To narrow down the causes of arm pain, think of the combinations of symptoms:
1. The arm pain aggravated by touch AND movements can be due to delayed-onset muscle soreness, muscle strain, tendonitis, bone fracture, arthritis, peripheral neuropathy or shingles.
2. The arm pain aggravated by movements, but NOT touch, can be from osteoarthritis or a pinched nerve in the neck, armpit or wrist.
3. The arm pain NOT aggravated by touch or movements can be from coronary heart disease.
4. Pain, tingling, numbness and weakness usually originate from nerve damage associated with a herniated disc in the neck or cubital or carpal tunnel syndrome.
5. Pain, redness and rash can be from insect bites, skin infections, shingles or thrombophlebitis.
1. Right arm
2. Left arm
3. Neck, upper back and arm
5. Elbow and forearm
6. Wrist and hand
7. Both arms and legs
8. Muscles, joints, bones, nerves or blood vessels
9. Arm infections
10. Cancer and arm pain
11. Women and arm pain
1. Right Arm Pain
There seem to be no health conditions that would cause pain specifically in the right arm.
1.1. Writer’s cramp refers to involuntary muscle contractions in the dominant (usually right) hand due to prolonged, repeated handwriting. Similar cramps can occur during piano or violin playing. The underlying neurological disorder–dystonia–can be genetic or acquired .
1.2. The pain from the gallbladder can radiate into the right shoulder blade or tip of the shoulder and, rarely, in the right arm.
2.Left Arm Pain
2.1. Angina Pectoris and Heart Attack
2.1.1. Coronary heart disease, usually after the age of 40, can cause recurring pain behind the breastbone that can radiate to the left shoulder blade, neck and jaw and down the inside of the left arm, hand and fingers; other symptoms may include shortness of breath, dizziness and fatigue [1,57]. The pain called angina pectoris can be triggered by exercise, stress, large meals or exposure to heat or cold, but not by the movements of the trunk or arms.
Pain in angina pectoris lasts less than 5 minutes and is relieved by rest or nitroglycerin [1,57].
Pain in heart attack is usually severe, lasts for more than 15 minutes and is not relieved by rest or nitroglycerin .
In women, heart-related pain often radiates to both arms .
Picture 1. Heart-related arm pain
Inflammation of the heart sac (acute pericarditis) can cause low-grade fever and heaviness or sharp pain in the chest, which can radiate down the left arm. The pain, which can be aggravated by lying down and relieved by leaning forward, can persist for few weeks .
2.3. Panic Attack and Heart Anxiety Neurosis
In panic attack or heart anxiety neurosis due to emotional stress, chest pain can radiate down the left arm; other symptoms can include hyperventilation, dizziness, pounding heart (palpitations) and excessive sweating [24,59].
2.4. Trapped Gas
In the individuals with irritable bowel syndrome (IBS), the gas trapped in the upper left part of the large intestine (near the spleen) can cause pain in the left upper abdomen, chest and shoulder blade and can radiate down the inside of the left or both arms [26,58]. The condition is known as splenic flexure syndrome.
Gastroesophageal reflux disease (GERD or acid reflux) can cause pain behind the breastbone (heartburn) and metallic taste in mouth and, rarely, pain in the left arm .
3. Neck, Upper Back and Arm Pain
3.1. Pinched nerves in the neck spine (cervical radiculopathy) due to bulging or herniated discs or arthritis can cause discomfort or pain in the neck, medial shoulder blade border and outer side of the upper arm and tingling in the forearm, hand or fingers .
The pain can be triggered by bending the neck backward, turning the head sideways or lying down and relieved by placing a hand on the back of the neck or top of the head .
Picture 2. Herniated disc in the neck – pain in the neck, upper back, shoulder and upper arm and tingling in the forearm, hand and fingers
3.2. Repetitive forward arm movements during sprints, boxing, push-ups or bench presses can result in serratus anterior muscle pain on one or both sides of the chest, which can radiate down the inside of an arm and into the pinky and ring finger; the pain can be aggravated by deep breathing .
Picture 3. Serratus anterior muscle pain
3.3. Overuse of the upper back muscles in sports, like rowing or swimming, can result in myofascial pain syndrome with muscle knots, which act as trigger points: applying pressure on them triggers pain that can radiate down the arm.
