Nerve Compression and Cervical Spine Pathology in Arm Numbness and Tingling

Peripheral Nerve Entrapment Syndromes

The American College of Radiology suggests that nerve compression syndromes, specifically carpal tunnel syndrome, cervical radiculopathy, ulnar nerve entrapment, and less commonly thoracic outlet syndrome or radial tunnel syndrome, are the most common causes of unilateral arm numbness and tingling 1

New or progressive arm numbness with neck pain requires consideration of cervical radiculopathy, which results from nerve root compression due to disc herniation, foraminal stenosis, or degenerative spondylosis, according to the American College of Radiology 1
Most cases of cervical radiculopathy resolve spontaneously or with conservative treatment, as stated by the American College of Radiology 1
MRI is the most sensitive test for detecting soft tissue abnormalities, but has high false-positive rates in asymptomatic individuals, as noted by the American College of Radiology 1

The American College of Radiology and other guideline societies recommend that diabetes, hypothyroidism, vitamin B12 deficiency, alcohol use, and certain medications can cause peripheral neuropathy, though these typically produce bilateral symmetric symptoms 2
Assessment should include testing small-fiber function and large-fiber function, and screening labs should include glucose/HbA1c, thyroid function, vitamin B12, and renal function, as suggested by the guideline society 2

Acute onset, rapidly progressive, or multifocal paresthesias require urgent evaluation to exclude Guillain-Barré syndrome or vasculitis, according to the guideline society 4
Bilateral symptoms with motor weakness or severe dysautonomia are warning signs, and symptoms with decreased leg strength, unsteady gait, or radiating numbness from chest/groin suggest cervical myelopathy, as stated by the guideline society 3