Arm pain and tingling: nerve causes, when to worry and what tests show

Nerves carry both sensation and movement signals, so when one is compressed or irritated the result can be pain, tingling, numbness or weakness in the area it supplies. The NHS describes pins and needles as a pricking, tingling or numbness sensation that happens when the blood supply to the nerves is cut off, usually from sitting or sleeping on part of your body, and says it lasts only a few minutes. It also lists possible medical causes of long-lasting symptoms, including a trapped nerve in the back or neck, nerve damage after injury or illness, some medicines, poor diet, drinking too much alcohol, and conditions such as diabetes.

The NHS advises seeing a GP if you constantly have pins and needles or it keeps coming back, and warns not to self-diagnose. Treatment depends on the cause.

NICE Clinical Knowledge Summaries explains that cervical radiculopathy is pain, weakness or numbness in one or both arms matching the area supplied by an affected nerve root in the neck. It often occurs alongside neck pain, and pain can also be felt in the shoulders, upper back and chest. The most common causes are degenerative changes including disc herniation and spondylosis, and it is most common in people aged 50 to 54. It says most people improve whatever the treatment, with around 88% improving within four weeks with non-operative management.

Assessment should exclude red flags suggesting serious spinal disease and include examination; X-rays and other imaging are not normally required to diagnose it. For symptoms lasting 4 to 6 weeks or more, or if there are objective neurological signs, MRI and consideration of injections or surgery are suggested. The NHS notes that cervical spondylosis, a common wear-and-tear condition of the neck, can cause pins and needles in an arm along with neck pain, which it lists as a reason for an urgent GP appointment or NHS 111.

The NHS says carpal tunnel syndrome is pressure on a nerve in the wrist that causes tingling, numbness and pain in the hand and fingers. Symptoms include an ache or pain in the fingers, hand or arm, numb hands, tingling or pins and needles, and a weak thumb or difficulty gripping. They often start slowly, come and go, and are usually worse at night. The carpal tunnel inside the wrist swells and squeezes the median nerve.

You are more at risk if you are overweight, are pregnant, do work or hobbies that mean repeatedly bending the wrist or gripping hard, such as using vibrating tools, have arthritis or diabetes, have a parent, brother or sister with the condition, or have previously injured the wrist. It sometimes improves by itself in a few months, particularly in pregnancy.

The NHS suggests wearing a wrist splint at night (it may take up to 6 weeks to help), cutting down on activities that bend the wrist or grip hard, and notes painkillers may help pain short-term but there is little evidence they treat the cause. A GP can usually diagnose it from symptoms and an examination; if unsure, nerve conduction tests or scans may be arranged. A steroid injection may be recommended if a splint does not help, and surgery, which usually cures it, takes around 20 minutes under local anaesthetic.

The NHS describes thoracic outlet syndrome as nerves or blood vessels near the top of the ribs getting squashed. It usually affects one arm and hand, causing pins and needles (which can be worse at night and wake you up), an arm that gets tired easily, pain and swelling, and a hand and arm that feel cold, with skin that turns blue, grey or pale. Causes include being born with an extra rib (cervical rib), poor posture, large breasts, injury to the chest, neck or ribs, jobs or activities with repetitive arm movements such as building or swimming, and gaining a lot of muscle.

Treatment is usually physiotherapy and medicines, with surgery sometimes recommended if there are serious problems such as blood clots and other treatments have not worked. The NHS says throbbing or cramping pain, swelling, redness and warmth in one arm could be signs of a blood clot and need an urgent GP appointment or NHS 111.

Not every arm symptom is a nerve problem. The NHS lists chest pain that feels tight or like squeezing, or that spreads to the arms, neck or jaw, as a reason to call 999, along with severe difficulty breathing, pale, blue or grey lips or skin, or someone who has passed out. It says not to drive yourself to A&E.

The NHS neck pain guidance adds 999 signs after sudden lack of co-ordination, being unable to lift and keep both arms raised, a drooping face, slurred speech, new problems walking and loss of bladder or bowel control. It says severe sudden neck pain, heaviness or weakness in the arms or legs, pins and needles in an arm with neck pain, or arm pain between the shoulder blades should prompt an urgent GP appointment or NHS 111.

Some patterns from the sources above can help describe symptoms to a clinician:

The NHS says that in many areas you can refer yourself to NHS community musculoskeletal (MSK) services, for example for physiotherapy, without a GP referral. A GP or specialist may suggest nerve conduction tests, ultrasound or MRI if the cause is unclear, or imaging such as X-ray, CT or MRI for suspected thoracic outlet syndrome. Which test is right depends on where the symptoms are, which is why a clinician usually starts with an examination.