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

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.

Trauma

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.

Infection

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.

  • colipraju

    I am suffering from right arm pain occasionally while performing morning walker,while about to sleep. it starts from upper arm biceps, triceps and gets down to lower arm muscle remains for 15 to 20 mins, after message with moov or some other ointment it subsides. Rising shoulder becomes becomes difficult. No problem in driving. normal course time while in office I wont feel it. I am a diabetic and using medidcines for BP, diabetis and heart. please advice

  • Dr. Chris

    Hi Colipraju

    Some of these symptoms are possible side effects of your medication but another possibility is related to the heart as in angina. Refer to the article on heart chest pain. Given your history, this is not something you should ignore. An ECG stress test (stress ECG) is important here and you should see a cardiologist for this. Despite the fact that the pain eases and there may be no other symptoms, further medical investigation is most definitely warranted before a more serious condition strikes. Another possibility could be related to the position you sleep in or even the number of pillows you use. This could cause muscle spasm with referred pain down the hand or lead to a pinched nerve. Diabetic neuropathy/neuralgia (nerve pain due to diabetes) is another possibility but first exclude any heart related disorders.

  • Anbarasu.s

    good webpage

  • Frank

    Hi, My left arm started to ache several months ago. Top of the forearm. It has gotten worse every day since, so much that I couldn’t even use it yesterday without taking Tylenol. The bone hurts right at the top part of the elbow if I put my finger on it. There has been no injury. What could this be? I’m baffled and tired of the pain!

  • Dr. Chris

    Hi Frank

    Sometimes the injury is not so obvious so you could have hurt bone unknowingly. This pain can also be related to a muscle tendon or even the nerves – ulnar or radial. Nerve inflammation would cause pain, numbness or tingling lower down the arm as well. First try to immobilize the arm or at least use it minimally. If the pain subsides, you know that it more likely to be muscle or tendon related. Also try to stop leaning on the hand and this may also stop pressing and irritating any nerves. You should get this checked up. See your doctor as soon as you can.

  • madmom

    I have had pain in my right upper arm for over 3 months. The pain is near the elbow in the back of my arm and in the front near the top of my arm. The pain does not shoot down the arm, but goes across. I have had 2 mri’s and they say I have a 12mm hyperacute lesion in the intramedullary of the humerous. The doctor won’t tell me what that means, except now I have to go get another mri with contrast. What is he looking for? What could it be? Thank you.

  • Dr. Chris

    Hi Madmom

    Firstly I find it surprising that your doctor will not tell you what that means. Your doctor may wish not to comment on what may be suspected so as not to cause panic if you are the type of patient who get anxious or worked up about the differential diagnoses. However if you asked your doctor about the procedure, I am sure he/she will be glad to explain it to you.

    I cannot assume what your doctor may be looking for or not based purely on the information (which may have been limited) that you have provided. Your doctor may be suspecting metastatic bone disease or some other possibility. This can cause pain and may be a possibility if you have had cancer elsewhere. This is NOT to say that you have bone cancer. Please do not make that assumption. Follow what your doctor says, have the MRI and take it from there.

    It is important to realize that most doctors do not want to be boxed in about a diagnosis without confirming it first. Overzealous patients may get carried away initially, do something rash and turn around and lay a legal claim against the doctor because they (the patient) chose to hear and remember what they wanted. So doctors ensure that they are 100% sure before divulging information.

    Your doctor may be suspecting 2 or 3 possible diagnoses after the first round of tests and case taking. He/she has to now confirm or exclude diagnoses. So be patient, follow your doctor’s instructions and if you are not happy with the service you are receiving, go and see a specialist (orthopedist/orthopedic surgeon) in the field. Do not avoid tests, try to self diagnose or ‘hop’ between doctors unnecessarily.

  • Mayuri

    Hi,
    i had weird kind of pain in my left arms, the dr gave me neurobine forte and fastum gel to be applied. the pain went away. on stopping the medicines a similar kind of pain has stated in my right arm. the pain is wierd. its like the muscles are being pulled and relived. it occurs after intervals. pls advice. as per the dr, he advised that its due to damaged tissues. many thanks

  • Dr. Chris

    Hi Mayuri

    There are many possible causes and you don’t mention much about yourself – your age, gender, past medical history and so on. First muscle strain should be excluded. You may be straining one arm more than the other due to some physical activity which could be causing this and this will change sides as you compensate for the pain. Another condition that should be investigated is neurological causes due to some pathology in the spinal column. More importantly though, you will need further tests to exclude neuromuscular conditions, many of which can be degenerative – I will not go into it here so that you don’t get too stressed by these possibilities. Rather speak to your doctor and preferably see a neurologist. Lastly, it is important to remember that many heart, lung and breast related conditions could cause arm pain.

  • carter64

    i am 46 years old and have pain in my upper right arm it only hurts when extended either over my head or around my back the doctoer gave me exersices for rotator cuff but it isnt my sholder that hurts was i wrongly diagnosed?

  • Dr. Chris

    Hi Carter

    We cannot conclusively say whether you condition was incorrectly diagnosed or not without knowing all the facts of your case. However any condition affecting the rotator cuff muscles can cause upper arm pain. If you are unhappy with the diagnosis and measures taken by your doctor, you should seek a second opinion.

