What causes shoulder, arm, and hand pain. How to distinguish between normal discomfort and concerning symptoms. What are effective prevention and treatment methods for upper extremity pain. When should you seek medical attention for arm and hand pain.

Understanding Upper Extremity Pain: From Shoulders to Fingertips

Pain in the shoulders, arms, and hands is a common complaint that can significantly impact daily activities and quality of life. This type of discomfort can range from mild soreness to debilitating pain, and its causes are diverse. Understanding the underlying mechanisms of upper extremity pain is crucial for proper diagnosis and effective treatment.

Upper extremity pain often originates from various structures, including muscles, tendons, ligaments, nerves, and joints. The complexity of the shoulder, arm, and hand anatomy means that pain in these areas can be challenging to diagnose accurately without professional medical assessment.

Common Causes of Upper Extremity Pain

• Overuse injuries
• Trauma or acute injuries
• Degenerative conditions like arthritis
• Nerve compression or irritation
• Poor posture or ergonomics
• Repetitive strain injuries

Distinguishing Between Normal Discomfort and Concerning Pain

One of the most crucial aspects of managing upper extremity pain is distinguishing between normal discomfort and pain that requires medical attention. After physical activity or new exercises, it’s common to experience some level of muscle soreness. This is often referred to as Delayed Onset Muscle Soreness (DOMS) and is generally not a cause for concern.

However, certain types of pain should prompt a visit to a healthcare provider. Sharp, localized pain, especially when accompanied by swelling, redness, or loss of function, may indicate a more serious condition that requires professional evaluation.

Red Flags for Upper Extremity Pain

1. Severe pain that doesn’t improve with rest
2. Numbness or tingling sensations
3. Weakness in the affected limb
4. Visible deformity or swelling
5. Pain that wakes you from sleep
6. Pain accompanied by fever or unexplained weight loss

Cervical Radiculopathy: A Common Cause of Neck and Arm Pain

Cervical radiculopathy, often referred to as a “pinched nerve” in the neck, is a frequent cause of pain that radiates from the neck into the shoulder, arm, and sometimes the hand. This condition occurs when a nerve root in the cervical spine becomes compressed or irritated.

The symptoms of cervical radiculopathy can vary but often include:

• Sharp or burning pain that radiates down the arm
• Numbness or tingling sensations in the arm or hand
• Weakness in the affected muscles
• Neck pain that may worsen with certain movements

Causes of Cervical Radiculopathy

Cervical radiculopathy can result from various factors, with the most common being:

1. Degenerative changes in the spine due to aging
2. Herniated or bulging intervertebral discs
3. Bone spurs (osteophytes) that narrow the space where nerves exit the spine
4. Acute injury or trauma to the neck

Is cervical radiculopathy a serious condition? While cervical radiculopathy can be painful and disruptive, it is generally not considered a serious or life-threatening condition. In most cases, it responds well to conservative treatment approaches. However, if left untreated, it can lead to chronic pain and potentially permanent nerve damage in severe cases.

Prevention Strategies for Upper Extremity Pain

Preventing upper extremity pain is often more effective than treating it after it occurs. By implementing proper techniques and habits, individuals can significantly reduce their risk of developing pain in their shoulders, arms, and hands.

Ergonomic Considerations

Proper ergonomics play a crucial role in preventing upper extremity pain, especially for those who spend long hours at a desk or performing repetitive tasks. Here are some key ergonomic tips:

• Maintain a neutral wrist position when typing or using a mouse
• Keep your computer monitor at eye level to prevent neck strain
• Use a chair that provides adequate lumbar support
• Take regular breaks to stretch and move around
• Consider using ergonomic keyboards and mice designed to reduce strain

Exercise and Stretching

Regular exercise and stretching can help strengthen the muscles that support the upper extremities and improve flexibility. This can reduce the risk of injury and pain. Some beneficial exercises include:

1. Shoulder rolls and shrugs
2. Wrist flexor and extensor stretches
3. Neck rotations and side bends
4. Upper back and chest stretches
5. Arm circles and tricep stretches

How often should you perform these exercises? For optimal results, try to incorporate these exercises into your daily routine. Aim for at least 5-10 minutes of stretching and strengthening exercises each day, particularly if you have a sedentary job or engage in repetitive activities.

