Treatment for Tingling in the Back of the Arm Radiating into the Shoulder
This symptom pattern should be evaluated and treated as potential rotator cuff-related shoulder pathology, as hand and arm paresthesias occur in approximately one-third of patients with rotator cuff tears and typically improve with treatment of the underlying shoulder condition. 1
Initial Clinical Assessment
The key diagnostic consideration is that shoulder pathology, particularly rotator cuff impingement and tears, commonly causes referred paresthesias to the arm and hand, not just shoulder pain. 2, 1
- Look specifically for a positive impingement sign that reproduces the tingling symptoms radiating to the arm/shoulder region, as this confirms the shoulder as the pain generator. 2
- The tingling may be accompanied by shoulder pain during rest, overhead activities, or sleep—these are classic presentations of rotator cuff-related shoulder pain. 1
- Determine if there was a specific injury that caused the symptoms, as this predicts persistence of numbness after treatment. 1
Diagnostic Imaging Protocol
Start with plain radiographs as the mandatory first step to exclude bony abnormalities, fractures, and assess acromial morphology. 3
- Standard views should include anteroposterior views in internal and external rotation PLUS an axillary or scapular Y view. 4, 3
- If symptoms persist beyond 6 weeks with noncontributory radiographs, proceed to ultrasound examination as the recommended next imaging modality to exclude rotator cuff rupture. 5
- Both ultrasound and MRI without contrast are equally appropriate (rated 9/9) for evaluating rotator cuff pathology and bursal inflammation, with ultrasound offering the advantage of real-time assessment and lower cost. 3
Treatment Algorithm
First-Line Conservative Management
Subacromial pain syndrome should preferably be treated non-operatively, as exercise therapy confers at least equivalent benefit to surgery for rotator cuff tendinopathy and tears. 5, 6
- For acute pain: Use analgesics as needed for immediate symptom control. 5
- For persistent or recurrent symptoms: Subacromial injection with corticosteroids is indicated and can provide immediate relief of both shoulder pain and arm paresthesias. 5, 2
Exercise Therapy Protocol
Exercise therapy should be specific, low intensity, and high frequency, combining the following elements: 5
- Eccentric training of the rotator cuff
- Attention to relaxation and posture correction
- Treatment of myofascial trigger points with muscle stretching 5
- Avoid strict immobilization and aggressive mobilization techniques. 5
Activity Modification
- Avoid the shoulder impingement position (forward elevation of the arm above 90 degrees) to minimize symptom recurrence. 2
- If symptoms persist longer than 6 weeks, occupational interventions are useful to modify work-related activities. 5
Important Clinical Pitfalls
- Do not dismiss arm/hand paresthesias as a separate neurological problem—they are frequently part of the rotator cuff pathology presentation and improve with shoulder treatment. 1
- Preoperative hand numbness and injury-related onset predict persistence of numbness even after successful rotator cuff treatment, so counsel patients accordingly. 1
- The severity of hand tingling and numbness typically improves by 50-60% within just 1 week of rotator cuff repair, indicating the strong connection between shoulder pathology and arm symptoms. 1
Surgical Consideration
There is no convincing evidence that surgical treatment for subacromial pain syndrome is more effective than conservative management. 5
- Surgery should only be considered after failure of comprehensive conservative treatment, including corticosteroid injection and structured exercise therapy. 5, 6
- For chronic, treatment-resistant cases with pain-perpetuating behavior, rehabilitation in a specialized unit should be attempted before surgery. 5