Causes of Arm Pain – Right and Left Hand, Upper Limb

Arm pain may be due to many causes, ranging from s simple injury to more complex causes like the arm pain arising from a heart attack (myocardial infarction). While the arm is only one section of the upper limb, the area between the shoulder and elbow joint, the entire upper limb is commonly referred to as the arm or hand. In order to determine the cause of arm pain, it is important to identify any incidents that preceded the onset of the pain and take into consideration the medical history. This will allow for a more definitive diagnosis of the cause of the arm pain, although this is a common symptom that affects many of us at some point in our life.

Joint Pain

Arthritis is a generalized term referring to inflammation of a joint and the symptoms most commonly produced are pain, swelling, and restricted joint mobility. There are various types of arthritis, including osteoarthritis and rheumatoid arthritis, the latter being more likely to cause arm pain.

  1. Rheumatoid arthritis is an autoimmune disease which leads to the inflammation of the joints and surrounding tissues. It may occur at any age, with women being affected more often than men. Joints of the fingers, wrist, knees, ankle and feet are likely to be involved. There is usually bilateral (both sides) involvement of joints, occurring in a symmetrical pattern causing joint pain and stiffness. Rheumatoid factor test, or a specific blood test to diagnose rheumatoid arthritis and differentiate it from other types of arthritis, called the anti-CCP antibody test, may be done to confirm the diagnosis.
  2. Osteoarthritis is a slow progressing, degenerative joint disease, which occurs more frequently in older people. It may be limited to or start in one joint, such as the knee, hip, or hands, or it may involve a number of joints. If it affects the hands, multiple joints of the fingers are likely to be affected. Osteoarthritis may be hereditary, or it may be due to repetitive actions or overuse, injury, or muscle strain.

Gout is a disorder where there are high levels of uric acid in the blood and tissues. Uric acid crystals are deposited in the joints, causing gouty arthritis, which can be an extremely painful condition. It normally affects the big toe, but may also affect the wrist and fingers, causing swelling, redness, and severe pain in the fingers and wrist joints.

Referred Pain & Nerve Pain

Referred pain is pain felt in one area of the body when the actual cause is in some other part. The exact cause of referred pain is not known but may be due to signals from different areas of the body traveling through the same nerve pathways in the brain and spinal cord. Nerve pain or neuropathic pain is the pain experienced along the course of the nerve due to injury, inflammation or degeneration of the nerve. Nerve compression or pinched nerve pain is an example of neuropathic pain.

Heart attack (myocardial infarction) causes left or right arm pain.
  • Myocardial infarction or a heart attack typically causes chest pain (sometimes described as a breast bone pain)  although other symptoms may accompany this medical emergency, including upper middle abdmoinal pain (epigastric pain), sweating, nausea, vomiting, or pain in the jaws, neck, or the characteristic left arm pain, although there may be referred pain in the right arm. Early diagnosis is vital because heart attack with even mild symptoms may become life-threatening, hence the possibility of a heart attack should always be kept in mind in case of pain in the arm with or without chest pain. An ECG (electrocardiogram) and blood tests for cardiac enzymes must be done on the slightest suspicion that a heart attack is occurring so that a quick diagnosis and appropriate medical treatment can be initiated.
  • Carpal tunnel syndrome is a condition which develops due to compression of the median nerve as it passes through the carpal tunnel at the wrist. It gives rise to symptoms of pain and paresthesia (arm numbness and tingling or  “pins and needles” sensation) along the distribution of the median nerve , which includes the nerves supply to the thumb, index, middle, and half of ring finger.
  • Radial tunnel syndrome is caused by the compression of the radial nerve in the forearm, leading to pain along the distribution of the radial nerve in the hand. The symptoms are similar to those of tennis elbow, such as pain at the back of the forearm and elbow.
  • Cubital tunnel syndrome occurs due to compression of the ulnar nerve at the elbow. Prolonged flexion of the elbow or leaning on the elbow for a considerable time can produce this syndrome, causing pain and numbness along the distribution of the ulnar nerve, especially in the ring and little finger.
  • Cervical radiculopathy or pinched neck nerve may occur due to a damaged intervertebral disc in the cervical or neck region of the vertebrae and may be the cause of hand pain. Depending upon the severity of nerve damage, there will be symptoms such as tingling and numbness, “pins and needles” sensation, or burning pain in one or both arms. Refer to the article on Pinched Neck Nerve.
  • A cervical rib is an extra rib, just above the first rib, that may be present at birth. It may cause arm pain if it presses upon the brachial plexus, which is a bundle of nerve fibers that controls muscle movements and sensation of the shoulder, arm and hand.
  • Phantom pain is a type of neuropathic pain which arises from an amputated body part, such as a leg or arm. Although initially thought to be a psychological phenomenon (psychogenic pain), this sensation is now understood to originate from the brain and spinal cord. Phantom pain in the amputated arm can start within a few days of amputation of the hand, either due to trauma or surgery,  and may be experienced as a shooting, stabbing, squeezing, or throbbing type of pain. This pain may seem to originate from the distal (farthest) part of the amputated arm, such as the fingers, and may be initiated by emotional stress or pressure on the remaining part of the hand.