Treatment Options for Upper Extremity Pain

When upper extremity pain does occur, there are various treatment options available, ranging from home remedies to medical interventions. The appropriate treatment will depend on the underlying cause and severity of the pain.

Conservative Treatment Approaches

For mild to moderate pain, conservative treatments are often the first line of defense. These may include:

• Rest and activity modification
• Ice or heat therapy
• Over-the-counter pain medications (e.g., NSAIDs)
• Gentle stretching and exercises
• Topical pain relief creams or gels

Physical Therapy

Physical therapy can be highly effective in treating upper extremity pain. A physical therapist can develop a personalized treatment plan that may include:

1. Manual therapy techniques
2. Specific exercises to improve strength and flexibility
3. Postural correction strategies
4. Modalities such as ultrasound or electrical stimulation
5. Education on proper body mechanics and ergonomics

How long does physical therapy typically last for upper extremity pain? The duration of physical therapy can vary depending on the specific condition and individual response to treatment. On average, patients may attend physical therapy sessions 2-3 times per week for 4-8 weeks. However, some conditions may require longer treatment periods.

When to Seek Medical Attention for Upper Extremity Pain

While many cases of upper extremity pain can be managed with self-care measures, there are situations where professional medical attention is necessary. Knowing when to seek help can prevent complications and ensure proper treatment.

Indications for Medical Evaluation

Consider seeking medical attention if you experience:

• Persistent pain that doesn’t improve with rest and home treatments
• Pain accompanied by swelling, redness, or warmth in the affected area
• Sudden onset of severe pain following an injury
• Numbness, tingling, or weakness that doesn’t resolve
• Pain that interferes with sleep or daily activities
• Any signs of infection, such as fever or chills

What types of healthcare providers specialize in treating upper extremity pain? Depending on the nature and severity of your condition, you may be referred to various specialists, including:

1. Orthopedic surgeons
2. Rheumatologists
3. Neurologists
4. Pain management specialists
5. Physiatrists (Physical Medicine and Rehabilitation doctors)

Advanced Diagnostic and Treatment Techniques

In cases where conservative treatments are ineffective or when a more precise diagnosis is needed, healthcare providers may employ advanced diagnostic and treatment techniques.

Diagnostic Imaging

Various imaging techniques can help visualize the structures of the upper extremities and identify potential causes of pain. These may include:

• X-rays to assess bone structures and detect arthritis or fractures
• MRI scans to evaluate soft tissues, including muscles, tendons, and nerves
• CT scans for detailed images of bones and joints
• Ultrasound for real-time imaging of soft tissues and to guide injections

Minimally Invasive Treatments

For certain conditions, minimally invasive treatments may be recommended. These can include:

1. Corticosteroid injections to reduce inflammation
2. Nerve blocks to alleviate pain
3. Platelet-rich plasma (PRP) therapy to promote healing
4. Radiofrequency ablation for chronic nerve pain

Are these advanced treatments always necessary for upper extremity pain? Advanced diagnostic and treatment techniques are typically reserved for cases where conservative measures have failed or when the diagnosis is unclear. Many patients find relief through non-invasive approaches, and these more advanced options are considered on a case-by-case basis.

Long-Term Management and Lifestyle Modifications

Managing upper extremity pain often requires a long-term approach that includes lifestyle modifications and ongoing self-care. By adopting healthy habits and making necessary changes, individuals can reduce the likelihood of recurrent pain and improve their overall quality of life.

Ergonomic Adjustments

Implementing ergonomic principles in daily activities can significantly reduce strain on the upper extremities. Consider the following adjustments:

• Optimize your workspace with ergonomic furniture and equipment
• Use proper lifting techniques to avoid overexertion
• Adjust your sleeping position and pillow to support your neck and shoulders
• Modify your smartphone and tablet usage to reduce “tech neck”

Stress Management

Chronic stress can contribute to muscle tension and exacerbate upper extremity pain. Incorporating stress-reduction techniques into your routine can be beneficial:

1. Practice mindfulness meditation
2. Engage in deep breathing exercises
3. Pursue hobbies that promote relaxation
4. Consider cognitive-behavioral therapy for stress management

How does stress impact upper extremity pain? Stress can cause muscle tension, particularly in the neck and shoulders, which can lead to or worsen existing pain. Additionally, stress can lower pain thresholds, making individuals more sensitive to discomfort. By managing stress effectively, you can reduce muscle tension and potentially alleviate some types of upper extremity pain.

