Arm Pain: Causes by Location and When to Worry

Is heart-related arm pain in the muscle or the bone?

Neither. Heart pain comes from the heart muscle running short of oxygen. The nerves from the heart enter the spinal cord at the same levels as nerves from the arm, chest and jaw, so the brain "refers" the pain to those areas. That is why heart-related arm pain:

• feels deep and diffuse, like an ache, heaviness or pressure, rather than a pinpoint spot
• is not tender when you press the arm, and does not change when you move it
• is often brought on by exertion, cold or stress and eases with rest (angina)
• often comes with chest discomfort, breathlessness, sweating or nausea
• can affect the left arm, right arm or both, and the shoulder, neck or jaw

Pain that you can reproduce by pressing on a spot, or that changes clearly with a certain arm movement, is much more likely to be musculoskeletal. But people can have both, so if heart pain is possible, get checked.

Arm pain causes by location

Shoulder and upper arm

• Rotator cuff tendinitis or tear: pain at the outer upper arm, worse lifting the arm overhead and lying on that side. See rotator cuff injury.
• Frozen shoulder: gradual pain then marked stiffness, often in people with diabetes.
• Biceps tendinitis: pain at the front of the shoulder.
• Humerus fracture: after a fall, especially in older adults.
• Muscle strain from lifting or new exercise.

Elbow

• Tennis elbow: pain on the outer elbow, worse gripping, lifting a cup or turning a doorknob. Despite the name, it is mostly from work and household tasks.
• Golfer's elbow: the same on the inner side.
• Olecranon bursitis: a soft swelling at the point of the elbow.
• Ulnar nerve compression: aching at the inner elbow with numb little and ring fingers.

Forearm and wrist

• Carpal tunnel syndrome: tingling in the thumb and first fingers with aching that can spread up the forearm, worse at night.
• De Quervain tenosynovitis: pain on the thumb side of the wrist.
• Repetitive strain: aching forearms from typing, assembly work or gaming.
• Fractures: a fall on an outstretched hand commonly breaks the wrist.

Pain spreading down the whole arm

• Cervical radiculopathy: a pinched nerve in the neck causes sharp, shooting or burning pain from the neck down the arm, often into specific fingers, with tingling and sometimes weakness. Looking up or tilting the head toward the painful side often makes it worse.
• Thoracic outlet syndrome: aching, tingling and heaviness worse with the arms raised.
• Brachial neuritis: sudden, severe shoulder and arm pain followed days later by weakness, often after an infection or vaccination.
• Shingles: burning pain in a strip of skin before a rash appears.

Left arm pain vs right arm pain

Left arm pain worries people most because of the link to the heart. Heart attack pain can be felt in either arm, both arms, or neither. Studies have found that pain in both arms or the right arm is at least as strongly associated with heart attack as left arm pain. The side matters less than the pattern: exertion, chest pressure and other symptoms.

Right arm pain in right-handed people is more often from overuse, tendinitis and strain simply because that arm does more work.

Other serious causes

• Blood clot: a deep vein thrombosis in the arm causes aching, swelling and a bluish tinge, often after an IV line or with cancer.
• Arterial blockage: sudden pain, pallor, coldness and numbness in the hand. This is an emergency.
• Infection: cellulitis or an infected joint causes a red, hot, swollen, painful area with fever.
• Compartment syndrome: severe forearm pain after a crush injury or fracture.
• Bone tumors: rare; constant deep pain that is worse at night.

How doctors diagnose arm pain

A doctor will ask where the pain is, how it started, what makes it worse, whether you have numbness or weakness, and about heart risk factors. They will examine the neck, shoulder, elbow and wrist, test strength, reflexes and sensation, and check pulses.

Tests depend on the clues:

• ECG and troponin if heart pain is possible
• X-ray for fractures and arthritis
• ultrasound for tendon problems and blood clots
• MRI of the neck or shoulder for disc problems and tears
• nerve conduction studies for carpal tunnel and other nerve compression

Treatment and home care

For strains, tendinitis and overuse:

1. Relative rest: avoid the movements that cause pain for 1 to 2 weeks, but keep the arm moving gently.
2. Ice for 15 to 20 minutes several times a day in the first 48 hours, then heat for stiffness.
3. Pain relief: ibuprofen, naproxen or acetaminophen (paracetamol), following the label dose. Topical NSAID gels work well for elbows and wrists.
4. Bracing: a forearm strap for tennis elbow, a wrist splint at night for carpal tunnel syndrome.
5. Physical therapy: stretching and strengthening exercises, especially for tendon problems, which typically take 6 to 12 weeks to settle.

Medical treatments include steroid injections, nerve-release surgery and treatment of underlying heart disease.

Frequently asked questions

When is arm pain a sign of a heart attack?

Arm pain may be a heart attack when it comes with chest pressure, shortness of breath, sweating, nausea, lightheadedness or jaw pain, or is brought on by exertion. It can affect either or both arms. Call 911 rather than waiting to see if it passes.

Is heart-related arm pain in the muscle or bone?

Neither. It is referred pain: the heart's pain signals are felt in the arm because they share nerve pathways. It feels like a deep ache or heaviness that is not tender to touch and does not change when you move the arm.

What causes pain in the upper arm?

Upper arm pain most often comes from rotator cuff tendinitis or tears, which are felt on the outer upper arm. Other causes include muscle strain, biceps tendinitis, frozen shoulder, a pinched neck nerve and, after a fall, a humerus fracture.

Can a pinched nerve in the neck cause arm pain?

Yes. Cervical radiculopathy causes sharp, burning or electric pain that travels from the neck into the arm and often specific fingers, with tingling or weakness. It frequently improves over 6 to 12 weeks with physical therapy and pain relief.

How do I know if my arm pain is serious?

Arm pain is serious if it comes with chest pressure or breathlessness, sudden weakness or numbness, a deformed arm after injury, a cold or pale hand, or a hot, swollen, red arm with fever. Pain lasting more than 2 weeks also deserves a check.