3.4. Thoracic outlet syndrome refers to the entrapment of the nerves or blood vessels that travel through the “thoracic outlet” between the clavicle, upper rib and neck muscles into an arm. Risk factors include anatomical abnormalities (cervical rib), bad posture and arm overuse . Symptoms include pain in the neck, shoulder and outer side of the upper arm and pain, pins and needles, numbness, coldness or weakness in the forearm, hand and fingers .
Picture 5. Thoracic outlet syndrome – pain in the shoulder and outer side of the upper arm and tingling in the forearm and hand triggered by raising an arm above the shoulder level
3.5. T4 or upper thoracic syndrome. Repeated twisting of the upper part of the body can irritate the joints in the upper thoracic spine and the nearby sympathetic nerves and cause pain between the shoulder blades and abnormal sensations (paresthesia) and coldness in the forearm, hand and all 5 fingers on one or both sides .
Picture 9. Pain between the shoulder blades and tingling in a forearm
4.1. Rotator cuff tendonitis (shoulder impingement) with tenderness in the front of the shoulder and pain in the outer side of the upper arm can result from repeated overhead activities in tennis, golf, lifting, swimming, or painting .
4.2. Calcific tendonitis (a chronic inflammation of the tendons around the shoulder) can cause recurring pain in the shoulder and upper arm and snapping in the shoulder.
4.3. Adhesive capsulitis (frozen shoulder–a chronic inflammation of the ligament capsule that embraces the shoulder joints) can cause stiffness and aches in the shoulder and upper arm.
Picture 4. Frozen shoulder pain location
4.4. Arthritis of the shoulder joint can cause swelling in the shoulder and pain in the shoulder and upper arm.
4.5. Shoulder sprain usually presents with swelling and pain in the shoulder and upper arm.
4.6. Shoulder pain can develop within few months after stroke .
4.7. Brachial neuritis (an inflammation of the nerves of the brachial plexus) can cause sudden sharp or throbbing pain in one or both shoulders and upper arms. Causes include recent illness, flu shot, surgery and trauma .
4.8. Avascular necrosis (the death of the bone in the head of the upper arm bone–humerus) can cause deep throbbing pain in the shoulder, which radiates down to the elbow.
5. Pain in the Elbow and Forearm
5.1. Medial epicondylitis (golfer’s elbow) is an inflammation of the tendons with pain and tenderness on the inner (medial) side of the elbow due to repetitive gripping, for example in golfers, bowlers and tennis or baseball players (pitcher’s elbow) [17,18].
5.2. Lateral epicondylitis (tennis elbow) is an inflammation of the tendons of the forearm muscles with pain and tenderness on the outer (lateral) side of the elbow due to repetitive use of the elbow(s), for example, in tennis players, carpenters, plumbers and painters .
Golfer’s elbow (the upper image): pain on the inner side of the elbow
Tennis elbow (the lower image): pain on the outer side of the elbow
5.3. Cubital tunnel syndrome. Entrapment of the ulnar nerve on the inner side of the elbow (“funny bone”) due to leaning on the elbows (students) or sleeping with bent elbows can cause pain, tingling and numbness in the little and ring finger and on the related side of the lower arm and elbow .
Picture 7. Cubital tunnel syndrome: pain down the inner side of the forearm and hand
5.4. Radial tunnel syndrome. Entrapment of the radial nerve on the outside of the elbow due to repetitive elbow extension or forearm rotation can cause pain on the outer side of the forearm and back of the hand, but no numbness or tingling .
6. Pain in the Wrist and Hand
6.1. Carpal tunnel syndrome. Entrapment of the median nerve in the wrist due to arthritis, hypothyroidism, diabetes mellitus or wrist overuse can cause pain, tingling and numbness in the first 3 fingers (thumb, index and middle) and the related part of the palmar side of the hand, wrist or forearm . Provocative tests for carpal tunnel syndrome include Phalen’s and Tinel’s test.
Picture 8. Pain distribution in carpal tunnel and Guyon’s canal syndrome
6.2. Guyon’s (ulnar) canal syndrome. Entrapment of the ulnar nerve in the wrist due to repetitive compression of the pinky side of the hand, for example in cyclists, can cause pain, tingling and numbness in the little and ring finger and the related side of the hand and wrist and on the inside of the forearm.
6.3. DeQuervain’s tendonitis is a wrist overuse injury with an inflammation of the muscle tendons that move the thumb. Symptoms include pain, swelling and a catching sensation at the thumb side of the wrist and forearm, especially during grasping and twisting the wrist .
