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Tingling, numbness, burning, or “pins and needles” in the arm or hand can be unsettling. These sensations—called paresthesias—often come and go, but when they persist, they can interfere with work, sleep, and daily activities. One of the most common sources of upper-extremity paresthesias lies in a highly complex network of nerves called the brachial plexus.
In this post, we’ll break down what the brachial plexus is, how it becomes irritated, and why physical therapy is one of the most effective conservative treatments for restoring comfort and function.
What Are Upper Extremity Paresthesias?
Upper extremity paresthesias are abnormal sensory experiences in the shoulder, arm, forearm, hand, or fingers. They can feel like:
• Tingling
• Numbness
• Electric or shooting sensations
• Burning or “hot/cold” feelings
• A sense of heaviness or “dead arm”
Paresthesias usually indicate irritation, compression, or altered signaling of the peripheral nerves that supply the arm.
Meet the Brachial Plexus: The Nerve Highway of the Arm
The brachial plexus is a network of nerves that originates from the spinal cord in the neck (C5–T1). After exiting the cervical spine, these nerves weave through the scalene muscles, travel under the clavicle, pass between the pectoralis minor and rib cage, and eventually branch into the major nerves of the arm—such as the median, ulnar, and radial nerves.
Because this pathway is long and intricate, there are many places where nerves can become irritated or compressed. Common contributors include:
• Postural stress (forward head, rounded shoulders, prolonged computer work)
• Muscle tightness (scalenes, pectoralis minor, upper trapezius)
• Joint dysfunction in the cervical or thoracic spine
• Thoracic outlet compression
• Repetitive or overhead activity
• Trauma such as whiplash
• Neural tension or restricted nerve gliding
When one or more of these impinges on the nerves, patients may experience radiating symptoms anywhere along the arm.
How Physical Therapy Helps
Physical therapy is a first-line, non-invasive approach to treating upper extremity paresthesias related to brachial plexus irritation. PT addresses both the root cause and the symptoms through targeted interventions that restore mobility, reduce compression, and improve posture and motor control.
1. Postural Assessment and Correction
Poor posture—especially forward head and rounded shoulders—reduces the space available for the brachial plexus. PT helps by:
• Retraining deep neck flexors
• Strengthening scapular stabilizers (mid/low trap, serratus anterior)
• Improving thoracic extension
• Adjusting desk ergonomics
Correcting posture reduces tension on the nerve pathway and helps prevent recurrence.
2. Manual Therapy to Relieve Compression
Hands-on techniques can improve mobility and decrease muscle-driven nerve pressure. These may include:
• Soft tissue mobilization of the scalenes, upper trapezius, pec minor, or subclavius
• Joint mobilization of the cervical and thoracic spine
• Rib mobility techniques
• Myofascial release to decrease neural irritation
These approaches reduce mechanical stress on the nerves.
3. Nerve Gliding Exercises
Also known as neural mobilization, nerve glides help the brachial plexus move smoothly through surrounding tissues. When nerves slide and glide properly, symptoms often diminish.
Therapists prescribe specific glides tailored to the irritated nerve branch—for example, median, ulnar, or radial nerve mobilizations.
4. Strengthening and Motor Control Training
Weak stabilizing muscles often contribute to nerve compression or dysfunctional movement patterns.
Strengthening focuses on:
• Deep neck flexors
• Rotator cuff muscles
• Scapular stabilizers
• Core and thoracic extensors
Improved muscular balance reduces strain on the neck and shoulder structures that influence the brachial plexus.
5. Education and Activity Modification
Finally, understanding symptom triggers helps patients manage and prevent flare-ups. PT may address:
• Sleep positioning
• Workstation setup
• Phone or laptop use
• Proper lifting and overhead reaching mechanics
Empowering patients with knowledge improves long-term outcomes.
When Should You Seek Physical Therapy?
You may benefit from PT if paresthesias:
• Persist longer than a few days
• Frequently recur
• Are triggered by a specific posture or activity
• Interfere with sleep or daily function
• Are accompanied by neck or shoulder tightness
Immediate medical evaluation is recommended if symptoms involve significant weakness, sudden loss of function, or if they follow a traumatic injury.
The Bottom Line
Upper extremity paresthesias can be frustrating, but they’re often highly treatable. Because the brachial plexus is influenced by posture, muscle balance, joint mobility, and repetitive stress, physical therapy offers a comprehensive approach that addresses each of these factors.
If you feel like any of these symptoms sound like you, contact us for a free screen or full evaluation! We are happy to help.
