Written By: Chloe Wilson BSc (Hons) Physiotherapy
Arm nerve pain is a common problem caused by pressure or irritation of one of the arm nerves, anywhere along its path from the neck to the hand.
Nerve damage typically causes a stabbing, shooting or burning pain in the arm and may be accompanied by tingling or decreased sensation in the arm or hand.
Whilst it is rare for there to be a pinched nerve in the shoulder itself, arm nerve pain usually develops due to a problem in the neck, wrist or elbow.
Here we are going to look at the most common causes of arm nerve pain. As most cases of arm and shoulder nerve pain actually come from a problem in the neck, we will start there and then go on to look at what happens if there is a pinched nerve in the arm. We will also look at how to tell whether the problem is coming from your neck or further down the arm, and the best ways to treat arm nerve pain.
The neck is made up of seven bones, known as vertebra, that sit on top of each other - imagine a stack of cotton reels.
In between the bones are squashy oblong structures known as intervertebral discs - imagine jam donuts. Running down through the middle of the spine, from the bottom of the brain, is a long cable known as the spinal cord – imagine a tree trunk.
At each spinal level (each cotton reel), a pair of nerves (known as nerve roots) divides off the spinal cord. They branch out through gaps at the side of the vertebrae known as the intervertebral foramen and, in the case of the neck, the nerves extend down various parts of the arm to the hand – imagine branches coming off the tree trunk.
These nerves have receptor cells which are looking for information to send to the brain. They also link with muscles telling them when and how to move. Signals travel up and down the nerves (known as the peripheral nervous system), to and from the brain and spinal cord (the central nervous system). Let me give you an example: when you place your hand on a table, signals travel from the peripheral to the central nervous system to tell you that you are touching something. The peripheral and central nervous system work together to decipher what the surface feels like e.g. hot, cold, rough, smooth as well as information such as how much pressure you are putting through your hand.
The central nervous system sends out instructions (e.g. to move) and interprets incoming signals (e.g. touch – sharp, hot etc). At the same time the peripheral nervous system passes the messages along, to and from the brain and carries out the appropriate actions (e.g. tells muscles to move).
Anything that affects how the messages are transferred up and down through the central and peripheral nervous system can result in pain, weakness and altered sensation in the neck, shoulder, arm and even down into the hands.
Neural damage that results in arm nerve pain can be caused by:
Nerve damage may occur right at the origin of the nerve in the neck, or anywhere down in path to the hand.
Let’s look at the most common causes of nerve damage that cause shoulder and arm pain.
Shoulder and arm nerve pain is often due to a problem in one of the spinal discs in the neck.
Each disc has a thick outer layer of cartilage, the annulus, and inner gel-like material, the nucleus.
As we move, different parts of the disc are compressed. For example, when we bend forwards, pressure goes through the front of the disc and when we bend backwards the back portion of the disc is compressed.
The discs are designed to cope with this and are there to allow the spine to move smoothly, but if there is sufficient force, or repetitive overloading on the discs, then damage can occur which affects the nearby spinal nerves.
There may be a:
Disc herniation is often unhelpfully referred to as a “slipped disc”. This term is misleading - the disc itself does not pop in and out, it is firmly held in place, it is only the nucleus that leaks out.
Any of these types of disc disease can result in nerve damage which can causes arm nerve pain. You can find out loads more about the specific symptoms associated with cervical disc disease in the burning shoulder pain article.
Spinal stenosis is when there is narrowing of one or more of the spinal foramina, the bony openings in the spine where the spinal cord and nerves sit. Spinal stenosis can occur at the:
If there is sufficient narrowing at either of these places, it can place pressure and compression through the spinal cord or spinal nerves leading to arm nerve pain.
Spinal stenosis may be caused by:
Spinal stenosis can occur anywhere in the spine but when it affects the neck it is known as cervical stenosis. Many people with cervical stenosis have no symptoms but as the disease progresses it can lead to arm nerve pain. You can find out more about the specific symptoms of spinal stenosis in the burning arm pain section.
Most cases of arm nerve pain from spinal stenosis can be treated non-operatively with a combination of physical therapy, exercises, medication and activity modification. However, if there is severe narrowing, then surgery may be required to remove some of the bone to relieve the pressure on the spinal cord or nerves.
Whilst a majority of cases of arm nerve pain originate from a problem in the neck, nerve damage can also occur anywhere along the path of the nerve as it travels through the shoulder and arm to the hand.
A pinched nerve in the shoulder or arm happens when something either internal or external to the body squashes the nerve. The compression irritates the nerve and can cause inflammation which leads to arm nerve pain. The medical term for a pinched nerve is nerve entrapment.
Any of the nerves that come from the neck and travel down the arm may be affected:
A pinched nerve in the arm most commonly occurs at the elbow or the wrist where the nerves travel through narrow spaces and passageways formed by bones and other tissues.
Damage to the nerves affects how the signals travel. There may be:
Pain in the shoulder or arm that is due to nerve irritation or spinal damage presents differently to problems in the muscles, bones, tendons or ligaments of the shoulder. If the pain in your shoulder or arm is due to nerve damage you may experience:
The first symptom of mild nerve compression or irritation is usually pain. Arm nerve pain tends to get progressively worse becoming more intense and extending further down the arm as the compression increases. Tingling or pins and needles may be felt, not necessarily in the same location as the pain e.g. there may be a shooting pain in your upper arm but tingling in your fingers.
With more major nerve compression, you may start to lose feeling in your hands. Some people actually find they have less pain when this happens, but any loss of sensation should be investigated as soon as possible by your doctor.
So how do you tell if your arm nerve pain is from compression in the neck or down the arm?
It is very uncommon for there to be a trapped nerve in the shoulder itself. Shoulder nerve pain is almost always caused by compression or irritation of the nerve root at the spine. So if you are experiencing arm nerve pain around the neck, shoulder or upper arm, it is likely that the problem is actually coming from the neck.
If your symptoms are below the elbow or in the hand, then the problem could be in the neck, even if there are no symptoms in the neck or upper arm. This is quite common. When this is the case, symptoms will be affected more by neck movements and posture than arm and hand movements.
But what if the point of compression is somewhere in the arm rather than the neck? Symptoms of a pinched nerve will only be felt below the point of compression not above. This means if the compression point is at the wrist, there will be no pain, tingling or altered sensation in the upper arm. Nerve pain only travels down the nerve, not up it. So if you have symptoms around your neck or upper arm, it is unlikely to be from nerve compression below your elbow.
If you are suffering from a pinched nerve in your shoulder, arm or neck, there are various things you can do to help:
Most cases of arm nerve pain will settle down with these treatments. However, if the mechanical compression or chemical irritation is sever enough, then you may need surgery to remove excess bone, tight ligaments or to repair a damage disc.
The most common cause of arm nerve pain is mechanical compression in the neck. Typical symptoms include a stabbing, shooting pain, tingling and numbness. There may be a burning sensation in the shoulder, but that could be due to other problems such as brachial neuritis or shoulder bursitis – visit the burning shoulder pain article to find out more.
Whilst it is unusual to have a pinched nerve in the shoulder, nerve compression in the neck is fairly common. In most cases of arm nerve pain, symptoms will settle down with a combination of medication, physical therapy and exercises.
If this isn’t sounding quite like your pain, visit the shoulder pain diagnosis section for help working out what is wrong.
Page Last Updated: 06/07/2021
Next Review Due: 06/07/2023