightness
Arterial Thoracic Outlet Syndrome
This occurs when an artery is compressed.
Possible symptoms include:
Coldness in the hand
Pale or bluish fingers
Weak or absent pulse
Arm pain with activity
Changes in circulation
Vascular symptoms require medical evaluation because blood-flow problems can be serious.
Why Can Posture Matter?
The nerves and blood vessels traveling into the arm have to pass through several relatively narrow anatomical spaces.
Changes in shoulder and neck position can alter the amount of space available around these structures.
For example, repeatedly working with the shoulders rounded forward may place additional stress on tissues around the neck, chest, and shoulder.
This doesn't mean poor posture automatically causes thoracic outlet syndrome. However, movement and positioning can influence symptoms in some people.
Activities involving prolonged overhead positioning or repetitive arm use may also aggravate symptoms.
Brachial Plexus Problems Can Be Mistaken for a Neck Problem
This is where things can get complicated.
The nerves that eventually form the brachial plexus originate from the cervical spine.
Therefore, symptoms in the arm can potentially originate from:
The cervical spine → brachial plexus → shoulder region → peripheral nerves
A cervical disc problem or nerve-root irritation can produce symptoms similar to those caused by brachial plexus or thoracic outlet problems.
That means simply looking at where the pain is located may not tell the whole story.
The Location of the Symptoms Isn't Always the Location of the Problem
A person may feel pain in the hand while the problem is actually higher up the nerve pathway.
This is why a careful examination is important.
The goal is to determine where along the nerve pathway the problem may be occurring.
What Can Make These Problems Worse?
Symptoms may be aggravated by:
Working with the arms overhead
Repetitive arm movements
Heavy lifting
Certain sleeping positions
Prolonged sitting
Rounded shoulder posture
Neck or shoulder injuries
Repetitive occupational activities
Previous trauma
Sometimes symptoms are present only during certain activities.
Other people may experience symptoms throughout the day.
Why an Examination Matters
When someone reports arm or hand numbness, tingling, weakness, or unexplained pain, several different conditions may need to be considered.
An examination can evaluate things such as:
Neck movement
Shoulder movement
Muscle strength
Reflexes
Sensation
Grip strength
Posture
Nerve tension
Joint movement
Symptoms produced by specific positions
This can help determine whether the symptoms appear to be coming from the neck, shoulder, brachial plexus, thoracic outlet, or another part of the nervous system.
Sometimes additional medical testing or imaging is appropriate.
When Should Arm or Hand Symptoms Be Checked?
Don't simply assume persistent numbness or weakness is a normal part of getting older.
An evaluation is especially important when symptoms are:
Persistent
Getting worse
Affecting grip strength
Causing weakness
Interfering with work or daily activities
Waking someone at night
Repeatedly occurring with certain positions or activities
Sudden weakness, significant loss of sensation, severe swelling, a cold or discolored arm, or other sudden neurological or circulation changes require prompt medical evaluation.
The Bottom Line
Arm and hand symptoms don't always originate from the elbow, wrist, or even the neck.
The brachial plexus is a complex network of nerves that travels from the neck into the arm, and the thoracic outlet is one of the important areas where these nerves and blood vessels pass.
When these structures become irritated or compressed, symptoms can include pain, numbness, tingling, burning, or weakness.
The important question isn't simply:
“Where does it hurt?”
It's:
“Where along the nerve pathway is the problem occurring?”
At Big Stone Chiropractic Health Center, we can evaluate the neck, shoulder, spine, and surrounding structures to help determine what may be contributing to arm and hand symptoms.
If numbness, tingling, pain, or weakness keeps coming back, don't just learn to live with it. Schedule an examination and find out what may be causing it.
