What causes upper arm pain at night. How can you alleviate nighttime arm discomfort. When should you consult a doctor for arm pain during sleep.

Common Causes of Nighttime Arm Pain

Experiencing arm pain at night can significantly disrupt sleep and impact overall quality of life. Understanding the underlying causes is crucial for effective management and treatment. Here are some of the most common reasons for nighttime arm discomfort:

Cervical Disc Problems

The cervical spine consists of seven vertebrae, with shock-absorbing discs between each bone. These discs can become injured due to trauma, degeneration, repetitive motion, or surgery. Disc bulges or herniations may compress or irritate nerves, leading to arm pain that intensifies at night. The sensation can range from a pressure-like feeling to numbness, tingling, or electrical sensations down the arm.

Cervical Stenosis

Cervical stenosis occurs when the spinal canal narrows, potentially compressing the spinal cord and exiting nerve roots. This narrowing can result from various factors, including trauma, instability, disc protrusion, facet joint overgrowth, and thickening of spinal ligaments. The compression of neural structures can manifest as arm pain, particularly noticeable during nighttime hours.

Rotator Cuff Injury

The rotator cuff comprises four tendons that provide support and stability to the shoulder joint. These tendons are susceptible to injury from trauma, overuse, impingement, and degeneration. Risk factors for rotator cuff tears include advancing age, female gender, smoking, and poor posture. A rotator cuff injury can cause persistent arm or shoulder pain, often exacerbated at night.

Bursitis

Bursae are fluid-filled sacs that allow tendons and muscles to glide smoothly over bony surfaces. The shoulder and elbow contain multiple bursae that can become inflamed or irritated. Sleeping on one’s side can increase pressure on these bursae, resulting in throbbing arm pain during the night.

Thoracic Outlet Syndrome (TOS)

TOS is a group of disorders involving compression and irritation of nerves, arteries, and veins in the lower neck and chest area. Symptoms can include intermittent or constant pain in the lower neck, collarbone, arm, and hand. Numbness in the hand is common, and symptoms typically worsen when lifting the arm overhead.

Less Common but Serious Causes of Nighttime Arm Pain

While less frequent, certain serious conditions can also manifest as arm pain at night. It’s essential to be aware of these potential causes:

Referred Pain

Referred pain occurs when discomfort is perceived in an area different from the actual site of tissue injury. A classic example is a heart attack, where the pain is often felt in the arm despite the injury occurring in the heart muscle. Persistent arm pain at night could be referred pain and warrants evaluation to rule out serious underlying conditions.

Autoimmune Diseases

Autoimmune diseases, such as Rheumatoid Arthritis and Lupus, can cause the immune system to attack the body’s own tissues. Pain is a common symptom of these conditions and may be particularly noticeable at night.

Diagnosing the Cause of Nighttime Arm Pain

Accurately diagnosing the cause of arm pain at night is crucial for effective treatment. Healthcare providers may use various diagnostic methods:

• Physical examination
• Medical history review
• Imaging studies (X-rays, MRI, CT scans)
• Nerve conduction studies
• Blood tests to check for inflammatory markers or autoimmune conditions

Is arm pain worse at night? Yes, many individuals experience increased arm pain during nighttime hours. This can be due to several factors, including:

1. Reduced distractions and increased focus on bodily sensations
2. Changes in sleeping position that may aggravate existing conditions
3. Hormonal fluctuations that can influence pain perception
4. Decreased circulation during sleep

Treatment Options for Nighttime Arm Pain

The treatment for arm pain at night depends on the underlying cause. Here are some common approaches:

Conservative Treatments

Many cases of nighttime arm pain can be managed with conservative treatments, including:

• Rest and activity modification
• Ice or heat therapy
• Over-the-counter pain medications (NSAIDs, acetaminophen)
• Physical therapy exercises
• Ergonomic adjustments to sleeping position and work environment
• Braces or supports to stabilize affected joints

Medical Interventions

For more severe or persistent cases, medical interventions may be necessary:

• Prescription pain medications
• Corticosteroid injections to reduce inflammation
• Nerve blocks
• Surgical procedures (in severe cases or when conservative treatments fail)

Can arm pain be a sign of heart problems? Yes, in some cases, arm pain can be a symptom of heart-related issues. Left arm pain, in particular, can be associated with heart attacks or angina. However, it’s important to note that arm pain alone is not a definitive indicator of heart problems. Other symptoms such as chest pain, shortness of breath, and nausea should also be considered.

