Upper Arm Pain

Upper arm pain refers to pain that is felt anywhere from just below the shoulder joint to just above the elbow. It may be a problem in the muscles, tendons or bones, or even referred pain from elsewhere such as the neck or heart.

Here we will look at the most common causes of upper arm pain, how they present, how to tell the difference between them, how to know if it is serious and how to treat them.

Causes of Upper Arm Pain

1) Rotator Cuff Tear

What Is It: This is a common cause of pain in the upper arm caused by damage to one of the tendons of the rotator cuff - a group of muscles that surround the shoulder joint and control the movement and stability of the shoulder 

A rotator cuff tear is a common cause of upper arm pain

Onset: May be gradual due to wear and tear over time from repetitive friction, or sudden with an injury such as falling on to an outstretched arm or picking up something heavy

Symptoms: Upper arm pain across the shoulder and down the upper arm, usually a dull ache, weakness and cracking/popping noises when you move your arm

Aggravating Factors: Lying on the affected arm, lifting or twisting the arm

Treatment: Rest from aggravating activities, rotator cuff exercises to strengthen and stretch the shoulder and steroid injections. In severe cases, surgery may be required

Recovery: Rotator cuff tears are often slow to heal and it can take a few months to fully recover. If symptoms persist for more than 6 months, surgery may be recommended

Find Out More: Visit the Rotator Cuff Tear section

2) Broken Arm aka Fracture

What Is It: A break or crack in the upper arm bone known as a fractured shaft of humerus. It may be anything from a small hairline fracture to a complex fracture where the bone has completely broken into two or more pieces

Upper arm pain may indicate a fractured humerus (aka broken arm)

Onset: Sudden onset from a direct blow to the upper arm, e.g. a fall or RTA, sudden severe twisting of the arm or occasionally from an extreme contraction of one of the arm muscles e.g. when throwing. In most cases there is an obvious event that caused the fracture. If this is not the case, there may be an underlying pathology that has weakened the bone making it more likely to break e.g. osteoporosis or cancer

Symptoms: Severe upper arm pain - often described as a sharp pain, deformity (if the fracture has displaced there may be a bulge where the bone is out of place), shortening of the arm, bruising, swelling, minimal arm movement

Aggravating Factors: Any arm movement, pressure over the fracture site

Treatment: Minor fractures may be treated by immobilising the arm in a cast for 4-6 weeks. Major fractures will require surgery to realign the bones and fix them back together using either a metal rod or a metal plate and screws

Recovery: It usually takes around 3-6 weeks for the bone to knit back together and then the same length of time again for it to strengthen. However, in elderly patients healing is often slower. You will need physical therapy to regain strength and movement in the arm as stiffness and weakness is a common problem. It can take up to a year to fully recover from an arm fracture

3) Shoulder Impingement

What Is It: This is a collective term for anything that reduces the amount of space in part of the shoulder, known as the subacromial space, which places pressure and friction on the rotator cuff. It is a common cause of shoulder and upper arm pain affecting approximately 20% of people at some point usually caused by repetitive overhead activities such as throwing or swimming, aging, posture or genetics

A painful arc is a common feature of shoulder impingement.  Shoulder movement is usually full and only the middle range of movement is painful (shown in red)

Onset: Gradual onset that gets progressively worse over time. Most frequently develops in middle age (45-65)

Symptoms: Shoulder and upper arm pain, usually on the outside of the arm which may extend down to the elbow, often described as feeling like toothache. Painful arc with shoulder movement (as shown in picture) and weakness. Shoulder movement is not usually restricted initially, but over time, stiffness may develop due to lack of use

Aggravating Factors: Reaching and lifting above your head, lying on your side, reaching behind your back, getting dressed

Treatment: Rest from aggravating activities, ice, rotator cuff exercises to strengthen and stretch the muscles and steroid injections. If the impingement is caused by small bone spurs in the subacromial space, surgery will be required to remove them, known as a subacromial decompression

