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 insyncphysio.com. Thanks, Iyad. 

Iyad: Thanks, Mark.

Mark: Hi, it's Mark from Remarkable Speaking. I'm here with Wil Seto of Insync Physio in Vancouver. And today we're gonna talk about arm pain coming from your neck. How you doing Wil? 

Wil: I'm doing good. Thanks. How about you, Mark? 

Mark: Good. So this doesn't seem to make sense really. How can you have arm pain from your neck?

Wil: Yeah. So I guess the first thing to really understand is the different kinds of neck issues that you can get. And you can have four basic types, I guess, to really narrow it down. And you look at what's called standalone neck pain. So you have this type of nonspecific neck pain that doesn't affect anything else. And so you have this pain that's happened, whether it's like a traumatic injury, you know, or something like that. Or you wake up in the morning and you sleep wrong on it. And you kind of have this neck pain that you're experiencing. And it's just neck pain, so there's no other symptoms. And it could be stiff. And it could be not be stiff. 

And then you have neck pain, with a headache related symptom, like you have neck issue, neck pain related with headache stuff. And that's quite common when you have this referral of the things going on with your neck joints that refer up into the head. And so that neck joint related pain or the technical term is called cervicogenic headache. Because the headache is coming from referral points from joints in your neck. And so the muscles get all really tight too as well. And they can also refer right into the base of your skull. 

And then the third type is sort of like this whiplash type of associated neck pain or disorder and there's all these classifications with that where it's like trauma. So I did mention trauma earlier, but I meant like more trauma.

That's kind of like, you know, you wake up, that's still, I consider that trauma, but it's not like acute trauma where you've had an accident. Right. So with the third type. The whiplash associated trauma is like a specific sort of acceleration and decelerated force. And basically you can either have pain in your neck without issues with motion, but you have pain. Or you can have limited range of motion. Or you can also have that with now it goes into the fourth category, which is neck pain with arm pain.

And so the technical term of that, I guess is, ridiculopathy or neuropathy. And so when you look at the neck pain with ridiculopathy or neuropathy, that's when the actual pain in your arm you know, and we've had this on our physio team where clients have said to our physios. Yeah, I think I've got tennis elbow and then they've been treated for, with some other healthcare providers and, you know, and it didn't help at all. Like they're treating their tennis elbow or what supposedly thought was tennis elbow or some kind of overuse thing going on in their arm. But in fact, if you do a thorough assessment and you do this clinical examination and look at where is their arm pain coming from, it's actually coming from their neck.

And so when you start treating that and you look at you know, the cause of that, and you start putting the pieces together and you treat that whole picture, then you start to actually affect that arm pain. Because you can get referral from your neck all the way down in your arm. And especially if, you know, someone that it may not even be an accident, it could be an accident, but it may not be an accident. And it may be like something that's just gradually happened over time. 

So I can think of a client that one of our physios had. Who said, yeah, you know, like they were talking about this patient who had arm pain. They said, yeah, the other healthcare provider was basically treating them for tennis elbow and it just wasn't getting you better. Well it was because it wasn't really tennis elbow is what she told me.

And started treating this client for their neck issue. And within a few treatments, their arm pain was dissipated from like an eight out of 10, which they would feel, for like a 3 out of 10. It's a process. Because these things developed over time for this person, and it was something that wasn't just over like a traumatic incident and this person didn't have any issue with them to begin with.

I mean, like traumatically speaking. They did have other non sort of repetitive going on. Cause they were on the computer a lot, and they did some sports that probably wasn't super helpful, like boxing, but never had an injury that they could remember. So the proper diagnosis or the proper assessment of what's causing the arm pain is really important. It's the first step.

Mark: So as an athlete, can I diagnose this myself? Is there something that's obvious so that you could point to and say, well, this is often what it feels like that's different than just regular tennis elbow or arm pain that would indicate it or do I have to come and see you really to get the testing done to find out?

Wil: No, that's a good question. So I think one of the biggest things is like you know, you can confuse it. It's very confusing because you're like, oh yeah, you know, I'm hurt because sometimes that area, it becomes more sensitive. So you have this sensitization of that arm, so that's why it legitimately feels like it's just arm pain and you may not actually have neck pain.

Like it just maybe neck stiffness until we start poking around in there and be like, oh yeah, my neck hurts a little bit. It hurts a little bit there. And so some of the things that you can sort of just rule out quickly for yourself is you can just do a lot of like resist detecting. So if it's like a tennis elbow thing, you know, like aside from the fact that it feels more sensitive and it's a little bit sore.

Like with this person, they were, it was interesting because there's like two things really hurt it the most, like doing weighted chin ups and doing pushups. And so, oh, that's interesting. So then I was thinking, yeah, it could be maybe like something related locally. Around that area of their arm. But then when I actually put them through the test, which you can do on your own or an athlete can do on their own, like just test yourself, do some simple, wrist resistant testing with your arm bent, arm straight. And then do what I call like sort of the P symbol with the arm straight and then resist. And then do that with it bent. And if you're getting the reproduction of that pain that you're experiencing when it's sort of that yeah, when you touch it, then that's usually a good indication. Oh yeah, maybe there's something going on. Because that's actually testing the structures related to tennis elbow.

So I don't know if that helps if it's sort of a initial thing. Cause that is actually a really quick test that you can do. Because sometimes if you just touch it, it can be sensitive. But if you're doing specific things to test for if it's sore and weak, then it could be maybe a tennis elbow thing. But if it's just weak and it's not sore, then it might not be. 