Lifestyle Changes to Alleviate Nighttime Arm Pain

In addition to medical treatments, certain lifestyle modifications can help reduce the frequency and intensity of arm pain at night:

Sleep Hygiene

• Invest in a supportive mattress and pillow
• Experiment with different sleeping positions
• Use pillows to support your arm and shoulder while sleeping
• Maintain a consistent sleep schedule

Stress Reduction

Stress can exacerbate pain perception. Incorporating stress-reduction techniques can be beneficial:

• Meditation or mindfulness practices
• Deep breathing exercises
• Yoga or gentle stretching before bed
• Engaging in relaxing activities before sleep

Diet and Exercise

A healthy lifestyle can contribute to overall pain management:

• Maintain a balanced diet rich in anti-inflammatory foods
• Stay hydrated throughout the day
• Engage in regular, low-impact exercise to improve circulation and flexibility
• Avoid caffeine and alcohol close to bedtime

How long should you wait before seeking medical attention for persistent arm pain at night? If arm pain at night persists for more than a few weeks, interferes with your daily activities, or is accompanied by other concerning symptoms, it’s advisable to consult a healthcare professional. Prompt evaluation can help identify underlying causes and prevent potential complications.

Prevention Strategies for Nighttime Arm Pain

While not all causes of arm pain at night can be prevented, certain measures can reduce the risk or frequency of episodes:

Ergonomic Considerations

• Maintain proper posture during daytime activities
• Use ergonomic equipment at work and home
• Take regular breaks during repetitive tasks
• Practice proper lifting techniques

Regular Exercise

Engaging in regular physical activity can help strengthen muscles, improve flexibility, and enhance overall joint health. Focus on exercises that target the upper body, including:

• Shoulder and arm stretches
• Rotator cuff strengthening exercises
• Core strengthening to improve posture
• Low-impact cardiovascular activities

Maintaining a Healthy Weight

Excess body weight can put additional stress on joints and muscles. Maintaining a healthy weight through proper diet and exercise can help reduce the risk of developing conditions that lead to arm pain.

Are there specific exercises to alleviate arm pain at night? Yes, certain exercises can help reduce arm pain and improve overall upper body function. These may include gentle stretches, range-of-motion exercises, and strengthening exercises targeting the shoulder, arm, and upper back muscles. However, it’s important to consult with a healthcare professional or physical therapist before starting any new exercise regimen, especially if you’re experiencing pain.

When to Seek Immediate Medical Attention

While many causes of arm pain at night are benign, certain symptoms warrant immediate medical evaluation:

• Sudden, severe arm pain accompanied by chest pain or shortness of breath
• Arm pain following a significant injury or fall
• Visible deformity or swelling of the arm
• Loss of sensation or inability to move the arm
• Arm pain accompanied by fever or signs of infection

These symptoms could indicate serious conditions such as heart attack, fracture, or severe nerve compression that require prompt medical intervention.

Advanced Diagnostic Techniques for Persistent Arm Pain

For cases of persistent or complex arm pain at night, healthcare providers may employ advanced diagnostic techniques to pinpoint the underlying cause:

Electromyography (EMG)

EMG measures the electrical activity of muscles and can help identify nerve or muscle disorders contributing to arm pain.

Arthrography

This imaging technique involves injecting contrast material into a joint to provide detailed images of the joint structure, useful in diagnosing conditions like rotator cuff tears.

Bone Scan

A bone scan can detect areas of increased bone metabolism, which may indicate fractures, infections, or tumors not visible on standard X-rays.

Ultrasound

Ultrasound imaging can provide real-time visualization of soft tissues, helping diagnose conditions like bursitis or tendonitis.

Can chronic arm pain at night lead to long-term complications? Yes, chronic arm pain, if left untreated, can potentially lead to various complications:

• Decreased range of motion and flexibility
• Muscle weakness and atrophy
• Development of compensatory movement patterns that may cause additional strain
• Chronic sleep disturbances leading to fatigue and decreased quality of life
• Psychological impacts such as anxiety or depression related to chronic pain

Therefore, it’s crucial to address persistent arm pain promptly and comprehensively.

Integrative Approaches to Managing Nighttime Arm Pain

In addition to conventional medical treatments, some individuals find relief through integrative or complementary approaches:

Acupuncture

This traditional Chinese medicine technique involves inserting thin needles into specific points on the body. Some studies suggest acupuncture may help reduce pain and improve function in conditions like shoulder impingement syndrome.

Massage Therapy

Therapeutic massage can help reduce muscle tension, improve circulation, and promote relaxation, potentially alleviating arm pain at night.

Herbal Supplements

Certain herbs with anti-inflammatory properties, such as turmeric or ginger, may help reduce pain and inflammation. However, it’s essential to consult with a healthcare provider before starting any new supplements, as they can interact with medications or have side effects.

Mind-Body Techniques

Practices like guided imagery, progressive muscle relaxation, or biofeedback can help manage pain perception and promote relaxation, potentially improving sleep quality.

Are there specific sleep positions that can help alleviate arm pain at night? Yes, certain sleep positions may help reduce arm pain:

• For shoulder pain: Try sleeping on your back with a small pillow under the affected arm
• For neck-related arm pain: Use a supportive pillow that keeps your neck aligned with your spine
• For general arm discomfort: Experiment with placing a pillow between your arms when sleeping on your side

Remember that the most effective position can vary depending on the underlying cause of your arm pain. If pain persists, consult with a healthcare professional for personalized advice.

