A woman in her 30s with neck pain, right arm numbness, and a cold sensation in her hand
A woman in her 30s who worked near Yokohama Station visited Spine Chiropractic in Bashamichi with numbness throughout her right arm that had started approximately two weeks earlier.
This was her first visit to Spine Chiropractic, but I had previously treated her at another chiropractic clinic where I used to work. At that time, she had been receiving care for lower back pain.
Based on her previous experience, she decided to consult me again when her new symptoms developed and searched for Spine Chiropractic in Yokohama.
For approximately two weeks before visiting the clinic, she had been taking medication prescribed by a hospital, including Loxoprofen and Methycobal. The medication temporarily reduced her symptoms, but the numbness returned as its effects wore off.
She was also concerned because her right hand had started to feel colder than her left hand.
[Initial Symptoms]
Medical Interview
The patient reported that she had gradually become aware of numbness in her right arm. Over approximately two weeks, the symptoms became more frequent and eventually spread throughout the arm.
At first, she thought the symptoms might be related to fatigue from work and tried massaging her arm herself. However, the symptoms continued and gradually became more noticeable.
Around the same time, she noticed that her right hand felt colder than her left.
Although the medication prescribed by the hospital temporarily reduced the numbness, the symptoms would return after the effect wore off.
Visual Inspection
No obvious abnormalities were observed during visual inspection.
Static Palpation
Increased muscle tension was noted on the right side of the cervical region, including the upper trapezius and sternocleidomastoid (SCM) muscles.
Compared with the left side, increased muscle tension was also observed in the right upper arm and forearm.
Motion Palpation
When the patient rotated her neck to the left, the numbness in her right arm became slightly stronger.
The numbness also increased when her arm was positioned in a way that stretched the muscles of the chest.
Orthopedic Tests
- Morley’s Test: Positive
- Adson’s Test: Positive
- Costoclavicular Maneuver: Negative
- Wright’s Test: Positive
These findings were considered together with the patient’s symptoms, symptom distribution, and changes in symptoms with neck and arm movement.
Because these provocative tests are not sufficient on their own to confirm or exclude thoracic outlet syndrome, the overall clinical presentation was considered rather than relying on any single test.
Muscle Strength Examination
No obvious muscle weakness was identified during the examination.
[Initial Treatment]
Based on the patient’s history and examination findings, her presentation was considered consistent with thoracic outlet syndrome (TOS).
TOS can involve irritation or compression of nerves and/or blood vessels as they pass through several anatomical regions between the neck and upper limb.
In this case, particular attention was given to the scalene muscles and pectoralis minor, as the patient’s symptoms changed with neck and arm positioning and increased muscle tension was observed in these areas.
Treatment focused on improving the mobility and function of the muscles and joints around the cervical spine, shoulder girdle, chest, and upper limb.
Muscular treatment was applied to the scalene muscles, pectoralis minor, and other surrounding tissues. Myofascial release was also performed where appropriate.
Cervical adjustments were applied to the C4–C6 region based on the restricted cervical movement observed during examination.
After the initial treatment, some numbness remained, but the overall intensity of the symptoms decreased, and the patient reported that rotating her neck to the left had become easier.
A follow-up visit was scheduled five days later to assess how the symptoms responded over time.
[Prognosis]
Second Session
The patient reported that her symptoms had eased slightly for approximately two days after the first treatment, but then gradually returned to a similar level.
The same general treatment approach was used, with additional attention given to the shoulder joint and surrounding tissues.
A forward shoulder posture, or rounded shoulder posture, was also observed. Considering the increased tension around the chest and shoulder region, the position and mobility of the shoulder girdle were taken into account during treatment.
A follow-up visit was scheduled for one week later.
Third Session
The patient reported that the improvement following the second treatment lasted longer than after the first session.
One week later, she rated the numbness at approximately 4 out of 10 compared with the initial intensity of 10 out of 10.
The same general treatment approach was continued, and the interval between visits was extended to 10 days.
She also reported that the cold sensation in her right hand had improved significantly.
Fourth Session
There was a slight increase in symptoms during the longer interval between treatments. However, both the intensity and the area of numbness were substantially reduced compared with her initial visit.
The cold sensation in her right hand had completely resolved.
As the symptoms continued to improve, treatment was expanded to include the upper arm and forearm as well as the cervical and shoulder regions.
