Neuralgia of the arm

Term associated with arm neuralgia

• Brachialgia: pain in the arm, which may be caused by a nerve or another structure.

What is arm nerve pain?

Une Neuralgia of the arm est une douleur ressentie dans le territoire d’un ou de plusieurs nerfs du bras. Ce terme décrit la localisation de la douleur selon la définition de l’Association internationale pour l’étude de la douleur¹. Une douleur est dite neuropathique lorsqu’elle est causée par une lésion ou une maladie du système qui transmet les sensations du corps². Une lésion est un dommage à un tissu. La douleur peut s’accompagner de brûlures, de chocs électriques, de fourmillements ou d’engourdissements³. Ces sensations seules ne prouvent pas une lésion nerveuse.

What is a nerve?

Un nerf (notre guide sur les nerfs) transmet des messages entre le corps et le cerveau ou la moelle épinière. La moelle épinière est un cordon de tissu nerveux qui passe dans la colonne et relaie ces messages. Les messages voyagent sous forme de signaux électriques liés au passage de petites particules chargées à travers l’enveloppe des cellules⁴. Un nerf contient des fibres, les parties allongées des cellules nerveuses. Les fibres sensitives transmettent notamment les sensations de la peau. Les fibres motrices transmettent les commandes qui font contracter les muscles et bouger les membres⁵.

What are the nerves in the arm?

Les principaux nerfs du bras sont les nerfs médian, ulnaire, radial, musculocutané et axillaire. Ces cinq nerfs principaux⁶ proviennent d’un réseau de nerfs situé entre le cou et l’aisselle. Ils ont des rôles différents :

• The median nerve is involved in the movements of the wrist and fingers, as well as in the sensation in the thumb, index finger, middle finger, and part of the ring finger, especially on the palm side.
• The ulnar nerve controls several small muscles in the hand and transmits sensations from the little finger and part of the ring finger.
• The radial nerve helps extend the elbow, wrist, and fingers. It also transmits sensations to the back of the hand, on the thumb side.
• The musculocutaneous nerve helps bend the elbow and transmits sensations to the outer side of the forearm.
• The axillary nerve helps you raise your arm and transmits sensations from the side of the shoulder.

Compressive neuropathy is nerve damage caused by pressure on a nerve. At the wrist, compression of the median nerve results in carpal tunnel syndrome. At the elbow, compression of the ulnar nerve can occur in the cubital tunnel, a passageway inside the elbow ⁷. In Finnish specialized care, carpal tunnel syndrome was the most common of these diagnoses, followed by ulnar nerve compression and then radial nerve compression ⁸. This classification does not account for all causes of arm pain.

What are the causes of arm nerve pain?

Une Neuralgia of the arm peut être liée à une compression d’un nerf, à un étirement important ou à une blessure nerveuse. Le problème peut se situer dans le bras ou près du cou (notre guide sur la Neck pain)⁹. Après une lésion nerveuse, une réaction inflammatoire peut contribuer à d’autres changements du nerf¹⁰. L’inflammation est une réaction des tissus à une agression; elle n’entraîne pas automatiquement une douleur neuropathique.

Nerves also adapt to normal movements. A posture or movement alters the forces of stretching, shearing, and compression around the nerve ¹¹. This does not mean that every unusual position causes damage. The evaluation looks for what is causing your symptoms and for signs of nerve damage.

Cervicobrachialgia refers to pain in the neck and arm. This term alone does not confirm nerve damage. Cervical radiculopathy is damage to a nerve root—the part of the nerve near the cervical spine—and can affect strength, sensation, or reflexes.

What situations can contribute to the problem?

• Excessive stretching of the nerve
• Prolonged compression of the nerve
• An inflammatory reaction or swelling that increases pressure around a nerve, depending on the affected area
• Movements or positions that worsen symptoms, without necessarily damaging the nerve

What is the connection to diabetes?