Nighttime arm pain can significantly impact one’s quality of life, but with proper diagnosis and management, relief is often achievable. By understanding the potential causes, recognizing warning signs, and exploring various treatment options, individuals can work towards restful, pain-free nights. Remember to consult with healthcare professionals for persistent or severe arm pain to ensure appropriate care and prevent potential complications.

Arm Pain at Night: Causes & Treatments

Arm pain at night can be miserable.  The pain can interrupt your sleep and erode your quality of life. Irritability becomes increasingly more common.  What are the causes?  When should I worry about it?  What are the treatment options for arm pain at night?  Let’s dig in.

What Causes Arm Pain at Night?

There are many causes of arm pain at night.  The most common causes are:

Cervical Disc Problems

The neck is composed of 7 boney building blocks numbered 1- 7.  Sandwiched between the bones is a disc that functions as an important shock absorber.  The cervical discs are susceptible to injury due to trauma, degeneration, repetitive motion, and surgery(1).  Common disc injuries include disc bulges, and herniations.  The injured disc can compress or irritate one or more nerves resulting in arm pain at night.  It can feel like pressure in the muscles like a blood pressure cuff.  Alternatively, there can be numbness, tingling, or electrical sensations down your arm. Arm pain at night is a warning signal that warrants your attention.

Cervical Stenosis

The spinal cord extends the entire length of the spine.  The spinal canal is a hollow passage formed by neck bones and spinal fluid.  The spinal cord travels the length of the spine within the spinal canal.  If the canal is narrowing at any point the spinal cord and exiting nerve roots can be compressed.  Narrowing of the spinal canal is called stenosis.  It can be caused by trauma, instability, disc protrusion, facet joint overgrowth, and thickening of spinal ligaments (2).  Compression of the spinal cord and nerve roots can cause arm pain.

Rotator Cuff Injury

The Rotator Cuff is a group of 4 tendons that provide support and stability to the shoulder.   A tendon is a band of connective tissue that connects muscle to bone. The Rotator Cuff tendons are the supraspinatus, infraspinatus, subscapularis, and teres minor tendons.  The Rotator Cuff is susceptible to injury as a result of trauma, overuse, impingement, and degeneration (3).     Risk factors for a Rotator Cuff tear include advancing age, female gender, smoking  and poor posture (4).  A Rotator Cuff injury can cause arm and/or shoulder pain at night.

Bursitis

A bursa is a fluid-filled sac that allows tendons and muscles to smoothly slide over boney surfaces.  There are multiple bursae in the shoulder and elbow that can become inflamed or irritated.  Sleeping on your side can increase in the pressure on the bursae resulting in throbbing arm pain at night.

Thoracic Outlet Syndrome (TOS) 

Thoracic Outlet Syndrome is a group of disorders that involve the compression and irritation of the nerves, arteries, and veins in the lower neck and chest.  Pain is a major symptom and can be intermittent or constant and varies in severity and quality.  The pain can involve the lower neck, collar bone, arm, and hand.  Numbness in the hand is common.  Symptoms are typically worsened with lifting the arm overhead.

Referred Pain 

Referred pain is pain that is perceived or felt in an area that is different in the location from where the actual tissue injury occurs.   A classic example is a heart attack.  The actual tissue injury is in the heart muscle. The pain from a heart attack however is oftentimes is referred or felt in the arm.   Arm pain at night can be referred pain and if it is persistent warrants evaluation.

Autoimmune Diseases

Autoimmune diseases are where your own immune system attacks itself.  Common examples include Rheumatoid Arthritis and Lupus.  Pain is common and can occur at night.

Deep Dive Into the Conditions Cause Pain in Arms at Night

AC Joint Impingement

AC joint Impingement is a painful condition that occurs when the space beneath the acromion bone is narrowed.   This narrowing can result in irritation of the rotator cuff tendons and bursa.  A bursa is a fluid-filled sac that reduces the friction on tendons and muscles as they cross bony surfaces.  A tendon is thick collagen tissue that connects muscles to bones.  The rotator cuff tendons provide important support and enable movement in the shoulder.    If severe,  impingement can cause tears in the rotator cuff tendons.  Patients with AC joint impingement typically have pain with elevation of the arm and or while lying on the shoulder.

Read More About AC Joint Impingement

Cervical Radiculopathy

Common Cervical Radiculopathy symptoms include neck pain, arm pain, shoulder pain radiating down arm to fingers, numbness, tingling, and weakness. Cervical Radiculopathy is a clinical condition in which a nerve or nerves in your neck become irritated or compressed. It is also known as ” a pinched nerve,” The causes are discussed below. It can affect individuals of any age with peak prominence between ages 40-50 years of age. Cervical Radiculopathy is due to spinal nerve inflammation, irritation, or compression. The most common causes of Cervical Radiculopathy are: Disc Injury – The disc is an important shock absorber. Unfortunately, it is susceptible to injury.