Recovery: It can take 3-6 months for upper arm pain to settle with shoulder impingement syndrome, with or without surgery

Find Out More: Visit the shoulder impingement syndrome section

4) Frozen Shoulder

What is it: Thickening and tightening of the joint capsule, a fluid filled sac that surrounds the glenohumeral (shoulder) joint

A frozen shoulder causes pain and stiffness in the shoulder and arm

Onset: Gradual onset over weeks/months, most common between the ages of 40-70 and in females. Often no obvious cause but it can develop after a shoulder injury or surgery

Symptoms: There are three phases to a frozen shoulder symptoms - shoulder and upper arm pain that gets gradually worse (phase 1) then increasing restriction of shoulder movement (phase 2) in what is known as a capsular pattern – lateral rotation most limited, then flexion and medial rotation least affected. The pain gradually subsides but stiffness remains for a number of months (phase 3). The pain is often worse at night

Aggravating Factors: Arm movement, particularly above head height or twisting movements

Treatment: Initially focuses on pain management e.g. medication and steroid injections. Once the pain has settled, an exercise programme is followed to strengthen and stretch the shoulder to regain full movement. If symptoms fail to improve after six months, surgery may be recommended

Recovery: It can take up to 2 years to fully recover from a frozen shoulder. Each phase can last for a number of months

Find Out More: Visit the Frozen Shoulder section

5) Biceps Injury

What is it: Inflammation and thickening (tendonitis), or a tear, of the long head of biceps tendon. It is often associated with other shoulder problems such as impingement and arthritis. People who do lots of heavy lifting overhead are at increased risk of biceps injuries

Popeye Muscle from a biceps tendon tear

Onset: May develop gradually over time from overuse, or suddenly with an injury such as a fall or lifting heavy weights

Symptoms: Tendonitis – achy upper arm muscle pain, mostly at the front, especially when the arm is overhead. Tendon tear – sudden, sharp upper arm pain, sometimes accompanied by an audible pop, and bruising from the mid upper arm to the elbow. There may be a bulge in the upper arm, known as a “Popeye Muscle”. The upper arm pain may in both cases extend down to the elbow

Aggravating Factors: Heavy lifting, raising your arm above your head

Treatment: Rest, ice, injections and exercises. In persistent cases of tendonitis, or severe tendon tears, surgery may be required, after which you will need to wear a sling initially and then work on a rehab programme of strengthening and stretching exercises

Recovery: It usually take 3-6 months to fully recover from a biceps injury

Other Causes of Upper Arm Pain

In some instances, upper arm pain may actually be a symptom of a problem elsewhere:

Left upper arm pain can be caused by heart problems - this is a medical emergency

Heart Problems

Angina: A condition where the blood supply to the heart is restricted which can cause upper arm pain. The pain usually gets worse with activity and eases with rest

Heart Attack: Where a blood clot blocks the blood supply to the heart. This is a medical emergency. If your upper arm pain, usually in the left arm, is accompanied by chest pain (may feel like a squeezing sensation or pressure), shortness of breath, nausea, light-headedness or sweating call for an ambulance immediately

Nerve problems

Pressure on the nerves that run from the neck across the shoulder and down the arm can cause pain in the upper arm. The nerve may get pinched where it exits the spine or anywhere along its path which leads to pain. Nerve pain is often accompanied by pins and needles and/or numbness in the arm or burning shoulder pain

What Next?

You can find out more about the causes of upper arm pain by clicking on the link above.  If the pain is more across the front of the shoulder and chest, it may indicate a problem with your collarbone - visit the collar bone pain section for help working out what is going on. If it's radiating to the shoulder blades or across your upper back, visit the shoulder blade pain section.

Most cases of upper arm pain benefit from strengthening and stretching exercises - visit the shoulder exercises section for a whole range of exercises that might help.

If none of these is sounding quite like your pain, it may be that there is something else going on such as bursitis or a problem in the shoulder joint itself. 

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