Diabetes is associated with a higher incidence of carpal tunnel syndrome. A review of studies reports an odds ratio of 1.69 after adjusting for other factors ¹². This calculation compares the ratio of the probability of having the condition to the probability of not having it among people with and without diabetes. It does not mean that 69% of people with diabetes will develop this condition.

In a study of 122 people with type 1 diabetes, 26 had carpal tunnel syndrome. A calculation based on these data estimated an 85% probability of developing the syndrome after 54 years of having diabetes ¹³. This percentage was a projection, not a result observed in all individuals over a 54-year period. A review also cites a lifetime risk of approximately 10% in the general population ⁷. These figures, derived from different populations and using different methods, do not represent your personal probability.

What actions or events can cause sensations in the arm?

• Falling asleep with your head resting on your arm and waking up with a tingling sensation may be caused by temporary pressure on a nerve. Numbness is not always painful and is not sufficient on its own to diagnose neuralgia.
• Keeping the elbow bent at a sharp angle—for example, while on a phone call—can affect the speed at which the ulnar nerve transmits signals. A study examined this position in 114 people, some of whom already had symptoms ¹⁴. Another study compared 50 people who had undergone surgery for ulnar nerve damage to 50 controls. The position of the elbow being very bent was more common in the affected group, but the difference in total duration of phone use was not clear ¹⁵. These studies do not prove that cell phone use alone causes the symptoms. Adjusting prolonged postures may be helpful if they trigger numbness in the hand.
• Recevoir un coup directement sur le nerf ulnaire au coude peut donner une sensation de décharge et des picotements vers les doigts. Le nerf passe près de la peau à cet endroit, comme le décrit l’American Society for Surgery of the Hand, une société de chirurgie de la main⁶. Une blessure peut aussi causer une atteinte nerveuse qui demande une évaluation¹⁶. Les personnes ayant une douleur neuropathique décrivent parfois des chocs électriques, des fourmillements ou des engourdissements³.
• After an elbow sprain—an injury to the ligaments that stabilize the joint—swelling can sometimes increase pressure near a nerve. Nervous system symptoms following an injury require evaluation; they should not be automatically attributed to inflammation.

What are the symptoms of arm nerve pain?

Arm neuralgia can cause a burning sensation or electric shocks and may be accompanied by tingling, pins-and-needles, or numbness ³. Describing your sensations helps with the evaluation, but is not enough to determine their cause. You can use your own words, for example:

• Burning
• Tightness, heaviness, constriction
• A sensation of stretching, a tight cord, or an overstretched elastic band
• Wave sensation
• Sensation of swelling
• Hot or cold sensation
• Sensation of water running

Describe where you feel numbness, tingling, a prickling sensation, or electric shocks, and what triggers or relieves these symptoms. Symptoms can sometimes extend beyond the usual distribution of a nerve.

Nerve damage can also affect strength or sensation. Be sure to report the following:

• Feeling of loss of strength
• Feeling of a heavy or dead arm
• Change in sensation when touching the arm

How is arm neuralgia diagnosed?

A healthcare professional evaluates arm neuralgia by asking you about your symptoms and examining your strength, sensation, and reflexes—the automatic responses of your muscles. They look for signs of nerve-related pain and other possible causes. The location of the pain, when it began, how it has changed over time, and the actions that affect the pain guide the examination.

Des tests complémentaires peuvent être utiles selon la situation. Les tests de conduction nerveuse mesurent la transmission des messages dans les nerfs. Un électromyogramme mesure l’activité électrique des muscles. Une échographie ou une imagerie par résonance magnétique, appelée IRM, produit des images des tissus. Ces examens ne sont pas toujours nécessaires, et un test normal n’exclut pas toutes les atteintes nerveuses. La démarche diagnostique⁷ combine les renseignements plutôt qu’un seul test.

What symptoms require urgent medical attention?

Sudden arm pain accompanied by chest tightness, sudden weakness, or severe pain with difficulty moving the arm requires urgent evaluation.