Read More About Cervical Radiculopathy

Craniocervical Instability

Craniocervical Instability is a medical condition characterized by injury and instability of the ligaments that hold your head onto the neck. Common symptoms of Cranial Cervical Instability include a painful, heavy head, headache, rapid heart rate, brain fog, neck pain, visual problems, dizziness, and chronic fatigue.CCI or neck ligament laxity treatment options depend upon the severity of the instability and clinical symptoms. When appropriate, conservative care should always be the first-line treatment.
Craniocervical Instability Surgery is often recommended when conservative care fails. This involves a fusion of the head to the neck which is a major surgery that is associated with significant risks and complications…

Read More About Craniocervical Instability

Frozen Shoulder

Frozen shoulder, also known as adhesive capsulitis, is a painful loss of shoulder movement and range in motion.  The incidence of frozen shoulder is 3-5% in the general population and up to 20% in those with diabetes.  The peak incidence is between 40-60 years of age.  The exact mechanism is poorly understood.  In general, the capsule becomes inflamed, thickened, and contracted with pain and significant restriction in range of motion.  causes are poorly understood but risk factors include trauma, prolonged immobility, systematic diseases such as diabetes, stroke, connective tissue disease, and heart disease.  Other causes include post-surgery, chronic inflammation causing stimulation of myofibroblasts

Read More About Frozen Shoulder

Lateral Epicondylitis / Tennis Elbow

Lateral epicondylitis otherwise known as tennis elbow is an overuse injury involving the extensor muscles that originate on the bony prominence (epicondyle) on the outside (lateral) aspect of the elbow. It is more properly termed tendinosis that specifically involves the origin of the extensor carpi radialis brevis muscle. In a study, Nirschl and Pettrone attributed the cause of lateral epicondylitis to be tearing in the origin of the extensor carpi radialis brevis (ECRB) muscle (1).
The extensor carpi radialis brevis (ECRB) muscle originates from the lateral epicondyle. It functions to move the wrist so that the hand moves away from the palm and towards the thumb.

Read More About Lateral Epicondylitis / Tennis Elbow

Medial Epicondylitis / Golfer’s Elbow

Golfer’s elbow involves tears in the ulnar collateral ligament and pain or soreness on the inside of the elbow. The bony bump you feel there is the medial epicondyle of the humerus (upper arm bone). There are five forearm muscles that attach at this point, all of which are involved in helping to flex or rotate the forearm and wrist. Pain can get worse when you throw a ball, grip a dumbbell, turn a screwdriver, and other movements that involve the fingers, hand, wrist, and/or elbow. Tennis elbow is similar, however, it refers to the outside of the elbow, at the lateral epicondyle.

Read More About Medial Epicondylitis / Golfer’s Elbow

Rotator Cuff Tear

Are you plagued by shoulder pain that has now transitioned from intermittent to constant and keeps you up at night? Are daily shoulder movements, such as dressing and reaching for objects in the kitchen cabinets, painful? Is your range of motion decreasing as your pain is increasing? You may have a full- or partial-thickness rotator cuff tear. Has conservative therapy in the form of heat, ice, stretching, rest, and acupuncture failed to provide significant relief? Has an MRI demonstrated a full-thickness or partial-thickness tear of the rotator cuff? What to do? If left untreated, full-thickness and 26% of partial-thickness tears will progress.

Read More About Rotator Cuff Tear

Shoulder Impingement Syndrome

Pain is the most common symptom.  It typically occurs with the elevation of the arm, forced movement overhead, and when lying on the shoulder.  Impingement can also cause shoulder pain when reaching across the body. Narrowing of the subacromial space is the most common cause of shoulder impingement syndrome (6).  The subacromial space is the area between the top of the arm bone (humerus) and the AC joint.   This narrowing compresses or pinches the rotator cuff tendons and bursa.  If left untreated the rotator cuff tendons can become inflamed, damaged, and or torn.Bursa and tendons can not be seen on x-ray.   An x-ray may demonstrate…

Read More About Shoulder Impingement Syndrome

Shoulder Labral Tears

The labrum is a cartilaginous cup that circles the shallow shoulder socket (the glenoid) to make the socket deeper. The labrum supports and stabilizes the shoulder joint. Causes of Shoulder Labral Tears
Injury to the labrum typically occurs from repetitive trauma in overhead throwers, such as in baseball. It can also occur from a traction injury to the arm, such as lifting a heavy object off the ground or getting your arm jerked. Symptoms of Shoulder Labral Tears. Typical symptoms include pain in the front of the shoulder or deep inside the joint. Treatment options initially include physical therapy which is designed to restore range of motion and strength to the shoulder.

