In addition to feeling tingling or pins and needles in the arms and hand, symptoms commonly associated with TOS include dull to severe pain in the hand, arm, shoulder and/or neck, as well as arm weakness and numbness in the hands and fingers. The ring and pinky fingers tend to be most affected. TOS can also make grabbing objects difficult. When TOS involves compression of the blood vessels, symptoms may also include swelling, color changes and coldness in the hands and arms with black spots under the fingernails from burst blood vessels.