6.4. Trigger finger refers to a snapping sensation and pain during extending or bending a finger; the condition can develop due to repetitive straining of a hand .
6.6. In the individuals with Raynaud’s disease, which does not have a known cause, the exposure to cold or stress can trigger painful spasms and color changes (blue, red, white) in the fingers . When the underlying cause is known, for example, systemic sclerosis, systemic lupus erythematosus (SLE), vasculitis, lymphoma, leukemia, vibration injury or diabetes mellitus, the condition is called Raynaud’s phenomenon .
Picture 10. Raynaud’s disease – color changes in the fingers (source: Wikimedia, CC license)
7. Bilateral Pain in Arms and Legs
7.1. Fibromyalgia symptoms include tender points on the outer sides of the elbows, in the back of the neck, shoulder blades, in the hips and knees, and fatigue .
7.2. Peripheral neuropathy is the damage to the nerves in the feet and arms, for example, in the individuals with untreated diabetes mellitus, nutrient deficiencies, autoimmune diseases (Sjögren’s syndrome), and in chronic alcoholics. Symmetrical burning pain, extreme sensitivity to touch, tingling and numbness in the feet, lower legs, hands and forearms appear in a “stockings and gloves” pattern .
7.3. Other neurological disorders that can cause pain, muscle weakness, tingling or numbness in both arms and legs, headache or urinary incontinence:
- Cervical spinal stenosis with myelopathy 
- Syringomyelia due to a cyst in the neck part of the spinal cord 
- Transverse myelitis due to Lyme disease, shingles, vaccination, multiple sclerosis or autoimmune disorders
- Guillain-Barré syndrome with weakness, tingling, numbness and pain, which rapidly progresses from the toes and fingers toward the trunk and head 
- Post-polio syndrome, which can develop many years after an infection with the poliovirus 
7.4. Polymyositis and dermatomyositis is an inflammatory muscle disease with mild pain in the shoulder and hip muscles, and rash .
7.5. Polymyalgia rheumatica is a muscle disease in older people with a sudden onset of low-grade fever and pain and stiffness in the shoulders, upper arms, hips and thighs, which are worse in the morning .
8. Arm Pain By the Affected Tissue
8.1. Muscle Pain
Muscle and tendon pain are aggravated by muscle use and are associated with localized muscle tenderness and eventual swelling.
8.1.1. Delayed-onset muscle soreness can develop 24-48 hours after a heavy exercise, such as lifting, and may persist for few days .
8.1.2. Muscle strain (pulled muscle) can occur during overtraining or injury; symptoms include sudden pain, mild swelling and tenderness; the pain can persist for few weeks.
8.1.3. Muscle rupture (tear) causes sudden severe pain, bruise and a palpable deformity; the pain can persist for few months.
8.1.4. Compartment syndrome refers to an acute or chronic increase in the pressure in the compartments between the muscles. Causes include bleeding or swelling after prolonged compression of the arm (lying unconsciously in alcoholics or surgical patients, wearing tight splints), crush trauma or intense muscle use (in cyclists or motocross racers). The blood flow to the muscles is interrupted . Symptoms include intense burning pain, swelling and tightness in the affected part of the arm . Treatment delay can result in muscle death (necrosis), which may require the amputation of an arm.
8.1.5. Rhabdomyolysis (muscle breakdown) can occur as a complication of acute compartment syndrome; symptoms include muscle soreness and dark urine .
8.2. Joint Pain
Joint disorders usually present with joint pain, tenderness and swelling.
8.2.1. Joint injury, such as sprain or dislocation, causes joint pain, swelling and tenderness.
8.2.2. Shoulder or elbow overuse can cause bursitis (an inflammation of the fluid-filled sacs between the tendons and bone) with tenderness, swelling and redness.
8.2.3. Osteoarthritis (joint damage due to wear and tear), mainly in the shoulders and wrists, causes pain and stiffness, which worsen through the day, but no swelling. Bone spurs near the joints may present as hard lumps.
8.2.4. An inflammation of the joints in the fingers due to rheumatoid arthritis , psoriatic arthritis  or systemic lupus erythematosus , causes swelling and redness of the finger knuckles and pain and stiffness, which is worse in the morning. The shoulders, wrists, hips, knees and feet can also be affected.