Read More About Shoulder Labral Tears

Slipping Rib Syndrome

Slipping Rib Syndrome can be incredibly painful and is often misdiagnosed. It is also known as rib dislocation, rib subluxation, Tietze syndrome, Davies–Colley’s syndrome, rib-tip syndrome, painful rib syndrome, costochondral separation, and clicking or moving rib syndrome. It is very common for athletes involved in contact sports to get a slipped rib. Trauma causes stretching and sometimes tearing of the ligament attachments of the rib, creating instability. We also see this in many of our motor vehicle accident patients, caused by the seat belt and/or airbag. Once damaged, it can take several weeks to resolve (4-12 weeks). After 3 months, if the rib continues to…

Read More About Slipping Rib Syndrome

Spinal Instability

Spinal instability is a condition that occurs when the spinal column is not able to maintain its normal alignment and function under normal loads. It can be caused by various factors such as trauma, degenerative changes, infections, tumors, or congenital abnormalities. In a stable spine, the bones, discs, ligaments, and muscles work together to support and protect the spinal cord and nerve roots. However, in an unstable spine, the structures that support the spine may be damaged or weakened. This can lead to abnormal movement and excessive stress on the spinal cord and nerves. In most cases, bone and joint problems…

Read More About Spinal Instability

Thoracic Outlet Syndrome

The thoracic outlet is an area around the collar bone where the nerves that come from your neck meet up with the blood vessels from your heart and together supply the entire upper extremity (shoulder and arm). These blood vessels (subclavian artery and vein) and nerves (brachial plexus) travel from the base of your neck to your armpit (axilla) and are considered the “thoracic outlet”. Now that you know what the thoracic outlet is, what is thoracic outlet syndrome? Simply listening to a patient’s history and completing a physical examination is all that is needed to diagnose TOS. But more involved imaging such as X-rays…

Read More About Thoracic Outlet Syndrome

Ulnar Neuropathy

Simply put, ulnar neuropathy refers to the compression or damage to the ulnar nerve in the arm. It affects up to 6% of the population, based on reports.The ulnar nerve is one of three main nerves in the arm that run from the shoulder to the hand and is responsible for providing sensation to the small and ring fingers and for controlling the movement of specific hand muscles. When the ulnar nerve is damaged or compressed, it can lead to a range of symptoms, including pain, numbness, weakness, and tingling in the affected hand. The symptoms of ulnar neuropathy can…

Read More About Ulnar Neuropathy

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When Should I Worry about Arm Pain at Night?

If arm pain is infrequent and mild it most likely is a result of overactivity and does not warrant worry or evaluation.  Warning signs that are concerning include.

• Arm pain that progressed from intermittent to constant
• Increase in the severity of the pain
• Reduced range of motion
• Numbness and tingling
• Loss of muscle strength
• Shrinkage of the muscles (atrophy)

Treatment Options for Shoulder Pain

Identifying the underlying cause of the pain is key.  Conservative care in the form of physical therapy is always the best first line of treatment when possible.

Cervical disc injuries can be effectively treated with PRP or stem cells depending upon the severity of the injury.   PRP is rich in growth factors that can increase the blood flow in an area of tissue damage.  A patient’s own stem cells are powerful tools to accelerate healing and orchestrate healing.

Cervical stenosis can arise from different causes. X-ray-guided injections of PRP can reduce disc or facet swelling and tighten lax spinal ligaments thereby improving clinical symptoms. To learn more about spinal stenosis please click on the video below.

There are different types of Rotator Cuff tendon tears.   The three principal RC tears are partial-thickness tears, full-thickness tears, and full-thickness tears with retractions. PRP and a patient’s own stem cells can be injected directly into the tear under MSK ultrasound.   Our recent midterm analysis of a multi-year shoulder Rotator Cuff randomized controlled demonstrated exciting results. It demonstrated that precise injection of high dose bone marrow-derived stem cells into damaged Rotator Cuff tendons helped patients avoid surgery (5).

A common treatment for bursitis is the injection of steroids.  This should be avoided as the steroids are toxic.  Steroids are very powerful anti-inflammatory agents but are also toxic to the cartilage, tendons, and ligaments (6).  PRP is an effective alternative to steroid injections as it promotes healing.

Thoracic Outlet Syndrome is often treated by surgery which is very invasive with poor long-term results.  At the Centeno-Schultz Clinic, we examine the many causes of nerve, vein, and artery compression and provide the best regenerative option.  Orthobiologics are used instead of steroids.  Orthobiologics are biological substances naturally found in the body that are used to promote quicker healing of muscle, tendon, and bone injuries.   They have been reviewed in a previous blog. To better understand orthobiologics please click on the video below.

In Conclusion

Arm pain at night can erode one’s sleep and well-being.  There are many different causes of arm pain.  The most common include injuries of the cervical spine or Rotator Cuff, cervical stenosis, bursitis, Thoracic Outlet Syndrome, referred pain, and autoimmune diseases.   