The interval between visits was extended to two weeks to monitor whether the improvement would be maintained.
Fifth Session
Two weeks later, the patient reported that the numbness was almost completely gone.
She described her symptoms by saying:
“If I really think about it, I might notice it slightly, but otherwise, I don’t even remember it when I’m busy.”
At this point, the symptoms were no longer significantly interfering with her daily activities.
The intensive phase of care was therefore concluded. At the patient’s request, she subsequently continued with approximately monthly maintenance visits to address general musculoskeletal issues and work-related physical fatigue.
[Practitioner’s Opinion]
Thoracic Outlet Syndrome (TOS) refers to a group of conditions involving irritation or compression of nerves and/or blood vessels as they pass through the region between the neck and upper limb.
When nerve-related symptoms are predominant, patients may experience numbness, tingling, pain, or weakness in the arm or hand.
Several anatomical regions are commonly considered when evaluating TOS. Three important areas are the following:
1. Scalene Muscle Syndrome
The brachial plexus, the network of nerves that supplies the upper limb, passes through the space between the anterior and middle scalene muscles in the lower neck.
If the surrounding muscles become excessively tense or the available space becomes restricted, the brachial plexus may be irritated or compressed, potentially contributing to symptoms such as numbness or pain in the arm.
For this reason, the scalene region is an important area to assess when evaluating symptoms that may be related to TOS.
2. Costoclavicular Syndrome
After leaving the neck, the brachial plexus and the subclavian vessels pass through the space between the clavicle and the first rib.
Changes in the relationship between the clavicle and first rib, or changes in the surrounding tissues, may contribute to compression or irritation in this region.
This is not a common cause of arm numbness in everyday situations, but previous trauma or a history of clavicle fracture may alter the anatomy and contribute to symptoms in some cases.
3. Pectoralis Minor Syndrome
The brachial plexus and blood vessels pass beneath the pectoralis minor muscle before continuing into the arm.
Increased tension around the pectoralis minor, together with a forward shoulder or rounded shoulder posture, may reduce the available space and contribute to irritation of the nerves or blood vessels.
Symptoms may become more noticeable when the arms are held overhead or in an elevated position for an extended period.
Examples of everyday activities that may place the arms in this position include holding onto a strap on a train, hanging laundry, or cleaning windows.
This presentation is sometimes discussed in relation to pectoralis minor syndrome or hyperabduction-related symptoms.
Clinical Assessment in This Case
In this patient, the combination of right arm numbness, a cold sensation in the right hand, increased tension around the scalene and pectoralis minor regions, and changes in symptoms with neck and arm positioning led me to consider that both the scalene and pectoralis minor regions may have been contributing to her symptoms.
Therefore, I considered her presentation consistent with thoracic outlet syndrome involving both areas and focused treatment on the cervical spine, shoulder girdle, chest, and upper limb.
The patient’s symptoms gradually decreased over the course of treatment, and the cold sensation in her hand resolved before the numbness had completely disappeared.
However, arm or hand numbness can have many different causes, including cervical radiculopathy, carpal tunnel syndrome, ulnar nerve entrapment, and other peripheral nerve disorders. Therefore, numbness should not automatically be attributed to TOS.
In addition, symptoms such as significant or persistent coldness, changes in skin color, swelling, progressive weakness, or worsening neurological symptoms may require medical evaluation to assess possible vascular or neurological conditions.
In this case, the patient’s symptoms improved progressively during conservative chiropractic care, together with changes in the treatment approach and observation of her symptoms over time.
The case also highlights the importance of considering not only the area where symptoms are felt, but also the relationship between the cervical spine, shoulder girdle, chest, and upper limb when evaluating patients with arm numbness.
Chiropractic Care in Yokohama
Spine Chiropractic is located in Bashamichi, Yokohama, just a one-minute walk from Bashamichi Station.
The clinic is also approximately seven minutes from JR Kannai Station, eight minutes from Nihon-Odori Station, and 12 minutes from JR Sakuragicho Station.
I provide chiropractic care in both Japanese and English for patients in Yokohama, including Bashamichi, Kannai, Minatomirai, Sakuragicho, and surrounding areas.
If you are experiencing arm numbness, hand numbness, neck pain, or similar symptoms, Spine Chiropractic can assess your musculoskeletal condition and determine whether chiropractic care may be appropriate.