• Call 911 if you experience sudden arm pain accompanied by pressure, heaviness, or tightness in your chest.
• Appelez le 911 pour une faiblesse soudaine d’un bras, un visage qui s’affaisse ou une difficulté soudaine à parler, même si le signe disparaît. Ce sont des signes possibles d’accident vasculaire cérébral, un problème de circulation dans le cerveau¹⁷.
• Seek medical attention right away if your arm hurts during physical activity but stops hurting when you rest, or if your arm is swollen and you have a very high fever or feel hot, cold, or have chills.
• Allez à l’urgence pour une douleur très forte avec difficulté à bouger le bras, ou après une blessure avec craquement ou déformation. Des picotements ou un engourdissement du bras demandent aussi un avis urgent selon les consignes sur la douleur au bras¹⁸.

Un syndrome du tunnel carpien déjà évalué peut provoquer des fourmillements intermittents, souvent la nuit. Ses symptômes qui s’aggravent ou persistent demandent un nouvel avis médical, comme le précise la fiche sur le tunnel carpien¹⁹. N’attribuez pas vous-même un nouveau symptôme à ce diagnostic.

When should you consult a physiotherapist for arm neuralgia?

It is a good idea to see a physical therapist if your arm pain limits your activities, persists, or recurs—after you have ruled out the urgent symptoms listed above. The physical therapist can assess your condition, recommend appropriate treatment, and refer you to a doctor if necessary.

Au Québec, vous pouvez consulter un physiothérapeute en clinique privée sans prescription médicale, selon l’Ordre professionnel de la physiothérapie du Québec²⁰. Cet accès direct ne remplace pas une consultation urgente quand les signes le nécessitent.

How does physical therapy treat arm neuralgia?

Physical therapy helps manage nerve pain in the arm through tailored exercises, manual therapy, and activity recommendations. The approach depends on which nerve is affected, the severity of the symptoms, and your goals. Nerve treatment may include gradual arm movements to adjust the stress on a nerve ⁷.

The studies focus primarily on carpal tunnel syndrome. A 2012 review concluded that the evidence regarding exercises and mobilization was highly uncertain ²¹. However, a 2024 meta-analysis reported improved nerve conduction velocity following mobilization. The confidence in the results was moderate for motor signals—which control the muscles—and very low for sensory signals. Other measures of nerve conduction did not differ significantly between groups ²². These results primarily concern carpal tunnel syndrome and do not prove the repair of every painful nerve.

Your physical therapist will conduct an evaluation to understand the possible causes and effects of your pain. The evaluation may include:

• Your ability to move your neck, shoulder, elbow, and wrist
• How your symptoms respond to movements that put pressure on the nerves
• Movements and positions that make your activities easier or more difficult
• Your strength and your ability to control your arm movements

What types of care are available?

• Certaines techniques de Manual therapy, des mouvements réalisés avec les mains du thérapeute, peuvent réduire la douleur et améliorer l’usage de la main dans le tunnel carpien. Une synthèse de six essais rapporte des bénéfices après le traitement, notamment pour des mouvements qui sollicitent progressivement les nerfs, comparés à une intervention simulée ou à l’absence de traitement²³. Les techniques variaient, et le maintien des bénéfices à long terme restait à vérifier.
• Specific exercises can gradually stimulate a nerve through coordinated arm movements. A review of 25 articles found less pain and fewer functional difficulties compared to the absence of treatment. However, the evidence was of low or very low quality, and the authors did not conclude that there was an established clinical benefit for mild to moderate carpal tunnel syndrome ²⁴. Your program should therefore be adjusted based on your symptoms and the actual progress you make.
• Your physical therapist can help you adjust the duration, intensity, and breaks in your daily activities and leisure pursuits, and then gradually increase what you can handle.
• Your physical therapist may suggest changes in posture or movement to reduce what triggers your symptoms, without trying to find a perfect position to maintain all day long.