Arm pain at night is a warning signal that you have a problem that requires attention.  Warning signs that warrant evaluation include:

• an increase in the frequency or severity of pain,
• reduced range of motion,
• numbness and tingling,
• loss of muscle strength, and
• muscle atrophy.

Treatment starts with identifying the underlying cause of the arm pain.

The Centeno-Schultz Clinic physicians are experts in the management of many of the causes of arm pain.  While steroids should be avoided,  PRP and a  patient’s own stem cells are effective treatment options for cervical disc injuries, Rotator Cuff tears, mild to moderate forms of cervical stenosis, and bursitis.

Again, arm pain is a warning sign.  If left untreated, it can become a much larger problem, which includes muscle shrinkage, permanent nerve damage, massive Rotator Cuff tears, and impaired arm and hand function. 

👉 Schedule a telemedicine consult from home, where a board-certified physician will review your history, current imaging, and treatment to date.  Learn what is causing your arm pain at night and the best regenerative treatment option. It is time to stop the sleepless nights!

References

1. Peng B, DePalma MJ. Cervical disc degeneration and neck pain. J Pain Res. 2018;11:2853-2857. Published 2018 Nov 14. doi:10.2147/JPR.S180018

2.Meyer F, Börm W, Thomé C. Degenerative cervical spinal stenosis: current strategies in diagnosis and treatment. Dtsch Arztebl Int. 2008;105(20):366-372. doi:10.3238/arztebl.2008.0366

3.Sambandam SN, Khanna V, Gul A, Mounasamy V. Rotator cuff tears: An evidence based approach. World J Orthop. 2015;6(11):902-918. Published 2015 Dec 18. doi:10.5312/wjo.v6.i11.902

4.Yamamoto A, Takagishi K, Kobayashi T, et al. The impact of faulty posture on rotator cuff tears with and without symptoms. J Shoulder Elbow Surg. 2015;24(3):446-452. doi:10.1016/j.jse.2014.07.012

5. Centeno CJ, Fausel Z, Stemper I, Azuiike U, Dodson E. A Randomized Controlled Trial of the Treatment of Rotator Cuff Tears with Bone Marrow Concentrate and Platelet Products Compared to Exercise Therapy: A Midterm Analysis. Stem Cells International. 2020 Jan; 2020. https://doi. org/10.1155/2020/5962354

6.Wernecke C, Braun HJ, Dragoo JL. The Effect of Intra-articular Corticosteroids on Articular Cartilage: A Systematic Review. Orthop J Sports Med. 2015;3(5):2325967115581163. Published 2015 Apr 27. doi:10.1177/2325967115581163

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Upper Arm Pain at Night

By Catherine Etty-Leal
Physiotherapist at Life Ready Physio + Pilates Camberwell.

Arm pain can result for many different reasons. The most common sources of upper arm pain are the shoulder, neck or rib cage. When the cause is of a musculoskeletal origin, or a mechanical reason, the pain will usually come on with a particular movement. Often, the neck, shoulder and rib cage can be a source of pain with sustained postures as well. These include sitting for long periods of time, awkward lifting postures, or lying down. It is often lying down at night time for a prolonged period of time that results in upper arm pain at night.

Most commonly, pain is resultant from an incident or injury. It might be something obvious like falling off your bike, or it might be something less obvious such as sleeping awkwardly. Sometimes, pain can appear gradually. This tends to happen with repeated loading from the same or similar tasks. The most common ones include heavy lifting, overhead activities like tennis and throwing sports, and pushing and pulling heavy or awkwardly shaped items. Other mechanisms are usually related to a sudden or unexpected change in load. This can be related to starting a new sport or activity, or a lifestyle change like becoming a new parent and having to lift, carry and hold your baby.

All three of the neck, shoulder and rib cage can refer pain to the upper arm. This is because these structures share a nerve supply with the skin overlying the upper arm. In some cases, a person can experience upper arm pain as their only symptom. It is important that you seek advice from a physiotherapist, as they will be able to assess all of these areas thoroughly and therefore determine the source of your pain. This will make it easier to implement strategies to manage and treat your pain.

The most common treatment your physiotherapist will provide you is a combination of manual therapy (hands on therapy) and exercise. Ultimately it is the exercise-based therapy that will lead to long term recovery, but the manual therapy can be very useful in reducing pain in the short term. At times, you may need to pursue imaging to further assess the exact structure that is the source of your pain. This can be anything from an ultrasound to an MRI. Your physiotherapist may organise this scan, or they may direct you to source the image from your doctor. In some cases, a medical approach may be indicated. This can be something as simple as oral medication, which your doctor will prescribe to you, or in rarer cases may involve injections or surgical procedures. It is important that you discuss all of your available options with both your physiotherapist and doctor to find the right plan for you.