  • Carol

    I am 34 yrs old female. Married with 4 kids. Lately i’m having bad hand pain. it starts from upper arm biceps, triceps and gets down to lower arm muscle. The pain is like some wound in my muscle. mostly i have the pain at night. I have frequent neck pain and neck sprain and all. dr gave me neurobine and flanil cream to be applied.

  • Dr. Chris

    Hi Carol

    There are many causes of arm pain and since you have noticed that it seems to be related to the muscles, it could be due to poor posture (neck pain extending down the arm) or due to muscle strain. Try to rest the arm, avoid carrying heavy weight and see a physical therapist for the appropriate treatment and some exercises. However, it is always advisable to investigate it further, especially if you notice other symptoms like numbness, chest pain, dizziness and a fever starting up. Even if it is due to a muscular cause, this will not settle overnight. Speak to your doctor if you are uncertain.

  • Cass

    I’m 28 and have had left breast pain for 3 years now. I had an ultrasound done 2 1/2 years ago and all looked “ok.” In the recent 6 months the pain has moved into my entire left side. mostly my shoulder, elbow, wrist, and ribs and left ovary. My hip and knee occassionally throb and most recently my left earlobe and neck shoot pain into my collarbone. Both my mom and Grandmother have had breast cancer. I feel like my Dr. is just pushing me aside because of my age. Please help!

  • Dr. Chris

    Hi Cass

    This could be related to some breast pathology with referred pain to the other sites but could also be due to some neurological disorder like a pinched nerve. If you are not satisfied with the treatment you are receiving from your doctor, you should consider a second opinion. I would advise that you consult with a gynecologist and the see a neurologist if necessary. The fact that you have a family history of breast cancer does increase the risk but your doctor would not have ignored this. A mammogram should be done annually.

  • kate

    i went to a & e last weekend with on and of pain and numbness in my fingers and pain itching and burning all up my arm to my shoulder on the right side. They couldnt find a cause so discharged me. the next day it was worse and all down my right leg also so as instructed i went to an out of hours clinic, the doctor did pretty much the same tests then told me he thought it was just stress or all in my head. I have been back to work in the past 2 days (I have quite a physical job),I can finally after 5 days feel my fingers now and they hurt,so does my wrist and i keep gettin shooting pains in them along with my upper arm and right leg.

  • Jan Modric

    kate,

    stress does not likely cause shooting pains. It is important that you compile all the history of your symptoms together:
    1. What is your main (one) current trouble?
    2. What are your other current symptoms?
    3. Do all symptoms appear only on the right side?
    4. When did the symptoms start, are they constant, what triggers or relieves them?

    Pinched nerves in the cervical and lumbar spine would be possible. Carpal tunnel syndrome, from overuse of the wrist(s), could be an additional problem. It is a neurologist that can give you a diagnosis.

  • mike75

    I am a 34 y.o. male with recent pain on my right wrist. It is like a sensitivity when I touch the skin near the medial side of my wrist it hurts. I’ve had no trauma to the forearm/wrist. Over the past week or so it has spread up my forearm about 4 inches. There is no erythema or edema. The only other problems I’ve had recently include episcleritis and HSV labialis outbreak on the lip. Wondering what this could be?

  • Dr. Chris

    Hi Mike75

    Any wrist pain always raises the concern about carpal tunnel syndrome. However, given your history (episcleritis and HSV infection), it is important to exclude Behcet’s disease, which is one of the many types of vasculitis. Although this condition is rare, it nevertheless is something to consider as it may account for all your symptoms including the wrist pain, episcleritis and canker sores (HSV maybe). In addition, other autoimmune disorders may also account for some of your symptoms. A systemic infection may also be a possibility.

    Given your awareness of medical matters, I think you would be aware that an online platform such as this cannot adequately answer your question. Diagnostic investigation is necessary and this question-answer platform is intended to guide readers but not provide a conclusive diagnosis. You should see your doctor and possibly consult with a rheumatologist.

  • Patti

    I am a 48 year old woman and recently and suddenly I developped pain and heat in my upper arm area. It hurts to lift my arms … continued on http://answers.healthhype.com/arm-pain-and-menopause

  • Dr. Chris

    Hi Patti

    This question has been answered on Health Hype Answers at the following link : http://answers.healthhype.com/arm-pain-and-menopause

  • Jared

    I am a 21 year old male and usually very active. Four months ago after working out i woke up the next morning with a sharp pain in my tricep/armpit area. There was no bruising but it took about two weeks for that to mostly heal. Once it did I was left with tightness in my armpit and a constant ache in my left arm down into my hand. It has not gotten better with rest and the orthopedics I went to are not sure what it could be. There’s no pain when I use it the ache just intensifies. My arm and hand is also somewhat unsteady when I try to do refined movements, its not very obvious but it just doesn’t feel as steady as my right arm. Can this be nerve damage caused by pressure in my armpit? Thanks.

  • Dr. Chris

    Hi Jared

    First you need to exclude muscle related conditions before suspecting any neurological conditions. Muscle strain can be responsible for most of your symptoms. Even strain of a single muscle/muscle group may causes these symptoms. Speak to your doctor and possibly see a physical therapist. Only if it can be conclusively ruled out that it is not muscular in origin, should a neurological cause be considered. Tingling, numbness or other strange sensations however may be an indicate of nerve irritation.