Breast Pain

Breast pain may occur due to many causes and it can travel down to involve the arms and hands. Since chest pain radiating down to the arms can be a symptom of angina or myocardial infarction, and may be confused with arm pain caused by breast problems, it is important to differentiate between the conditions so that proper treatment can be initiated without loss of time.

  1. Cyclic breast pain typically starts about a week before the menstrual period and gradually decreases with the onset of menstruation. Pain is bilateral (in both breasts), dull and aching in nature, and often radiates down to the armpit or inner side of both arms.
  2. An infection in the breast (mastitis), if left untreated for long, may spread to other areas such as the armpit and upper arms and result in arm pain. Typically, swollen lymph nodes will be noted in and around the affected area.
  3. In the initial stages, breast cancer may not produce any symptoms of pain, but in later stages, with the development of a palpable lump in the breast, pain may be felt in the breast itself, the armpit and/or along the arm. Breast cancer can also cause severe pain in the arms by affecting the nerves in the spinal cord or by spread of cancer to the lymph nodes around the nerves.
  4. Breast cancer patients who have had axillary (armpit) surgery often suffer from chronic pain in the armpit, shoulder and upper arm and this pain seems to be related to the extent of the axillary surgery.


Ganglion is a small swelling or cyst that develops from the tissue lining a joint or tendon. The cause is usually unknown, but may sometimes be due to a local trauma to the joint or tendon. Recurring or persisting ganglion could be an early sign of arthritis. A ganglion is commonly found at the back or front of the wrist and symptoms may include a slow growing cystic swelling, which may or may not be painful, along with mild pain at the wrist.

Tendon Disorders

A tendon is the thick cord of tissue which connects a muscle to a bone. Arm pain may be caused by tendonitis (inflammation of a tendon) or tenosynovitis (inflammation of the lining of the tendon sheath which encloses the tendon). Rheumatoid arthritis, diabetes, overuse, injury, strain, or overexertion may lead to tendonitis or tenosynovitis, most often affecting the fingers or wrist, and causing symptoms such as swelling, pain or discomfort.