In rare instances there may be a medical reason for upper arm pain. If you are experiencing upper arm pain associated with shortness of breath, chest pain, loss of colour in your skin, slurred speech, difficulty swallowing, blurry vision, or unexplained weakness, seek emergency medical care to rule out anything sinister.

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Physiotherapy in Berlin – Thorough history taking

Your physiotherapist in Berlin Mitte makes time for you

In accordance with our guiding principle, your physiotherapist will take enough time to have a detailed discussion with you. Before starting therapy, we want to understand your complaints in detail. In this way, we can provide you with the appropriate treatment in a targeted manner. Our approach is to get rid of complaints in the long term. For this reason, the physiotherapist views you from a holistic perspective. In this way, we determine the root cause of your condition, which allows us to provide targeted therapy for comprehensive symptom relief.

Effective and gentle treatment

by your physiotherapist in Berlin

Our physiotherapists use tried and tested methods of manual therapy for treatment. These include osteopathic treatments or massage. These treatments can effectively eliminate, for example, knee pain. They are also a suitable remedy for the treatment of certain organic diseases.

The physiotherapy that we offer in our clinic in Berlin-Mitte is based, among other things, on the knowledge and practice of osteopathy. A basic understanding of the importance of fasciae in the body is the foundation for this. Fibrous connective tissue connects internal organs to joints, tendons, and muscles. If the fasciae are stuck together, matted or twisted, for example due to an unhealthy lifestyle, this will lead to limited movement. Whether it is orthopedic or neurological diseases or dysfunctions of the internal organs: for your physiotherapist in our Berlin practice, the focus is on identifying the root cause of your symptoms for subsequent targeted treatment.

Physiotherapy in Berlin – the right physiotherapy for you

All physiotherapists in our Berlin practice are guided by the same principle when drawing up an individual treatment plan: identify the root cause of your symptoms. During treatment, the physiotherapist focuses on activating your body’s self-healing powers: you learn to compensate for pain, functional or developmental impairments, and other limitations at your own expense.

Your physiotherapist

for physiotherapy in Berlin

As a private physiotherapy practice in Berlin-Mitte, we provide comprehensive support in the form of individual treatments and procedures. Our practice offers you a safe haven in the middle of our bustling capital.

Private patients who come to us with their problems should leave our practice in a good mood. The team at our physiotherapy practice in Berlin-Mitte aims to eliminate pain in your musculoskeletal system. So that you can enjoy the finer things in life without limitation.

News from practice

Osteopathy Berlin Mitte

News from practice and useful information on the topics of movement therapy, osteopathy, physiotherapy and personal training can be found in our physiotherapy blog.

Irritating cough

May 9, 2023 June 25, 2023

Who has not experienced this: suddenly there is a scratching sensation in the throat and you cannot stop coughing. Cough becomes irritating, especially if it is not accompanied by discharge . ..

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Tennis elbow

April 20, 2023 May 15, 2023

Tennis elbow is a disease of the elbow joint that can present with pain on the outside of the elbow, forearm, or wrist. This form of physical illness occurs mainly when… – like a chickenpox infection – remains in the body in the form virus and can (re-)activate in adulthood….

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Carpal tunnel syndrome

March 25, 2023 April 17, 2023

waving hand movements. This mainly applies to people who work a lot at the computer or do manual work. If…

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Impingement syndrome

February 28, 2023 March 23, 2023

Impingement syndrome is a condition that can be caused by compression or squeezing of soft tissues in the shoulder joint. The result is pain, weakness and limited mobility in… 9Osteoarthritis of the hip joint a (coxarthrosis) is a degenerative disease of the hip joint that can be accompanied by severe pain. Because in osteoarthritis of the hip, the cartilage gradually breaks down and the bones rub…

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Shoulder pain. Diagnostics. Treatment.

Prolonged pain in the shoulder significantly spoils the quality of your life, besides, if not treated in time, it threatens the health of the shoulder in the future, so you need to seek the help of an experienced orthopedic traumatologist in order to identify and eliminate the cause of pain in time.

Causes of pain in the shoulder joint and methods of its treatment are explained by traumatologist-orthopedist Medicīnas centrs ARS Dr. Janis DOBELNIEKS.

Worried shoulder

The shoulder is a complex biomechanism. The shoulder joint is the only joint in the human body that performs full rotation due to its anatomical structures. As soon as something is broken in this mechanism, even due to a minor injury, the shoulder does not work normally. If it was not a serious injury, then it is difficult to immediately determine the causes of pain, but pain always has a provoking factor that can cause long-term pain and complications in the future.

Don’t adapt to pain

Unfortunately, often the pain does not decrease, it becomes more pronounced and makes it difficult to sleep at night. Many people try to adapt to the situation, and if because of pain they cannot raise their arm, they simply try not to do it. Because of this, the shoulder becomes tighter, over time, extensive joint damage and other problems develop, which can result in shoulder joint prosthetics and disability. Self-medication with pain medications, ointments and compresses can reduce inflammation and pain, but it is not possible to eliminate the anatomical damage to the structure. If the shoulder hurts for a long time and does not go away, then you need to go to the doctor. It is important to understand that when treating shoulder pain, time is of the essence.

