Causes and Treatments for Arm Pain

Lisa Esposito


From your shoulders to your fingers, your arms have many moving parts: joints, bones, muscles, nerves, tendons and ligaments. Mysterious arm pain that seemingly comes out of nowhere can arise if any of these are affected.

Motions such as lifting, bending, swinging and raising your arms overhead all take an insidious toll. Conditions like rheumatoid arthritis may affect your arms from within. Aches, pain and reduced function can result in one or both arms.

Arm pain may occur from sports overuse injuries. In some cases, arm pain can serve as a warning sign for serious heart problems.

Whether it's a sudden sharp pain or constant dull ache, you need to get a handle on what's causing arm discomfort. From your shoulders to wrists, experts describe common sources of arm pain and how treatment can help.

[See: What Are the Types of Orthopedic Doctors?]


Shoulder

The shoulder is a ball-and-socket joint. Three bones connect to make up the shoulder: the scapula, or the shoulder blade; clavicle, or collarbone; and the humerus (upper arm bone).

Common shoulder conditions include the following:

-- Rotator cuff tear.

-- Tendonitis.

-- Distal clavicle osteolysis.

-- Bursitis.

-- Pinched nerve.

-- Frozen shoulder.

It's important to be evaluated for symptoms of shoulder aches and pains. A medical history, physical exam and possibly imaging tests can determine the cause.

Rotator Cuff Tear

Tendons are flexible, tough bands of tissue connecting muscles with bones. The rotator cuff, a part of the shoulder composed of four muscles and their tendons, can be vulnerable to injury.

The rotator cuff is basically a sheaf, or bundle, of fibrous tissue that goes over the shoulder, says Dr. Ellen Gravallese, chief of the division of rheumatology, inflammation and immunity at Brigham and Women's Hospital and Harvard Medical School. "It's like a piece of cloth and as you age, the cloth kind of frays over time," says Gravallese, who is also the president of the American College of Rheumatology.

To raise your arm properly, you need an intact rotator cuff. A direct rotator cuff injury, like falling on your outstretched arm, can put pressure on the rotator cuff and result in a tear. A small tear probably wouldn't limit motion but would cause pain, Gravallese says. "If you have a larger tear, it can actually impede your ability to raise your arm laterally at the shoulder," she adds. Sometimes surgery is necessary to repair a more serious rotator cuff tear.

Degeneration of a tendon due to normal aging can lead to a rotator cuff tear. Pain can spread from the front of your shoulder and down the side of your arm. You may feel pain or weakness of that arm with lifting, reaching or sleeping on the injured side.

Overuse injuries of the rotator cuff related to certain sports tend to occur among young adults in their early 20s, says Dr. Grant Jones, a professor of clinical orthopedics, orthopedic surgeon, sports medicine specialist and team physician at Ohio State University Wexner Medical Center. Baseball players, gymnasts, swimmers and tennis players are vulnerable because of repetitive, overhead arm movements required for their sports.

Oftentimes, people with rotator cuff tears that don't quickly heal find that their bodies compensate with other muscles groups that allow them to lift their arm upward, Jones says. That allows many people to adapt to rotator cuff tears over time. However, because these tears can get larger, they may still need medical attention.

"We usually start with an anti-inflammatory medication to calm down the inflammation," Jones says. "There are specific exercises for the shoulder as well as the elbow that can help train the muscles and take some of the pain away, too." Stretching exercises also help, he adds.

Tendonitis

Tendonitis, also a common sports overuse problem, involves inflammation or irritation of the tendons. Rotator cuff tendonitis pain may be dull and aching.

Mild tendonitis often can be treated at home with ice, rest and over-the-counter anti-inflammatory medications like ibuprofen (Advil or Motrin) or naproxen (Aleve or Naprosyn). If symptoms persists, your doctor may prescribe physical therapy to ease pain and strengthen that area of the arm.

Distal Clavicle Osteolysis

Inflammation at the end of the collarbone, called distal clavicle osteolysis, is another sports-related, wear-and-tear injury, which often affects young people. "We see this with weightlifters and offensive linemen -- football players who do a lot of lifting," Jones says. That's due to repetitive arm pushing.