  • Tennis elbow or lateral epicondylitis is a frequent cause of arm pain and is caused by damage of the tendons involved in bending the wrist backwards, away from the palms. There may be recurring pain at the back of the forearm and elbow when the arm is at the side of the body with the thumb turned away. Lifting or bending the arm or grasping even light objects may cause pain in the arm and/or hand.
  • Golfer’s elbow (baseball elbow) or medial epicondylitis is caused by damage of the tendons involved in bending the wrist towards the palm. This is another strain related condition causing arm pain which may be mistaken for tennis elbow, but in this case the pain is felt on the inner side of the forearm, extending from the elbow to the wrist.
  • Rotator cuff tendonitis is caused by inflammation of the shoulder capsule and associated tendons. There is usually a dull, aching pain in the shoulder which may radiate to the upper arm or chest, often getting worse at night. It may often occur due to overuse, such as during a sport or work related activity, which requires the arm to be lifted repeatedly, and will affect the dominant hand, example right shoulder in a right-handed person.
  • De Quervain’s tenosynovitis is the inflammation of the tendon sheaths on the thumb side of the wrist, causing pain and discomfort on trying to turn the wrist, grasp something, or when making a fist.
  • Trigger finger or trigger thumb is inflammation of the tendon sheath of a finger or thumb causing pain, swelling, and difficulty in flexing or extending the finger or thumb.


Injury to any part of the upper limb can result in pain and may continue long after the incident. Trauma may vary from soft tissue injury to breaks in the skin, muscle damage,  fractures of the bone or even loss of part of the arm. The cause of the injury is clearly evident and even after the area is treated or heals, pain may persist for months or years.

  • Muscle strain is the stretching or tearing of muscle fibers (torn muscle), often due to overworking a fatigued muscle, and occurs most frequently during sports activities. However, it may also occur while carrying out simple activities such as stepping off a curb or by carrying many heavy bags in the hand. Muscle strain in the hand will cause mild to severe pain in the affected arm along with swelling and decreased strength.
  • A sprain is an injury involving a tear or stretching of ligaments which arethe tough fibrous bands which connect bones to one another at a joint. A sprain in the hand may be caused by flexing the hand suddenly or by falling on an outstretched hand. It can occur by slipping and falling on the wrist or shoulder. Any unusual force across a joint can cause a sprain and often occurs during sporting activities. There will be pain, swelling, and instability of the joint.
  • Bursitis is the inflammation of the bursa, a small pouch between the bone and tendon. This can affect the elbow or shoulder joint and causes severe pain, without any loss in range of motion. Adhesive capsulitis or frozen shoulder is the inflammation of the capsule surrounding the shoulder joint. While both bursitis and a frozen shoulder can cause arm pain, in a frozen shoulder, the range of motion is severely restricted.
  • Fractures of one or more bones of the arm are among the most common types of fracture and may occur in all age groups. The severity of pain will depend on the type and site of fracture and other associated injuries.
  • Writer’s cramp is another type of arm pain commonly affecting the dominant hand, since this is the hand most often used for writing. It is caused by overuse of the hand in small fine movements, like writing, and may be due to the position of the hand during writing, gripping the pen, pencil or tool too tightly or continuous use or writing for long periods of time.


Cellulitis is a serious bacterial infection, which normally starts with infection of the skin, caused most often by Streptococcus pyogenes or Staphylococcus aureus (Refer to Staph Infection Symptoms). Bacteria usually penetrate the skin at the site of injury, such as a cut or puncture in the skin, and causes an infection, which then spreads to other tissues. This typically causes swelling, severe pain, heat or increased temperature of the skin and/or redness of the skin. Cellulitis is common in the hand as it is used for most activities, especially the dominant hand, so chances of injury and infection are high. Surgery on the arm or intravenous catheterization of a vein in the hand for the purpose of administering I.V. drugs or fluids may also become the initial site of infection leading to cellulitis.

Vascular Disorders

Raynaud’s phenomenon is a rare condition where there is extreme response of the blood vessels in the skin to a cold environment, resulting in severe constriction of the blood vessels (vascospasm), especially those of the fingers and toes. The affected skin turns white from loss of blood, then blue from lack of oxygen, and there is associated tingling and numbness. This phenomenon is temporary and reversible on applying warmth, which causes the skin to turn pink along with a throbbing sensation.

Psychogenic Pain

This type of pain arises from mental or emotional stress and is a perceived sensation that is usually not detectable even by a nerve conduction study. It typically occurs in persons with a type A personality, concerned about a heart attack, or in cases of anxiety, where a stressful incident may trigger the pain.