Hand, Wrist, and Arm Pain While Exercising: What Is It? Causes, Symptoms, and Treatment

Is it normal to have pain or soreness in my hands, wrists, and arms while exercising?

It depends. When you start with exercises you have never done or when you exercise some muscles you have not used in a while, these muscles can become sore. That is normal. Muscle activity produces lactic acid, which causes soreness in the muscles. Soreness means your muscles have been stressed, and they will likely recover after a few hours or a few days, when the lactic has been cleared away. If the exercise causes too much stress, your muscles may become sore to the touch and even might feel swollen.

Is there a difference between discomfort and pain in the hands, wrists, and arms?

“Discomfort” is an annoying sensation of mild pain; actual “pain” is when you feel that there is something wrong. In your physician’s office or in the hospital, you are often asked to rate your pain as a number or point to a picture of a face indicating your discomfort. The level of discomfort or pain is very different in each patient. It depends much on how you have been able to deal with uncomfortable situations in the past.

When should I pay special attention to my muscle or joint pain in my hands, wrists, and arms while exercising?

Most exercise-related pain is dull and spreads over a larger area of your arms or legs. This is normal. When it seems to be sharp pain focused in one spot that you can pinpoint with a finger, it may indicate a muscle strain of a tendon inflammation. Popping, clicking, or grinding in the muscles or tendons are signs of strain. You should cut back on the exercise or activity until the problem settles down. Also, you should watch for painful swelling, especially when compared to the other arm or leg. If rest or over-the-counter medications do not help, you should seek your doctor’s advice.

How can I prevent pain in my hands, wrists, and arms while exercising?

Athletic exercises or exercises in your occupation/physical therapy department are meant to make your muscles and tendons more tolerant to stress and strain, so some soreness is normal. The best way to ease into exercises is to work your muscles gradually to the point of discomfort but not pain. Your occupational therapist can assist you to become more flexible and stronger.

How do I treat pain in my hands, wrists, and arms after exercise?

It is helpful to know that discomfort is often the result of exercise. It does not mean that there is anything wrong with your muscles or your body. Staying active and exercising regularly is healthy and will make it easier for your muscles to recover. It is best to “listen to your body” and back off if exercises are too uncomfortable. Over-the-counter medications, such as a cream applied to the sore area or an occasional anti-inflammatory tablet, can be used.
 

Dr. Ekkehard Bonatz is an orthopedic upper extremity and hand surgeon in Birmingham, Alabama, where he trained and completed his hand fellowship. He is an active member of the American Society for Surgery of the Hand (ASSH) and the American Academy of Orthopaedic Surgeons (AAOS).

Neck & Arm Pain – Joshua Li, MD, PhD

Neck & Arm Pain – Joshua Li, MD, PhD

Cervical Radiculopathy (Pinched Nerve)

Cervical radiculopathy, commonly called a “pinched nerve” occurs when a nerve in the neck is compressed or irritated where it branches away from the spinal cord. This may cause pain that radiates into the shoulder, as well as muscle weakness and numbness that travels down the arm and into the hand.

Cervical radiculopathy is often caused by “wear and tear” changes that occur in the spine as we age, such as arthritis. In younger people, it is most often caused by a sudden injury that results in a herniated disk.

In most cases, cervical radiculopathy responds well to conservative treatment that includes medication and physical therapy.

Cause

Cervical radiculopathy most often arises from degenerative changes that occur in the spine as we age or from an injury that causes a herniated, or bulging, intervertebral disk.

Degenerative changes. As the disks in the spine age, they lose height and begin to bulge. They also lose water content, begin to dry out, and become stiffer. This problem causes settling, or collapse, of the disk spaces and loss of disk space height.

