Numbness in arm and pain in shoulder

by Wendy
(London)

Hello!

My question is around both cure and prevention of my injury/condition.

Symptoms:
My shoulder is painful, more of an ache than an outright pain, but bad enough that by the end of the day I feel slightly nauseous. The center of the pain appears to be under my collar bone and towards my neck, on the left side of my body.
I can feel a slight crunching feeling sometimes when I move. I just feel like I want someone to give my arm a good tug.

Recently, I have been waking up with my left arm completely numb, as if it is no longer part of my body, which is very disconcerting. Some mornings, I just have a numbness in my pinkie and ring finger. But there is numbness/tingling/loss of sensation every morning.

I normally sleep on my right side, in a relaxed fetal position but I have been waking up recently lying flat on my back with my left arm in the position a traffic policeman would use to stop traffic! Needless to say I also feel very tired.

I've noticed that my shoulder doesn't "look right", so I've attached a photo for you.

About me:
Female. 41 years old. Height 5' 7". 61 kg. Right handed. Work involves sitting in front of a computer. I don't remember a specific incident that happened to cause it, but I have been putting up with the pain/annoyance for some months.

And finally to the question! Is there enough information for you to know what this is? How do I fix it and how to I prevent it from coming back?

Many thanks in advance,

Hello Wendy,
Some questions:
1. Is the SC joint, arrowed, tender and is there a swollen lump?

2. Exactly where is the tingling and numb feeling in your arm and hand? The ring finger and pinkie belong to the C8 dermatome from your neck, but can also be affected in a thoracic outlet syndrome.

3. Is it painful out on the shoulder proper, and in the midback. Does using your arm hurt? Where? What movements?

4. It would seem that raising your arm relieves the ache. is that right? If you put your hand on your head, do you get relief, or is it worse? Do it when your arm is tingling.

5. Are any movements of your head and neck painful? Where and which movements?

In short, you really need a careful and thorough examination. If it goes down the arm then I usually recommend an xray of your neck and perhaps your chest. Any cough? Any lumps and bumps above the collarbone, in your neck, in the armpit?

Whilst this is a condition that chiropractors treat on a daily basis, it might be an idea to get an examination by your doctor; don't let him just prescribe you pills. What's needed is a diagnosis. Ask for an xray.

Let me know.

Dr B

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Jul 27, 2015
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Answers to questions
by: Wendy

Hi Dr. B,

Thanks for reviewing my contribution. Here are the answers to your questions:

1. I can't feel a lump at the SC joint, but it is tender to touch.

2. The tingling in the pinkie and ring finger are from the knuckle to the tip, and all the way around the fingers. On the occasions that the arm goes completely numb it is from the top of my shoulder to the tips of my fingers.

3. The shoulder aches, so it's difficult to pin point the source, but the soft tissue between the neck and shoulder to the left of my spine is very tender. Pain during movements is easier to define:

I'm unable to raise my arm laterally past the 90 degree angle.If I reach behind me and try to raise my arm the range of movement is limited to about 45 degrees. The arm feels weak overall.

4. I seem to raise my arm only in my sleep, but the pain of it coming back down usually wakes me, however, I do feel that it feels less painful in that position but only when lying down on my back, when it's fully supported.

5. Head and neck movements are fine.

No cough, no lumps or bumps! I will take your advice and book a visit to my GP and press him for an x-ray. Many thanks, I had been thinking that an x-ray would be the best course of action and you've certainly convinced me.

Hello Wendy,
Certainly the C8 dermatome is affected, and that could either be in the nerve root as it emerges from the spine, or in the thoracic outlet where the lowest most nerve fibres, C8, lie on the first rib.

The fact that movements of your neck are painless points away from the spine and towards a "thoracic outlet syndrome". This however is in conflict with the fact that at night you raise your arm for relief. That's more typical of a neck condition.

Are you unable to raise your arm because of pain, or just weakness? This is critical in making a diagnosis.

What's needed is a comprehensive examination including Adson's test to rule in or out a thoracic outlet syndrome and make a correct diagnosis. Don't just accept pills to cover up the symptoms. Insist on a proper examination.

Good luck, and let me know how you get on.

Dr B

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