8.3. Bone Pain
8.3.1. Bone bruise or contusion is a bleeding within a non-broken bone, for example, in the head of the upper arm bone (in the shoulder), elbow or wrist after a direct hit or fall. A visible bruise can disappear in few weeks, but bone pain can persist for several months.
8.3.2. Bone fracture causes sudden, severe pain, swelling, bruising and arm deformity .
8.4. Nerve Pain
Nerve disorders usually cause shooting or burning pain, tingling or numbness.
8.4.1. Complex regional pain syndrome can present with a continuous squeezing or throbbing pain in the entire arm after an arm injury, surgery, immobilization, heart attack or stroke. Other symptoms include changes in the skin appearance and temperature, abnormal sensations, muscle loss and weakness [48,49].
8.5. Pain From the Blood Vessels
8.5.1. Thromboangiitis obliterans (Buerger’s disease) is an inflammation of the arteries and veins, mainly in young male smokers. The pain in the feet and hands is triggered by walking or hand use .
8.5.2. A blood clot in a vein can cause thrombophlebitis (thrombus = blood clot; phlebitis = inflammation of a vein). Risk factors include an injury, prolonged immobilization, smoking, vasculitis, cancer and intravenous drug abuse . Pain, tenderness and red lines along the affected veins may persist for several weeks .
9. Arm Infections and Pain
9.1. Shingles occurs due to reactivation of the Varicella-zoster virus in one of the spinal nerves that supply the arm. Burning pain is typically followed by itchy red blisters, which crust over and disappear within several weeks.
Picture 11. Shingles in the shoulder and upper arm (source: Samuel Freire da Silva, MD, Dermatology Atlas)
9.2. Cellulitis (a bacterial infection of the underskin tissues), which can result from a skin cut, vasculitis or insect or animal bite, appears as a tender, red and warm swelling .
9.3. Lymphangitis, an inflammation of the lymphatic vessels, presents as tender, red streaks traveling from the hand or arm toward the armpit, enlarged lymph nodes in the armpits, fever and chills .
9.4. Bone infection (osteomyelitis) caused by trauma or systemic infection can present with fever, chills and deep dull or throbbing pain, swelling and redness .
10.1. Sarcoma (a malignant tumor of the soft tissues) can appear as painless or painful lump or arm swelling .
10.2. Bone cancer in an arm can cause constant deep, dull pain, in early stages only at night .
10.3. Hodgkin’s lymphoma can cause swelling of the lymph nodes in the armpits; drinking alcohol can trigger pain in the armpit and arm .
10.4. “Pancoast tumor” at the top of the lungs on either side can invade the nerves that supply the arm (brachial plexus) and cause pain around the shoulder blade, which can travel down the inner side of the arm .
11. Arm Pain in Women (Including Pregnancy)
11.1. Cyclic breast pain refers to pain and heaviness in both breasts and, sometimes, in the armpits and arms in the period between ovulation and menstruation .
11.2. Breast cancer with enlarged lymph nodes in the armpits or a radical breast cancer surgery with removal of the lymph nodes can result in arm swelling (lymphedema) and pain.
Poor posture or a change in sleeping position in pregnancy can cause arm pain.
12. Phantom Arm Pain
Phantom arm pain is a sense of boring or squeezing pain in the part of the arm that is no longer a part of the body because it has been amputated . Phantom pain can appear within days or years after amputation and can persist for several weeks or even years .
13. Unexplained Arm Pain
Often, the cause of the arm pain can not be identified, at least not initially, for example in brachial neuritis, Raynaud’s disease, complex regional pain syndrome or lung cancer.
In most cases, it is an orthopedist or neurologist who can find a cause of arm pain. Investigations, such as computer tomography (CT), magnetic resonance imaging (MRI) or blood tests, may be needed.
Treatment of arm pain depends on the cause.
Overuse injuries can heal on their own after relative rest or wearing braces.
If the pain persists, you may consider giving up a sports activity or changing a job.
Over-the-counter analgesics, such as aspirin, paracetamol or ibuprofen, can help in mild to moderate pain; for severe pain, a doctor can prescribe narcotics.
Severe shoulder or arm pain may require immobilization.
Surgery can help in a pinched nerve, calcific tendonitis, adhesive capsulitis, complicated fracture, thoracic outlet syndrome and carpal tunnel syndrome.
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