For mild to moderate carpal tunnel syndrome, non-surgical treatment may include advice, a splint, manual therapy, and exercises. A splint is a device that holds the wrist in a specific position. The benefits and limitations of each option should be discussed based on your individual situation. ^{7, 25, 21}

Wearing a splint at night can help keep the wrist straight and reduce carpal tunnel syndrome symptoms ⁷. Your healthcare provider will determine the proper fit and how long you should wear it.

For carpal tunnel syndrome, non-surgical treatment is often recommended first. Severe symptoms that worsen or persist despite treatment may warrant a surgical evaluation ⁷. A 2024 review indicates that surgery is more likely to result in overall improvement than wearing a splint after more than three months. However, the average differences in symptoms and hand function were small ²⁶. The decision takes into account the severity of the condition, previous outcomes, risks, and your preferences. A lack of progress warrants a reevaluation of the diagnosis and treatment options.

What to do at home for arm neuralgia?

- Will treat your nerves using manual therapy techniques specific to each nerve - Will provide you with specific exercises for your nerves - Will teach you how to properly manage your daily activities and leisure pursuits to optimize healing - Will give you advice on your posture and movement. Among these nerve exercises, we often teach a neurodynamic exercise for the upper limb (ULNT 1) to be performed without triggering symptoms. Home care aims to reduce movements that worsen your symptoms and to maintain activities that you can tolerate. This advice applies after checking for urgent signs. Temporarily limit a movement that is very painful, then gradually resume it based on your tolerance.

How can you make these positions more comfortable?

• Try supporting your arm with a pillow or an armrest if that provides relief. A small pillow near your armpit or your hand in a pocket may be comfortable for some people. Change your position if it makes your symptoms worse.
• If you experience pain at night or stiffness when you wake up, make sure your neck is comfortably supported by your pillow. Adjust the height of the pillow to avoid a position that worsens your symptoms.
• When sleeping, try keeping your arm alongside your body or resting it on a pillow. If placing your arm behind your head or under the pillow triggers symptoms, adjust your position. None of these positions is off-limits to everyone.