As the disks lose height, the vertebrae move closer together. The body responds to the collapsed disk by forming more bone —called bone spurs—around the disk to strengthen it. These bone spurs contribute to the stiffening of the spine. They may also narrow the foramen—the small openings on each side of the spinal column where the nerve roots exit—and pinch the nerve root.

Degenerative changes in the disks are often called arthritis or spondylosis. These changes are normal and they occur in everyone. In fact, nearly half of all people middle-aged and older have worn disks and pinched nerves that do not cause painful symptoms. It is not known why some patients develop symptoms and others do not.

Herniated disk. A disk herniates when its jelly-like center (nucleus) pushes against its outer ring (annulus). If the disk is very worn or injured, the nucleus may squeeze all the way through. When the herniated disk bulges out toward the spinal canal, it puts pressure on the sensitive nerve root, causing pain and weakness in the area the nerve supplies.

A herniated disk often occurs with lifting, pulling, bending, or twisting movements.

Symptoms

In most cases, the pain of cervical radiculopathy starts at the neck and travels down the arm in the area served by the damaged nerve. This pain is usually described as burning or sharp. Certain neck movements—like extending or straining the neck or turning the head—may increase the pain. Other symptoms include:

• Tingling or the feeling of “pins and needles” in the fingers or hand
• Weakness in the muscles of the arm, shoulder, or hand
• Loss of sensation

Some patients report that pain decreases when they place their hands on top of their head. This movement may temporarily relieve pressure on the nerve root.

Doctor Examination

After discussing your medical history and general health, your doctor will ask you about your symptoms. He or she will then examine your neck, shoulder, arms and hands—looking for muscle weakness, loss of sensation, or any change in your reflexes. Your doctor may also ask you to perform certain neck and arm movements to try to recreate and/or relieve your symptoms.

Tests

X-rays. These provide images of dense structures, such as bone. An x-ray will show the alignment of bones along your neck. It can also reveal whether there is any narrowing of the foramen and damage to the disks.

Computed tomography (CT) scans. More detailed than a plain x-ray, a CT scan can help your doctor determine whether you have developed bone spurs near the foramen in your cervical spine.

Magnetic resonance imaging (MRI) scans.These studies create better images of the body’s soft tissues. An MRI of the neck can show if your nerve compression is caused by damage to soft tissues—such as a bulging or herniated disk. It can also help your doctor determine whether there is any damage to your spinal cord or nerve roots.

Electromyography (EMG). Electromyography measures the electrical impulses of the muscles at rest and during contractions. Nerve conduction studies are often done along with EMG to determine if a nerve is functioning normally. Together, these tests can help your doctor determine whether your symptoms are caused by pressure on spinal nerve roots and nerve damage or by another condition that causes damage to nerves, such as diabetes.

Treatment

It is important to note that the majority of patients with cervical radiculopathy get better over time and do not need treatment. For some patients, the pain goes away relatively quickly—in days or weeks. For others, it may take longer. It is also common for cervical radiculopathy that has improved to return at some point in the future. Even when this occurs, it usually gets better without any specific treatment. In some cases, cervical radiculopathy does not improve, however. These patients require evaluation and treatment.

Nonsurgical Treatment

Initial treatment for cervical radiculopathy is nonsurgical. Nonsurgical treatment options include:

Soft cervical collar. This is a padded ring that wraps around the neck and is held in place with Velcro. Your doctor may advise you to wear a soft cervical collar to allow the muscles in your neck to rest and to limit neck motion. This can help decrease the pinching of the nerve roots that accompany movement of the neck. A soft collar should only be worn for a short period of time since long-term wear may decrease the strength of the muscles in your neck.

Physical therapy. Specific exercises can help relieve pain, strengthen neck muscles, and improve range of motion. In some cases, traction can be used to gently stretch the joints and muscles of the neck.

Medications. In some cases, medications can help improve your symptoms.

• Nonsteroidal anti-inflammatory drugs (NSAIDs). NSAIDs, including aspirin, ibuprofen, and naproxen, may provide relief if your pain is caused by nerve irritation or inflammation.
• Oral corticosteroids. A short course of oral corticosteroids may help relieve pain by reducing swelling and inflammation around the nerve.

