Arm Numbness Thoracic Outlet Syndrome with Iyad Salloum

Mark: Hi, it's Mark from Remarkable Speaking. I'm here with Iyad Salloum, the clinical director of Insync Physiotherapy in North Burnaby, British Columbia. And we're gonna talk about arm numbness, a specific cause of arm numbness. How you doing Iyad? 

Iyad: Good, Mark. How are you today? 

Mark: Good. So what kind of symptoms other than your arm is numb? Like what would be the, we're gonna get into the details of this specific type, but what's kind of the clues that you look for? 

Iyad: Usually people would come in and tell you something about, I've seen this a lot with, let's say somebody who develops a shoulder injury of some sort. So they say, Hey, I'm feeling a bit of weakness in my arm. You know, like some pain in certain positions. And then we, for example, could look at that and identify, oh, you have potentially some kind of rotator cuff involvement and maybe that's contributing to the kind of the feeling of weakness and the pain with certain positions. 

And we've seen this a lot work and kind change later, for example, they'll be like, yeah, it started off with the shoulder and now when it's really bad, my arm really feels heavy and numb. And sometimes they describe things as burning. Sometimes they describe things as tingling. So it's that pins and needles down the arm. It's very vague symptoms.

They're like, I just can't put my hand on it. Nothing hurts when I squeeze it or touch it. Cuz people will try to poke, prod their arm and just doesn't do anything when I massage it. So it's just like, why is this going though? 

So, yeah, there are lots of causes for arm numbness. Obviously, we always monitor for that because it could be an indicator that a nerve is getting sensitized. And you know, right off the bat, if somebody presents into our office with this, we would do a pretty good neck examination to figure out is this potentially an issue that is manifesting itself with symptoms down the arm. 

Obviously some people can worry about am I having a heart attack? That's why I'm feeling pain down my arm. And you know, usually whenever we see people like that, I tend to be not the first person who they've seen. Tends to be they've checked who their physician, the physician clears them and they're like, no, there's nothing wrong with that. It's potentially some kind of nerve sensitization. 

So what we think is going on here is that those peripheral nerves that kind of help us do things with our hands. So either, let's say feel the world by reading the signals from our periphery to our brain, or the other way around, controlling the movement of the hands could get sensitized. Once they get repeatedly sensitized, that kind of let’s say, time to numbness gets a bit shorter cuz you're repeatedly, let's say, stimulating an area, so you can get it that, let's say smaller things now cause the arm to go numb. 

The other thing that people could think is like, oh, I might have something like carpal tunnel syndrome. Cause that's the first thing that pops up on Google. However, carpal tunnel syndrome rarely, let's say, cause your forearm and your wrist to be numb. Some people say it starts at the shoulder and goes all the way down. And the other thing that it's unlikely to do is cause numbness in the backside of your hand. So that's not usually what we'd associate with carpal tunnel syndrome. So there's that factor too. 

However, it gets confusing when you google carpal tunnel syndrome and your palm is numb and you see palm numbness as one of the main symptoms of that. So that's kind of where we'd do a good thorough exam on that and figure out what are we dealing with and where should we intervene to, let's say, help this condition.

I guess the name of it is called thoracic outlet syndrome. And there are multiple types of thoracic outlets. The ones we're talking about are not involving the vascular tissues, so there are different types of thoracic outlet syndrome. So again, we're talking about just the one affecting the peripheral nerves and that's their only symptom. It tends to be either, some kind of function disruption of that nerve caused by you know, it's usually a secondary problem. It doesn't just kind of start on its own out of the blue. So it tends to be something kind of predisposes you to get that.

Mark: So, what causes this? 

Iyad: You know, it's the million dollar question it seems to develop after people have certain types of injuries or dysfunctions. So we see it from, there are areas, let's say, that could sensitize a nerve more if they're not functioning properly. So like the neck, you know, we're talking outside of the spine, like, so the muscles here. We've seen it, for example, when somebody can have a car accident and then that car accident beyond the injury to the neck, can also cause them to have a lot of anxiety and change in their, just like the way they hold themselves and they're breathing a lot faster and briefer, so they see their neck kind of really working hard with basic things.