Additional Reference

1. International Association for the Study of Pain (IASP). Terminology.↩ Back to text
2. Finnerup NB, Haroutounian S, Kamerman P, Baron R, Bennett DLH, Bouhassira D, et al. Neuropathic pain: an updated grading system for research and clinical practice. Pain. 2016;157(8):1599-1606.↩ Back to text
3. Crawford B, Bouhassira D, Wong A, Dukes E. Conceptual adequacy of the neuropathic pain symptom inventory in six countries. Health Qual Life Outcomes. 2008;6:62.↩ Back to text: 1st, 2nd, 3rd mentions
4. Goodwin G, McMahon SB. The physiological function of different voltage-gated sodium channels in pain. Nat Rev Neurosci. 2021;22(5):263-274.↩ Back to text
5. Rekling JC, Funk GD, Bayliss DA, Dong XW, Feldman JL. Synaptic control of motoneuronal excitability. Physiol Rev. 2000;80(2):767-852.↩ Back to text
6. American Society for Surgery of the Hand (ASSH). Body Anatomy: Upper Extremity Nerves. The Hand Society.↩ Back to text: 1st, 2nd mentions
7. Schmid AB, Fundaun J, Tampin B. Entrapment neuropathies: a contemporary approach to pathophysiology, clinical assessment, and management. Pain Rep. 2020;5(4):e829.↩ Back to text: 1st, 2nd, 3rd, 4th, 5th, 6th, 7th mentions
8. Hulkkonen S, Lampainen K, Auvinen J, Miettunen J, Karppinen J, Ryhänen J. Incidence and operations of median, ulnar and radial entrapment neuropathies in Finland: a nationwide register study. J Hand Surg Eur Vol. 2020;45(3):226-230.↩ Back to text
9. Malik T, Malik A, Abd-Elsayed A. Pathophysiology of Work-Related Neuropathies. Biomedicines. 2023;11(6).↩ Back to text
10. Estebe JP, Atchabahian A. The nerve: A fragile balance between physiology and pathophysiology. Eur J Anaesthesiol. 2017;34(3):118-126.↩ Back to text
11. Topp KS, Boyd BS. Structure and biomechanics of peripheral nerves: nerve responses to physical stresses and implications for physical therapist practice. Phys Ther. 2006;86(1):92-109.↩ Back to text
12. Pourmemari MH, Shiri R. Diabetes as a risk factor for carpal tunnel syndrome: a systematic review and meta-analysis. Diabet Med. 2016;33(1):10-6.↩ Back to text
13. Singh R, Gamble G, Cundy T. Lifetime risk of symptomatic carpal tunnel syndrome in Type 1 diabetes. Diabet Med. 2005;22(5):625-30.↩ Back to text
14. Padua L, Coraci D, Erra C, Doneddu PE, Granata G, Rossini PM. Prolonged phone-call posture causes changes of ulnar motor nerve conduction across elbow. Clin Neurophysiol. 2016;127(8):2728-2732.↩ Back to text
15. Vavalle G, Barbieri C, Messina D, Pietramala S, Rocchi L, Fulchignoni C. The Correlation Between Smartphone Use and Compressive Ulnar Neuropathy at the Elbow: A Retrospective Study. J Clin Med. 2026;15(5).↩ Back to text
16. Dy CJ, Mackinnon SE. Ulnar neuropathy: evaluation and management. Curr Rev Musculoskelet Med. 2016;9(2):178-84.↩ Back to text
17. National Health Service (NHS), Royaume-Uni. Symptoms of a stroke.↩ Back to text
18. National Health Service (NHS), Royaume-Uni. Elbow and arm pain.↩ Back to text
19. National Health Service (NHS), Royaume-Uni. Carpal tunnel syndrome.↩ Back to text
20. Ordre professionnel de la physiothérapie du Québec (OPPQ). Physiothérapie : comment ça fonctionne ?↩ Back to text
21. Page MJ, O'Connor D, Pitt V, Massy-Westropp N. Exercise and mobilisation interventions for carpal tunnel syndrome. Cochrane Database of Systematic Reviews. 2012;2012(6).↩ Back to text: 1st, 2nd mentions
22. Bittencourt JV, Corrêa LA, Pagnez MAM, do Rio JPM, Telles GF, Mathieson S, et al. Neural mobilisation effects in nerve function and nerve structure of patients with peripheral neuropathic pain: A systematic review with meta-analysis. PLoS One. 2024;19(11):e0313025.↩ Back to text
23. Jiménez-Del-Barrio S, Cadellans-Arróniz A, Ceballos-Laita L, Estébanez-de-Miguel E, López-de-Celis C, Bueno-Gracia E, et al. The effectiveness of manual therapy on pain, physical function, and nerve conduction studies in carpal tunnel syndrome patients: a systematic review and meta-analysis. Int Orthop. 2022;46(2):301-312.↩ Back to text
24. Paraskevopoulos E, Karanasios S, Gioftsos G, Tatsios P, Koumantakis G, Papandreou M. The effectiveness of neuromobilization exercises in carpal tunnel syndrome: Systematic review and meta-analysis. Physiother Theory Pract. 2023;39(10):2037-2076.↩ Back to text
25. Jiménez Del Barrio S, Bueno Gracia E, Hidalgo García C, Estébanez de Miguel E, Tricás Moreno JM, Rodríguez Marco S, et al. Conservative treatment in patients with mild to moderate carpal tunnel syndrome: A systematic review. Neurologia (Engl Ed). 2018;33(9):590-601.↩ Back to text
26. Lusa V, Karjalainen TV, Pääkkönen M, Rajamäki TJ, Jaatinen K. Surgical versus non-surgical treatment for carpal tunnel syndrome. Cochrane Database Syst Rev. 2024;1(1):CD001552.↩ Back to text

Nos physiothérapeutes ont défini la stratégie de recherche, le plan et le contenu clinique de cet article. Un outil d’IA a soutenu la recherche documentaire et la révision du texte pour assurer une cohérence du contenu et du style d’écriture.