Difficulty Moving Your Arm

Pain, stiffness or weakness?

Working out which of these limits your arm is the most useful first step.

Shoulder causes

Rotator cuff injuries

The rotator cuff is a group of four tendons that lift and rotate the arm. Tendinitis and wear-related tears are very common over 40. A rotator cuff tear causes pain at the outer shoulder, night pain, and weakness lifting the arm to the side or overhead. A large acute tear after a fall can leave you unable to raise the arm at all.

Shoulder impingement and bursitis

In shoulder impingement, the cuff tendons and bursa pinch under the bony roof of the shoulder when the arm is raised. There is a "painful arc" between about 60 and 120 degrees of lifting. Bursitis causes similar pain.

Frozen shoulder

Frozen shoulder (adhesive capsulitis) causes the joint capsule to thicken and tighten. Pain comes first, then severe stiffness, especially turning the arm outward. It affects people aged 40 to 60, is more common in women and much more common with diabetes and thyroid disease. It slowly resolves over 1 to 3 years.

Dislocation and fractures

A dislocated shoulder follows a fall or forceful twist. The shoulder looks squared off and any movement is very painful. Fractures of the collarbone, upper arm (humerus) or elbow also stop arm movement. In older adults, a fall onto an outstretched hand commonly fractures the top of the humerus.

Arthritis

Osteoarthritis and rheumatoid arthritis of the shoulder cause gradual stiffness, grinding and pain.

Nerve causes

• Pinched nerve in the neck (cervical radiculopathy): neck pain with pain, tingling or weakness running down one arm.
• Brachial plexus injury: damage to the nerve network between the neck and armpit from a fall, motorcycle crash or birth injury.
• Brachial neuritis (Parsonage-Turner syndrome): severe shoulder pain for days, followed by marked weakness as the pain fades.
• Axillary nerve injury: after a dislocation, causes weakness lifting the arm and a numb patch on the outer shoulder.
• Stroke: sudden weakness or clumsiness of one arm, often with facial and leg weakness on the same side and speech problems.

Remember BE FAST: Balance loss, Eyes (vision change), Face drooping, Arm weakness, Speech difficulty, Time to call emergency services.

Elbow and other causes

• elbow fractures, dislocations and arthritis limit bending and straightening
• tennis elbow and golfer's elbow make gripping and lifting painful
• after a stroke or prolonged immobilization, muscle stiffness (spasticity) or joint contracture can develop
• in young children, pulled elbow (nursemaid's elbow) makes a child refuse to use the arm after being pulled by the hand

Accompanying symptoms and what they suggest

How doctors find the cause

Your doctor will ask how the problem started, whether there was an injury, about neck pain, numbness and medical conditions such as diabetes. They will compare both shoulders, test active and passive movement, check the strength of each rotator cuff muscle, and examine the neck and nerves.

Tests may include:

• X-ray: fractures, dislocation, arthritis
• Ultrasound or MRI: rotator cuff tears, bursitis and other soft tissue damage
• MRI of the neck: nerve root compression
• Nerve conduction studies and EMG: nerve injuries
• CT or MRI of the brain: suspected stroke, done urgently

Treatment

• Rotator cuff tendinopathy and impingement: activity modification, physical therapy, pain relief, sometimes a steroid injection.
• Rotator cuff tears: physical therapy for many degenerative tears. Surgical repair for large acute tears, especially in younger, active people, ideally within weeks.
• Frozen shoulder: pain relief, steroid injections in the painful early phase, gentle stretching. Hydrodilatation or surgery for persistent cases.
• Dislocation: prompt reduction by a clinician, a sling, then rehabilitation.
• Fractures: a sling or surgery depending on the break.
• Nerve causes: treat the underlying cause. Many pinched nerves improve with time and physical therapy.
• Stroke: emergency treatment, then rehabilitation.

For short-term pain, acetaminophen (paracetamol) or an NSAID such as ibuprofen can help, following the label dose. Ice for 15 to 20 minutes helps after an injury. Avoid keeping the arm completely still for long periods unless advised, because the shoulder stiffens quickly.

Frequently asked questions

Why can't I lift my arm above my head?

Common causes are rotator cuff tendinitis or tears, shoulder impingement, bursitis and frozen shoulder. If the arm can be lifted by someone else but not by you, a rotator cuff tear or nerve problem is likely. If it will not move even with help, frozen shoulder or arthritis is more likely.

Is sudden difficulty moving one arm a stroke?

It can be. Sudden weakness or numbness of one arm, especially with face drooping, slurred speech, confusion or vision loss, is a stroke warning sign. Call 911 or your local emergency number immediately and note the time symptoms started.

What causes difficulty moving the arm without pain?

Painless weakness points toward a nerve or brain problem, such as stroke, a pinched nerve in the neck, or nerve injury. Some large chronic rotator cuff tears also cause weakness with little pain. Painless weakness should be assessed promptly.

How long does frozen shoulder last?

Frozen shoulder typically lasts 1 to 3 years, moving through a painful freezing phase, a stiff frozen phase and a gradual thawing phase. Treatment can reduce pain and speed recovery of movement, but most people regain much of their motion.

Should I keep my arm in a sling?

Only if a clinician advises it, such as after a fracture or dislocation. For most shoulder pain, gentle movement within comfort prevents stiffness. Long periods in a sling can trigger frozen shoulder, particularly in people over 40.