Athletes who use arcing overhead motions with their upper arm and shoulder, such as baseball pitchers and volleyball players, can also experience osteolysis from repetitive joint rotation.

Treatment for distal clavicle osteolysis begins with rest and ice packs. Some patients need a sling to keep the shoulder in place.

Shoulder Bursitis

Shoulder bursitis involves painful inflammation of the shoulder joint. This affects small fluid-filled sacs near a joint, called bursae. These bursae provide cushioning that prevents all the joint's moving parts from rubbing together. However, when bursae in the shoulder (or any joint) become irritated and inflamed, muscle and tendon movement is restricted, and it can be painful.

Shoulder bursitis can helped with conservative treatment such as limiting painful activities, splinting, anti-inflammatory medication and icing.

Pinched Nerve

A pinched nerve in the neck, or cervical radiculopathy, can cause radiating pain to the shoulder, and muscle numbness or weakness that can spread down the arm to the hand.

This may resolve on its own. If not, anti-inflammatory drugs, oral or injected steroids, pain medication, a soft collar and physical therapy may help. In some cases of progressively worsening pain, and depending on the cause, surgery to relieve pressure on the nerve and pain may become an option.

Frozen Shoulder

A frozen shoulder, or adhesive capsulitis, involves a stiff, tight painful shoulder that's increasingly difficult to use. Frozen shoulder can be a complication of immobility after an injury or surgery, or of certain chronic conditions.

Over-the-counter or prescription anti-inflammatory and pain medications may ease frozen shoulder symptoms. Physical therapy and range-of-motion exercises can help restore mobility.

Heart Involvement

Arm pain can come from the heart. That's one cause doctors always want to rule out, Gravallese says, especially when someone complains of pain in the upper arm. Instead of being muscular or joint-related, pain might actually be angina, a type of chest pain that occurs when the heart isn't getting enough oxygen-rich blood. Angina pain can radiate, or spread, from the heart to areas including the neck, jaw and arm.

With heart problems, it's typically left arm pain, Gravallese says. "It could also be neck pain, back pain and a number of other things as well," she says. "But the classic radiation of that pain is to the left upper arm. We want to make sure that it is actually a musculoskeletal problem. The location of the pain is very important."

The possibility that your arm pain could come from a cardiac condition -- like a heart attack -- is a compelling reason to get it checked out immediately by a health professional, particularly if you have left arm pain.


[See: 6 Signs You're Having a Heart Attack.]


Upper Arm and Elbow

You use your triceps muscle in your upper arm to extend your arm, whereas the brachialis and biceps muscles allow it to bend at the elbow.

The elbow is a hinge joint. It connects the further end of the humerus and the nearest ends of two lower-arm bones: the ulna and radius. The elbow flexes and extends the forearm, and rotates the forearm and wrist.

Upper arm and elbow conditions include the following:

-- Tennis elbow and golfer's elbow.

-- Nerve entrapment.

-- Joint infection or disease.

Tennis Elbow and Golfer's Elbow

Tennis elbow and golfer's elbow are common forms of arm tendonitis. Tennis elbow, or lateral epicondylitis, affects the outer side of the elbow. Tennis elbow can affect tennis players who continually swing a racket, but other people with jobs involving physical labor can also develop it.

Golfer's elbow, or medial epicondylitis, affects the inner side of the elbow. Swinging a golf club forcefully and repeatedly can put too much stress on the joint, as can other activities such as carrying a heavy suitcase, chopping wood or using a chainsaw.

If you press the bony protrusions around your elbows, called epicondyles, you can feel the discomfort, Gravallese notes. Muscles insert through ligaments onto the epicondyles, she explains. "If you stress that area, you can get a lot of pain," she says.

Simple treatments can ease tendonitis pain, including using a brace, taking anti-inflammatory medication such as ibuprofen or naproxen, stretching exercises and physical therapy. If those don't work, steroid injections in the arm can relieve pain and inflammation.

Nerve Entrapment

In nerve entrapment injuries, peripheral nerves of the arm become trapped at the joints. Cubital tunnel syndrome is a common example in which the ulnar nerve, one of the three main nerves of the arm, gets trapped at the elbow, Gravallese says.

