Differential Diagnosis for the Painful Tingling Arm

The painful tingling arm is a common presenting complaint for the musculoskeletal physician. The differential diagnosis for upper-extremity pain associated with paresthesias will be the focus of this review. Symptoms are often neurologic in etiology, originating from the spinal cord, nerve root(s), brachial plexus, or peripheral nerve(s). Localizing the pathology starts with a comprehensive understanding of neuromuscular anatomy. It also is imperative to understand the function of these respective structures. The differential diagnosis can be narrowed with a thorough history, including an assessment of sport-specific risk factors, along with a comprehensive physical examination and functional assessment. It is important to determine the sensory distribution of the patient's symptoms. If weakness also is present, the affected muscles must be identified. While the diagnosis can often be made clinically, electrodiagnostics, magnetic resonance imaging, and ultrasound can be used as needed for confirmation and more specific localization. Nonneurologic structures also may be causative or contributory to the patient's symptoms and also should be considered.