If you've never had this pain before, right or left upper arm pain needs very urgent medical assessment.
Arm pain may be the only indication of a heart attack.
A nerve pinched in your neck can cause very nasty arm pain, with burning, searing or electric shock like quality.
This is likely to be due to disc prolapse or foraminal stenosis (narrowing of the hole between two neck bones, where the nerve leaves the spinal canal.)
The particular nerve is indicated by the finger the pain shoots to. (Cervical 6 if to thumb, 7 if to middle finger and 8 if to little finger.)
Fortunately, 85% of people with disc prolapse get better over about 6 weeks. Once one starts to have a night's sleep, multiply the time to that point by three to get good recovery of pain. Involved muscles may stay smaller and numb patches may be permanent.
CT guided cortisone injections alongside the nerve root involved, are very useful. The radiologist will often inject a little contrast medium and take a film to ensure the needle tip is in the correct place, before injecting the local anaesthetic and cortisone.
Shingles is always possible. The same type of pain as above comes 4 days before the characteristic rash.
Brachial neuritis is nerve pain from inflammation of the nerves from the neck, possibly caused by autoimmunity or viral infection. The severe arm pain is preceded by a fortnight of pain around the shoulder and upper arm. This onset distinguishes it from a cervical disc prolapse, where the onset is very sudden, usually the person waking in the morning with severe arm pain.
Red flags are indications that something more sinister may be afoot. Difficulty walking may indicate damage to the cervical spinal cord itself. Recent trauma, past history of cancer and report of a normal CT scan are sometimes bad omens, the last because it is unlikely and may indicate poor reading of the films.
Nearly all upper arm pain causes are found in the shoulder, neck and upper back.
There is seldom much wrong in the arm, apart from tender spasm in Brachialis muscle.
The muscles causing the pain can be found by pressing around in the neck, shoulder blade and shoulder itself.
Treatment is nearly always prolonged stretching until the muscle relaxes, often by just continuing the same pressure that found the tender spot.
The exact techniques are described in the pages on each area.
One needs often to mobilize one or more spinal joints in the area as well. Joint fixations in the spine often keep the muscle tightness going.
This is an intense itch rather than pain, on the outer parts of the upper arm which got the most sun damage over the years.
Itch and pain are sensations with similar nerve mechanisms and sometimes common causes.
This particular itch often comes from a joint in the neck, but protection from the sun has apparently also helped in some people.
One of my first teachers of physical medicine at the Royal Melbourne Hospital was Dr. Joseph Silver Collings¹. He recognized this as coming from damage to the cervical spine.
When people complain of leg and arm pain on the same side, I look to their neck first and usually find the cause. The reason for such a pattern of referral is not usually obvious.
Unusual unless you've had a central venous line running.
This comes on suddenly and has swelling as well, as in deep vein thrombosis in the leg.
Fortunately it isn't as dangerous as the latter.
1. Dr. Joseph Silver Collings, born in Sydney 1918, and educated at the University of Sydney. After graduating with degrees in agricultural science and medicine, he later became a research fellow in the Harvard School of Public Health, and, on secondment to the Nuffield Trust in Great Britain, undertook a review of British general practice.
In 1952, in the United States, Collings was Assistant Medical Director of the Health Insurance Plan of Greater New York. He was also engaged as a consultant to President Truman's Commission on Health Needs of the Nation in 1952.
He was Head of the Department of Physical Medicine at Royal Melbourne Hospital when I was taught by him. He died in February 1971.
One obituary was published in the Medical Journal of Australia on June 19th 1971 and one in The Lancet on April 24th 1971. The MJA is a wonderful read, with contributions by several medicos and a barrister who dealt with him...
"It is gratifying to read the appraisals of his achievements in England and America in the accompanying notices from Sir Theodore Fox and Professor Milton Roemer. Both of these distinguished men write with obvious feeling for the triumphs against a background of frustration and often bitter attack.
Joe Collings achievements in his own country will prove to be no less remarkable when they are reviewed ten years from now. His contributions to the understanding and care of the injured worker, particularly those with spinal injuries, bore fruit for the individual patients who came under his care during the ten years between 1961 and his premature death in 1971. By giving evidence tirelessly on their behalf in the Victorian courts, he helped to change attitudes towards those with spinal injuries - emphasizing the social disasters that beset many of them and their families, and stressing the need for adequate compensation and rehabilitation."
The Lancet obituary details his research into family practice in Manitoba, the United States and England...
"...he went as a research scholar to Britain and conducted his now-famous reconnaissance in general practice there. His report, published in The Lancet in 1950, was an exposure of the deficiencies in British practice, and a plea for their correction. He advocated group practice from publicly provided premises with the practitioners themselves giving the fullest service they could for their patients, and relegating as little work as possible to the hospitals."
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