At home, avoiding activities that force you to bend your arm for long periods, avoiding leaning or otherwise putting pressure on your elbow or inner arm and using padding to keep your elbow straight while sleeping may help. Your doctor may prescribe anti-inflammatory medication, bracing or splinting.

If symptoms aren't relieved by other methods, surgery might be needed to reopen the nerve.

Joint infection or Disease

Infections can arise in any joint, Gravallese notes. "You can get crystalline disease like gout or pseudo-gout," she adds. Gout is more common in the base of the toe, but she often sees patients with gout in the elbow or surrounding bursae.

Gout pain in the arm can be treated with anti-inflammatory medication, splints and compression to ease swelling and reduce pain. Ongoing treatment with gout-controlling medication and dietary modifications can help prevent or limit gout attacks.


Lower Arm and Wrist

Your forearm is made up of two large bones, the radius and ulna. The radius runs from the inside of your elbow down to the thumb side of your wrist. The ulna runs parallel to the radius, from the outside of your elbow to the little finger (pinkie) side of your wrist.

The wrist is a gliding joint that's actually made up of several small joints. The wrist is formed where the ulna and radius meet the carpus -- four smaller bones on the upper end of the wrist and four bones on the lower side of the hand.

Lower arm and wrist conditions include the following:

-- Arthritis.

-- Carpal tunnel syndrome.

-- Peripheral artery disease.

-- Fracture.

Arthritis

Arthritis can damage the smooth cartilage covering the wrist joints, reducing the wrist's gliding action and causing bones to rub against each other. Several types of arthritis -- including osteoarthritis, rheumatoid arthritis, post-traumatic arthritis and psoriatic arthritis -- can affect the wrist, along with the hands and fingers.

Rest and modifying activities, or workarounds, bracing or splinting, heat or ice application and medications are used to ease wrist and hand arthritis pain. In some cases, surgery to repair or remove worn or deformed wrist bones may be considered.

Carpal Tunnel Syndrome

Carpal tunnel syndrome is a nerve entrapment syndrome that occurs at the wrist. Treatment options include bracing first, steroid injections if necessary and in some cases, surgery to cut through a ligament, called the carpal tunnel ligament, to relieve pressure on the median nerve of the wrist.

"The best thing is really prevention," Gravallese says. Make sure, for example, that your workstation is ergonomically sound. That means making sure when you're at your computer that it's setup in in such as way that "you're not constantly bending that wrist, or resting your wrist down on a table or on a keyboard," she says. That's because keeping your wrist in those type of positions, over time, can cause carpal tunnel syndrome.

Peripheral Artery Disease

Peripheral artery disease is a circulation problem that most often occurs in the legs but can also affect the arms. As arteries in the arm become narrow or entirely blocked, arm pain, tightness, numbness or cramping can result. Intermittent pain or discomfort while exercising -- referred to as claudication -- is a hallmark symptom.

In some cases, chronic pain from peripheral artery disease can be reduced with rehabilitation and exercise programs.

Fracture

Although a broken bone, or fracture, is usually an obvious source of pain, some smaller fractures can occur without your realizing it. That can be the case with a fracture of the scaphoid bone in your wrist, which causes few outward signs. Subtle signs include swelling and tenderness on the thumb side of the wrist or tenderness with gripping motions.

An X-ray or other imaging test can reveal a scaphoid fracture. Depending on its extent, treatment may include casting or splinting, followed by physical therapy with gentle range-of motion and strengthening exercises.


[See: Different Types of Pain, Explained.]

Find Answers

If you have persistent arm pain without a clear cause, seek an evaluation rather than being stoic. Don't assume it isn't serious.

By asking you about your medical history and performing a physical exam, your doctor can make a diagnosis or order appropriate imaging tests. Most patients don't need an MRI, Jones says. Some may not need any imaging tests at all, he says, or a standard X-ray might suffice.

In many cases, less-aggressive options like physical therapy, home exercises and supportive measures like rest, splinting and ice may be all you need to alleviate arm pain. Surgery comes with the risk of complications and the potential for weeks of recovery time needed for some procedures, Jones points out.

"Sometimes with pain, you have to be a little patient," Jones says. "Surgery is not the end-all answer."