Facet joint injection in the cervical spine

• Steroid injection. In this procedure, steroids are injected near the affected nerve to reduce local inflammation. The injection may be placed between the laminae (epidural injection), in the foramen (selective nerve injection), or into the facet joint. Although steroid injections do not relieve the pressure on the nerve caused by a narrow foramen or by a bulging or herniated disk, they may lessen the swelling and relieve the pain long enough to allow the nerve to recover.

• Narcotics. These medications are reserved for patients with severe pain that is not relieved by other options. Narcotics are usually prescribed for a limited time only.

Surgical Treatment

If after a period of time nonsurgical treatment does not relieve your symptoms, your doctor may recommend surgery. There are several surgical procedures to treat cervical radiculopathy. The procedure your doctor recommends will depend on many factors, including what symptoms you are experiencing and the location of the involved nerve root.

Adapted from OrthoInfo

Information on cervical radiculopathy is also available in Spanish: Radiculopatía cervical (nervio pinzado).

Pain in the wrist – causes

Symptoms of pain in the wrist

Pain in the wrist and hand can be different. It greatly affects the quality of human life.

Wrist pain prevents us from doing daily activities: picking up and holding objects, typing, writing.

Weakness, numbness, tingling, soreness, inflammation, and limited mobility may occur in the wrist.

A wrist injury usually causes bruising, swelling, and limited mobility.

How does wrist pain affect us?

Wrist pain makes it difficult to perform fine motor activities such as typing on the keyboard or playing the piano.

Ease the pain

DID YOU KNOW?

The long bones of the forearm (radius and ulna) and eight carpal bones join at the wrist joint.*

51% of people from different countries experienced pain in the hand.**

Get rid of pain

* Fundamentals of Anatomy and Physiology, Eighth Edition, 1996 Tortora GJ (Tortora GJ), Grabowski SR. (Grabowski SR), ed. John Wiley & Sons
**Global Pain Index: GSK sponsored study, full report, p. 47

Why Wrist Pain Occurs

Wrist pain can come from a variety of causes, which can sometimes be difficult to pinpoint.

Common causes of wrist pain

Wrist pain is often caused by sprains from injuries. The wrist can hurt due to inflammation of the tendons (tendinitis) and joint capsule (bursitis). These diseases develop as a result of injuries and excessive stress on the wrist joint.

Factors that increase the risk of developing wrist pain

Certain sports (bowling, tennis) and professions (hairdressers, pianists) increase the risk of developing wrist pain. In addition, the likelihood of developing wrist pain increases with diabetes and overweight.

Treatment

If pain and swelling in the wrist area does not improve within a few days, see a doctor immediately. In addition to the examination, additional tests (X-ray, MRI, or CT) and blood tests may be needed to rule out comorbidities (such as rheumatoid arthritis). Your doctor may also recommend wearing a wrist brace and doing hand and wrist exercises.

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Pain in the hand – Dr. Bubnovsky’s Center

Osteoarthritis

Arthritis

Gout

Osteochondrosis

Contents

Hand pain is a very common complaint. But it is difficult to differentiate such a syndrome due to the many reasons why it occurs.

Causes of pain

Pain in the hands is often experienced by people who, due to their profession, have their hands in one position for a long time (dentists, musicians, programmers). Prolonged stress and monotonous load lead to a deterioration in the microcirculation of the blood of the wrist joint, a violation of its nutrition. As a result, the cartilage loses its elasticity, deforms, and hurts.

Pain in the wrist joint can occur as a result of injuries, bruises, dislocations. With a fall or increased physical exertion, a tear of the tendon fibers occurs. The pain is often accompanied by swelling and reduced joint mobility.

Pain in the hands can signal the presence of:

– ischemic heart disease,

– myocardial infarction,

– systemic lupus erythematosus.

And they can also be triggered by such diseases as:

– gout,

– osteoarthritis,

– arthritis,

– osteochondrosis.

In the absence of adequate treatment, pathological changes in the joint become irreversible and lead to loss of hand function. Therefore, it is very important not to reduce pain treatment to the use of painkillers and ointments, but to consult a doctor to determine the cause of discomfort.

