Expert: Dr. J. Shawn Leatherman - 6/16/2008

Question
Hi. I lift weights 3 days a week. About a year ago I was doing military presses and noticed tingling(pins and needles) in my upper right arm when pressing the weight up. That is the first time I ever felt it and I quit working out immediately to allow it to heal. At the time I was having some chronic shoulder pain that I was working through. I stopped lifting for about six months. The tingling went away for the most part, but it gets reaggravated sometimes. Usually from pulling hard on something. It will normally go away after a couple of hours. I have been lifting again for the past 6 months and until recently I haven't had many problems. My shoulder is perfect. No pain, full range of motion and I stretch a lot to make sure of that. Recently I have started having tingling in that arm again which is aggravated by lifting weights. I can mostly just feel it on my skin in my right arm. I can feel the tingling on my skin in my forearm, upper arm and slightly in my chest and upper back. There isn't any pain, but obviously I have some nerve problem somewhere. I can't tell what the source is though because there isn't and localized pain anywhere. It's just this annoying tingling sensation. Also, I should mention that it probably isn't carpal tunnel in my wrist because when I feel it in my hand it's only in the little finger and part of the ring finger. What do you think could be causing this? What nerve is most likely compressed? What is the path of that nerve? What can I do to alleviate it? Any help you could provide would be much appreciated. Thanks.

Answer
Dear James,

The location of your problem is not in the shoulder per se, but either in the base of the neck or the fibers of the brachial plexus which is the group of nerves that run from your neck into your arms.

The specific nerve that you have described is the Ulnar nerve in the arm/hand...this is the nerve that supplies sensory and motor function to the last two fingers of the hand.  However, the answer is not just that easy.  You see the ulnar nerve originates from multiple nerve roots of the spinal cord in the base of the neck, and any of these nerve roots may be affected...and it runs through some very distinct anatomical regions before it gets into the arm.  This is corroborated by the fact that you are having symptoms in the anterior chest, shoulder and upper back...all of which are supplied by smaller branches of the Ulnar nerve.  

The specific nerve roots are:  C8 and T1, but there may be associated fibers above and below.  The specific smaller diameter nerves that arise from the Ulnar nerve are called the terminal branched of the Brachial Plexus and are as follows: Medial pectoral nerve, Medial Brachial Cutaneous nerve, Medial antebrachial Cutaneous nerve, and the Thoracodorsal nerve.  These above structures all separate from the Ulnar nerve at the level of the armpit and are may be irritated with the pulling motion you described because of pec minor/pec major/anterior deltoid muscle tightness.

Military press will definitely stress this area because it abducts the shoulder joint while stretching the pec muscle across the chest and upper arm.  This will stretch the lower portion of the brachial plexus and compress the nerve supply beneath the musculature.  This is a poor lift, and I do not recommend anyone performing it with heavy weight...dumbells are much better and stress the joint less.  I almost never perform the lift...maybe three to four times a year.

I would recommend that you eliminate all shoulder abduction lifts, and get some soft tissue work done in the area.  This will help to stretch out the pec musculature, and if there are any adhesions in the tissue, they can be worked out over time to allow for better movement of the brachial plexus in the tissue, and this should help reduce the symptoms.

Hope this helps explain the anatomy James, if you would like more complete information on the brachial plexus and the associated nerve branches, please feel free to e-mail me directly from my website, and I will send you a file that cannot be sent through the allexperts forum.  Good luck.

Respectfully,
Dr. J. Shawn Leatherman
www.suncoasthealthcare.net