Well, that all of it is gonna cause sensitization from the neural tissue here and it can kind of trickle down the arm. Again we talked about shoulder injuries. Well, if you change the way your muscles behave there, well the nerves have to kind of move through a lot of muscles or tissue as they kind of move down the arm.

Well, if I just kind of sustain a bit more pressure on them, you know, over a long time, they could get sensitive. Again, there's a lot of reasons why this would happen, but typically what we see is it's like a second problem. It's not the first problem on its own. Nerves don't, unless you're dealing with a nerve condition specifically, which again, would be a different story then. We're talking here like where you have a musculoskeletal injury that could potentially spill over and cause the nerves to get sore.

Mark: So this must make it fairly difficult to diagnose. 

Iyad: It could be, but we can kind of piece it together by looking at, like, you'd have to diagnose a few things. You'd have to, let's say, assess the function of the entire limb. But then it's not just enough to just, let's say, test the nerve for conduction. Because a lot of these people can have normal nerve conduction tests, let's say like what we would do like for strength testing and sensation testing because they get it periodically. So it could be just that the nerve is getting sensitized. 

So I'll give you an example. So if you just tap your funny bone which is where your ulnar nerve is. You can get a lot of sensitization down your arm and it really hurts. However, if I was to, let's say, test you outside of that time where you're pinging your funny bone, you're probably gonna be okay. So another thing to kind of keep in mind is, usually where we're assessing is just is the nerve involved or not. Because usually people tell you, Hey, it's numb, it's tingly, it's that.

So you kind of figure, okay, we're dealing with potentially a nerve here, but maybe the more important question is, well why? Why is this happening? So we would look at the affected areas and usually the treatment would be exercises that could target, let's say sensitive nerves, but it's probably not enough just to do those on their own. So if you don't address the original complaint of why this thing got sore in the first place, it's usually again, you have to do a bit of both. It's not enough just to do, oh, I'm just gonna deal with the symptom of the nerve getting sensitized and tingly and all these kind of things. 

Mark: So, typical course of treatment looks like?

Iyad: So depends if we think the neck is the primary involvement, we would start with the neck and we would try to clear that. It would take a few weeks usually on average. But we really like right off the bat, try to get people to learn and to recognize, let's say patterns of sensitization. So there's the way they breathe potentially, that could be one of the things that we get them to kinda clue in on and then teach them different ways to do it.

You know, breathing tends to be overlooked as a thing. We think, oh, I could breathe. I could just bring air into lungs, that's fine. There might be easier ways for them to do that and slightly better ways and more optimal ways for them. The other way is if we identify some kind of shoulder dysfunction or weakness we can also address that. And that tends to help a lot.

And sometimes it's just like habitual positions that people adopt. They don't think it's, for example, pulling your shoulder blades way back excessively, which might be looked at by some people as good posture. Might not actually be helpful in this case. And it can actually make it just more sore. You're unlikely to damage things by pulling your shoulders back, but it's just kind of, you can kind of keep it sore, if that makes sense. 

So we would just teach them those patterns, teach them things that feel good or relieve those things. And then, you know, eventually the second phase of it would be trying to expose people to the things that hurt them, because you don't want any movement to be a hundred percent off limits forever. That doesn't really seem to work with a lot of people.

Mark: Unless they can't brush their teeth anymore with that hand. Yeah. So if you're having issues with arm numbness and you want expert diagnosis, as you've heard, it can be really complicated, but the causes can be found. Get the detectives at Insync Physio in North Burnaby to help you out. They're experts in diagnosing this and coming up with a treatment plan that's gonna get your numbness cured essentially, or lessened at least. So give them a call at (604) 298-4878. Get in there sooner rather than later, or you can book online at Thanks, Iyad. 

Iyad: Thanks, Mark.