Types of pain in the hands

• Constant and intermittent pain.

Pain may always be present or develop under certain circumstances. So, with injuries, discomfort is most often felt when pressing on the hand or moving the joint. And with inflammatory or degenerative processes, it can last for hours even after the cessation of exposure.

• Discomfort may be moderate or severe.

The nature of burning unbearable pain is usually noted with gout. For carpal tunnel syndrome, dull pain is more characteristic.

• Painful tenderness may occur in one hand or be felt symmetrically in both hands.

Pain in the left hand is often characteristic of coronary heart disease. With gout, pain in the right hand after a while necessarily passes to the left limb.

But it is impossible to determine the cause of the pain only by the nature or localization, since the symptoms for various diseases can be similar. For example, pain in the crook of the wrist can be both the result of injuries and a symptom of pathologies of the nervous and cardiovascular systems. Because of this, it is difficult for a person to understand which doctor to contact for pain. In such cases, you should start with a therapist.

Treatment

Pain in the hand is a symptom, not a separate disease, so treatment is not limited to the use of pain pills and ointments. These methods only temporarily reduce pain, but do not eliminate their cause. As a result, the disease progresses, leading to loss of mobility and deformity of the joints. Doctor Bubnovsky’s centers help relieve pain and restore joint mobility.

The treatment of pain in the hands is based on the unique technique of Professor Bubnovsky – modern kinesitherapy. Such treatment not only eliminates discomfort, but also normalizes blood circulation, relieves inflammation and restores affected functions.

Exercises according to the Bubnovsky method are simple, affordable and have practically no contraindications. Thanks to gymnastics, blood flow in the tissues of the joint improves, its mobility increases, stiffness and tension in the hand go away.

The treatment program is prescribed by a kinesitherapist after examining the patient and a series of myofascial tests. At the same time, not only the state of hand function is assessed, but also the general condition of the musculoskeletal system. This approach makes it possible to prescribe a personalized and most effective treatment. Classes are held under the guidance of an instructor. It controls the technique of movement and breathing, monitors the reaction of the body.

Exercises are performed in a certain sequence using various simulators and devices. For narrow-local exercises, a decompression hand trainer is used. Classes on it strengthen the fingers, help eliminate excessive tension in the hand and restore tissue nutrition. As a result of stretching the brush, the pain goes away.

The treatment is supplemented by classes on the Bubnovsky multifunctional simulator (MTB) and rehabilitation series simulators. Exercises on them increase blood circulation in the muscles of the arm, strengthen the joints, and restore their mobility. Power loads can be supplemented with massage, cryotherapy, electrophoresis and magnetotherapy.

Such an integrated approach affects the root cause of the disease and has a beneficial effect on the entire body as a whole.

Prevention

To prevent pain in the hands, you must adhere to the following recommendations:

1. Avoid injury to upper limbs. Before playing sports, you need to warm up well and do not neglect the protective devices for the wrist during physical activity.
2. Wear mittens or gloves during cold seasons. Frequent hypothermia negatively affects the small joints of the hands and can cause the development of arthritis, pain in the hands.
3. Do hand exercises. This is not necessarily a complex of physiotherapy exercises. It is enough to make the usual rotational movements of the hand and from time to time stretch the fingers, hands, and wrist. Use carpal expanders.
4. Avoid physical overvoltage. For example, when working at a computer for a long time, it is recommended to use special pads for brushes, as well as take breaks during monotonous work.
5. Regularly undergo medical examination and monitor comorbidities. Even in the absence of complaints, it is necessary to undergo an examination of the body once a year. Do not wait for the development of complications, and at the first symptoms of discomfort, seek medical help.
6. Give up bad habits and eat a balanced diet. Caffeine and cigarettes constrict blood vessels, limit the blood supply to the articular tissues of the extremities. Alcohol increases the risk of developing osteoporosis. A lack of vitamins reduces the protective functions of the body.

Compliance with these recommendations does not require much effort, helps to maintain the mobility of the fingers and hands and overall health. Therapy of any disease in its early stages is easier, and the risk of complications is minimal.