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ARM PAIN

Arm pain is usually described as pain, discomfort, or stiffness that occurs anywhere from your shoulders down to your fingers in one or both arms. Most often, it's caused by an injury or overuse, but can be associated with other conditions.

Anatomy

The spinal column in the neck (cervical spine) is made up of a row of bones (vertebral bodies) that are separated by cartilage discs (intervertebral discs). There are joints between the vertebral bodies that allow the neck to twist and bend.  These are called facet joints.  

 

  

The spinal cord runs downwards within the spinal canal.  It has branches called nerve roots that pass out of the spine at the openings between the bones.  These nerve roots blend together to form the brachial plexus of nerves.  This plexus then divides up into the three nerves that supply the upper limb, hand and fingers.  

 

These are:

  • Radial nerve

  • Ulnar nerve 

  • Median nerve

Arm Pain Causes

Conditions

Pain in the arm is caused by pressure or inflammation of the nerve roots as they come out of the spinal column. The location of the symptoms will depend on the level at which the nerve root is involved.  The causes might be: 

 

  • Direct pressure from a prolapsed or herniated intervertebral disc in the neck (so called “Slipped disc’)

  • Pressure from wear and tear changes (osteoarthritis) of the bones and discs of the neck.  These changes (cervical spondylosis) cause a narrowing of the spaces through which the nerve roots travel out of the spine (foraminal stenosis).

  • Inflammation because of leakage fluid from the intervertebral disc.

  • Pressure from a broken or crushed vertebral body (vertebral fracture).

  • Pressure and inflammation from either an infection or cancer.

Arm Pain Symptoms

‘Chronic pain is the medical term for any pain that has persisted for longer than would usually be expected.  This is usually for longer than three months.  Patients sometimes describe pain in the neck as well as in the arm, hand and fingers.  If the pain is mainly in the arm, it is called ‘arm dominant pain’.

 

  • Pain going down the arm, and into the forearm, hand and fingers.

  • Weaknessof the muscles in the arm, hand and fingers.

  • Numbness in the arm, hand and fingers.

  • Pins and needles and a tingling sensation (paraesthesiae) in the arm, hand and fingers.

  • Difficulty in carrying out fine movements because of these symptoms.

 

The locations of these symptoms will depend upon which nerve root(s) have been affected.  

Arm Pain Diagnosis

History:

The diagnosis is usually made from the patient’s description of their symptoms.  The location of the symptoms will point to which nerve root is involved in the neck.

 

Physical examination: 

 This might show weakness of the muscles, and numbness of the skin in the involved area.  There might be absent tendon reflexes at the elbow and wrist.  

 

Magnetic resonance imaging (MRI) scan of the lumbar spine

 This uses radio waves and a strong magnetic field to create images of the body's structures. This is the most commonly used investigation. This would confirm the presence and location of the herniated disk and might identify which nerves are affected.

 

Computerized tomography (CT scan): 

 This uses multiple X-rays images that are combined from different directions to create a cross-sectional image of the cervical spinal column and the surrounding structures. 

 

X-ray images:

  A conventional single picture X-ray of the spine might demonstrate any ‘wear and tear’ changes of the cervical spine.

Arm Pain Treatment

1.         Conservative therapies:  It is usual to try simple and conservative therapies first.  (See treatment options chart.)

 

  These would involve:

 

Medications:

  • Simple painkillers such as (paracetamol and codeine) and the anti-inflammatory drugs (ibuprofen, naproxen).

  • Stronger morphine-related painkillers (tramadol and morphine) are used on occasions for severe pain.  These are potentially habit forming and can have distressing side effects. Their use is usually discouraged and these should not be used in the long-term.

  • Drugs to treat neuropathic pain (amitriptyline, gabapentin, and pregabalin).

 

Complementary and physical therapies:

  • Physiotherapy

  • Regular exercise 

  • Topical therapies.  These involve using the anti-inflammatory rubs or gels (Voltarol Emulgel, Mobilat, Ibulieve) and hot or cold pads.

  • A TENs machine

  • Acupuncture

  • Joint supplements (Glucosamine)

 

2.         Interventional therapies:     These involve injections and operations.  Interventional therapies have risks and these must be balanced against their potential benefit.

 

  • Nerve root block injection:

    • Transforaminal epidural steroid injection.  This involves using X-ray to place a needle around the affected nerve root. Local anaesthetic and steroid are then injected.  The purpose would be to treat the symptoms (therapeutic intention) and identify the source of the problem (diagnostic intention).

 

  • Cervical epidural steroid injection: 

    •  The nerve roots pass through the epidural space within the spinal canal.  The procedure involves injecting local anaesthetic and steroid into the epidural space of the cervical spine (therapeutic intention).  

 

  • Surgery:  

    • There are various operations that might be carried out.  The intention would be either to remove the prolapsed disc or relieve the narrowing caused by the ‘wear and tear’ process.  The precise operation and technique of the surgery would be explained to the patient by the operating surgeon.

Patient Information (PDFs)