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  • Hi Martha. Yes, it could be related to the fractures and surgery. You do not mention the type of surgery you had but if it was ‘open heart’ surgery then this may occur. Your doctor would have provided you with a chest brace if necessary and hopefully you used this as prescribed. However, it is worth having your arm pain checked up just in case it is due to another condition that would then require separate treatment. Speak to your doctor.

  • Debbie

    my hands look all chapped had pits and blisters and clears the skin is getting all red with skin hanging never clear for more that a full day for over 6 mos,. problems using my right arm with pain in armpit and inner arm, down the arm and right side of breast to sore above rib cage and constant headaches. if I lay on my back with my shoulder blade flat i need help with my left hand to lift the right arm in order to sit back up, Ive had three fractured ribs in 5 mos. I have been to one walk in clinic, one emergency, 2 doctor appointmens of which they act like i am over reacting, I finally got a biopsy at a dermatologist on my hand yesterday waiting on reply, But I have to still work and my arm headaches, etc not getting any doctors to do much. blood work looked fine at emergency. No heart desease. I am lost at what to do. I have requested that my doctor get me scheduled for a MRI. but still have not heard anything. Is anyone else having these symptoms because I am seeing mine increasing. Also forgetting everything now and fatigue. Fatigue and forgetfulness and headaches I wonder if thats all from worry

  • Hi Debbie. You have a host of symptoms which may be related to more than one condition. Start with isolating the skin problem. As you said you have had a biopsy and once the dermatologist gets back to you with the rest you will have some direction as to the possible cause. You may also need to see a neurologist as some of the symptoms with your arm and the headaches could be due to a nerve problem. This could vary from a pinched nerve to neurodegenerative conditions and it is difficult to say with any certainty what could be causing all these symptoms. A neurologist would possibly be a good place to start.

  • CL forever

    Iam 23 years old i have a stabing pain in my left breast traveling down to my left arm involving both little and ring fingers i have pain while iam awake but during sleeping iam better. I did self breast test i have no lump i cant feel anything i dont have any tissue change or breast malformation my period is normal iam scared that i might have cancer because my aunt she had cancer and knew about it after 3 years of having it .what is this pain? Please answer as soon as possible

  • Hi CL. We cannot tell you what the cause of this pain is with any certainty. You should be speaking to your doctor about this. Even if you cannot feel any lump, it does not mean that a cancerous lesion is not present. However, there is no reason to worry about cancer just yet. There are many other causes and it may not even be linked to the breast. The only way to know for sure is to undergo the necessary investigations as your doctor will advise.

  • Ardit

    Helo! I’m 29. My pain is in my right side of the lower back, goes in to my lower abdomin olso recently up to my right sholder neck and tricesps. In all my right side of the back, but never down my belly or legs. Had an MRI and showed bolged disc at l5 s1 and the neurologist said not to worry the pain would go away itself. It’s been almost 2 years now and still in pain. What could it be?

  • Hi Ardit. The bulging disc could have worsened and surrounding discs may also be affected, therefore causing the pain at so many areas on just one side. Of course, there are also other possibilities that could account for some of the pain that you are experiencing, such as a kidney problem. However, it is difficult to say on just pain alone and you do not mention any other symptoms. 2 years is a long time since you were last assessed and you should see a doctor who can evaluate your condition again. This could be an entirely new problem.

  • Ardit

    Thanks a lot for your answer, but if the l5 s1 disc bolg would have worsened, why shulden’t the pain go down my legs or hurt more on my lower back instead of going up? And up that far to my sholder and neck on my right side?

  • Hi Ardit. As advised you should consult with your doctor. We cannot diagnose you here or say for sure what may be causing these symptoms. There are many other factors that have to be taken into consideration which depends on a medical professional assessing you. Relying on your current symptoms alone as you report it can be misleading.