So the other key thing too, is if it is a tennis elbow thing, if it's an overuse thing, and if you're doing exercises to work on releasing the muscles, like tough massage and stretching, And then you're doing some specific strengthening for, and that doesn't get any better in like a couple weeks. And that's when you want to get it looked at. Maybe there's more to this that meets the eye. And you know, as great as Google can be, in terms of being a good resource you know, sometimes you just gotta get it looked at you know, if it's beyond that stage of like two weeks and especially if you're like, yeah, I want to start to play more tennis. I want to start to play more Ultimate Frisbee or rock climb or whatever it is that, you know, using your arm more. 

Mark: When you're working on a person's neck to reduce the stiffness or the pain that's referring down into that person's arm. What kind of stuff are you doing?

Wil: Yeah. So really good question. So one of the biggest things is, so there's three things that we're looking at in terms of the rehab process. So there's increasing mobility. So we want to increase the mobility of like the whole thing that's affecting the arm. 

So there's the neck. And the things that basically come up in attach neck, so the nervous system. So if we inspect the mobility to the neck and allow it to move better, then that's gonna allow things to move better all the way down. And then also the muscles around the neck. So if the muscles are just basically really super tight, if everything is always on like this. And then that's also gonna add more compression and also affect the movement patterning of how you rotate or how you flex or how you extend your neck. And so that's gonna also affect what's happening all the way down with the nervous system and how you use those muscles.

So that mobility issue with the muscles and the joints and the nervous system. And then being able to get your core strength to stabilize all that. And so then that way we can now focus on the third thing, which is basically the functional strength. So really getting in there and mobilizing and increasing mobility is one of the first key things to start.

Mark: There you go. If you suspect or been told you've got arm pain and it's not going away because you're doing the right things to heal it, come into Insync Physio and get it looked at. It might be something else. It could be referred from your neck for instance. And this is pretty common. I'm guessing is that accurate Wil?. 

Wil: Yeah, it's actually very common. I can't give you the exact percentage, but our team, our physio team, we see it a lot. 

Mark: There you go, if you want experts helping you out. They can diagnose this and get you on the right path so that you're feeling better and can get back to your sports sooner rather than later. Insync Physio. You can book at insyncphysio.com or you can call the Vancouver office at (604) 566-9716 to book or in North Burnaby, (604) 298-4878. Get in there. Thanks Wil. 

Wil: Thanks Mark.

Causes:
There are many possible causes of numbness and tingling in the upper or lower limbs. Some of these causes may include: nerve injury, prolonged sedentary position, pressure on the nerves due to a herniated disk, enlarged vessels, or tumors, shingles, abnormal levels of salts and minerals in the body, or congenital conditions. Other medical conditions such as carpal tunnel syndrome, diabetes, or strokes may lead to numbness and tingling. 

Local pressure on a nerve may cause distinct patterns of numbness that may also be associated with weakness or spasms. Compression of the ulnar nerve at the wrist may cause numbness and tingling of the little and ring fingers. Compression of the same nerve at the elbow may present numbness on the back of the ulnar side of the hand. Likewise, compression of the radial nerve just above the wrist may cause numbness on the back side of the thumb and index finger. Compression of the median nerve just below the elbow joint may present numbness on the palmar side from the middle finger to the thumb. 

​​​​Self-Care:
If the cause of the symptoms has been determined, ensure to follow the necessary steps as prescribed by your doctor to reduce or eliminate the condition. Certain exercises may be recommended to alleviate pressure on the peripheral nerves causing the numbness and tingling. Control blood sugar or vitamin levels with the appropriate daily dosage. Do not take large doses of any vitamins or supplements until discussion has been made with a medical professional. Large amounts of vitamins or supplements may result in nerve toxicity which can cause numbness and tingling.

Further testing may include X-rays, MRI, nerve or blood tests to help diagnose or treat the appropriate condition.

Exercises to Reduce Numbness and/or Tingling:
1. Ulnar Nerve Flossing

Begin in a seated position with tall posture and shoulders down. Then create a circle with your thumb and index finger and bring the elbow and forearm up while pointing the heel of the hand upwards forming a mask over your eye with the circle. Hold this for a second and then return the arm and hand back to the starting position. Repeat this for sixty seconds, doing five sets three times per day. The progression of this exercise is to first start with the head rotated away, then bringing the thumb and index finger over the eye. The duration is also for 60 seconds for 5 sets, three times per day.

2. Radian Nerve Flossing

Begin by extending the shoulder and arm with the elbow straight behind you while flexing the wrist and the hand out to receive a “low - five” from behind you. Return the arm and hand back to neutral position by the side and repeat this for up to thirty seconds when you initially start to get the hang of it and then increasing it to sixty seconds. Do five repetitions each time three times per day. The progression of this exercise involves the rotation of the head and neck to the opposite side first and then reaching back with the arm and hand for the “low-five” and then return the head and arm and hand back to the neutral start position. Do this for 60 seconds for 5 repetitions three times per day.

2. Median Nerve Flossing

Begin by placing your left hand on your right shoulder & look away to the opposite side. Abduct the shoulder to 90 degrees and together extend the elbow, wrist and fingers fully. Then turn your head to the right side and release the whole right upper extremity by flexing the fingers, wrist and elbow together. Repeat this again by looking to the opposite side and extending the entire right upper extremity again. Do this for 60 seconds for 3 sets 3 times per day.

When to See a Medical Professional:
Go to the hospital or call 911 if:  
· You are unable to move or have weakness in the body
· You do not have control of limb movement
· You have a loss of bladder or bowel control
· You are disoriented (confused) or have a loss of consciousness
· You have difficulty walking, talking, or a change in vision
· You notice signs and symptoms of a heart attack or stroke

References:
https://www.massgeneral.org/ortho-hand/conditions-treatments/numbness_and_tingling.aspx
https://medlineplus.gov/ency/article/003206.htm