• If your shoulder suddenly starts to hurt, you should start waiting, reduce the load and let the shoulder rest. If the pain does not go away within two weeks and intensifies, this is a signal that the shoulder is seriously damaged.
• In order not to waste time on unnecessary examinations , it is recommended to visit an orthopedic traumatologist for a detailed examination of the shoulder-joint and start qualified and professional treatment.

Why does my shoulder hurt?

First you need to find out what exactly causes shoulder pain. Often the cause of the pain is not found in the shoulder joint itself, but in the cervical spine, where the intervertebral discs, pinching the nerve roots, cause pain in the shoulder. It spreads along the nerve, through the entire arm to the fingertips. If there is a feeling of numbness and the pain does not depend on the load, then it is recommended to consult a neurologist.

If the cause of pain in the shoulder joint itself is caused by damage to the anatomical structures or inflammation , then it never extends below the middle third of the forearm. The painful area can be covered with the palm of your hand. One of the common causes of pain in the shoulder – partial damage to the tendon of the long head of the biceps – rupture , which often occurs in athletes and physically active people. The tendon can be damaged or torn for no particular reason, as over time it wears out and loses elasticity. This damage is characterized by pain when performing certain movements, even without the application of force. Sports activities are often limited – volleyball, swimming, golf. The second most common cause of shoulder pain is damage to rotator cuffs . The rotator cuff is a combination of many muscle tendons that provide mobility to the arm at the shoulder. When it is damaged, the main complaint is pain, which is expressed not only with the load of the arm, but also at night. The tendon can be completely torn from the bone or partially torn, the function of the hand seems to be preserved, but there are certain movements that cannot be performed. The cause can be either trauma or gradual damage to the tendon. Without moving the arm, the pain gradually decreases, but by resuming movement, the shoulder may again hurt. The third most common cause of shoulder pain is deformity at the junction of the clavicle and scapula . Often there are processes on the bone – osteophytes, which put pressure on the muscles, creating inflammation in the surrounding tissues and pain.

In half a year it may be too late . At the very beginning, the damaged tendon can be sutured, and the arm can fully work. Dragging time only causes harm – after 6 months, scar, fatty tissues grow into the muscle and cause muscle atrophy. These are irreversible changes that cannot be removed during surgery, as the tendon can no longer be pulled back to where it was previously attached. A year later, it is almost impossible to perform a qualified operation with a predictable restoration of hand function.

Feeling of instability in the arm is usually the result of various injuries that are caused by incorrectly executed, rapid movement, falling, etc. Not only during sports activity, but also in everyday life, there may be a feeling that the shoulder, as it were, jumps out of its place and hurts. Around the flat surface of the joint there is a cartilaginous lip, like the edge of a plate. If the “plate has one edge broken off”, then the head of the shoulder has a tendency to slip out and create pain. This is called a bankart injury, which often combines with a shoulder tendon injury, causing shoulder instability, pain, limited mobility, day-to-day movement anxiety, etc. An operation is required to preserve the quality of life, otherwise the consequences can be very serious. The more often the head of the shoulder is displaced from its place, the more the joint capsule is damaged, the stronger the pain, the more limited the mobility. Over time, arthrosis and irreversible damage to the cartilage develops, when a conventional operation will no longer help, since it is necessary to restore bone structures.

Diagnostics of the shoulder joint

Radiologist-diagnostician, Associate Professor, Dr. med. MAJA RADZIņA

Various methods can be used to examine the shoulder joint. The most informative for determining traumatic bone injury is radiography. To determine soft tissue injury, the first and foremost method is ultrasonography (ultrasound) – this is the only method that allows you to examine the shoulder joint in motion to make sure that the tendon is not damaged after the injury, or that the limitation of mobility is caused by swelling of the soft tissues or damage to them. The quality of ultrasound depends on both the specialist and the ultrasound machine itself. For the patient, this is a quick, affordable and acceptable examination.

If ultrasound detects damage to, for example, some element of the rotator cuff, then magnetic resonance imaging (MRI) of the joint should be performed to assess damage to deeply located tendons and cartilage. MRI shows an anatomical image of the shoulder joint, the exact distance to a specific structure. This helps the orthopedic traumatologist accurately plan the course and scope of the operation and perform the treatment better. The sooner you visit a doctor, the easier it is to diagnose the problem, the lower the risk of complications in the future.

Arthroscopic surgery

Most often, the shoulder joint is operated on arthroscopically. 3-6 small incisions 4-5 mm long are made. Through them, a miniature camera is inserted into the shoulder joint, which is connected to a computer, and tools that can be used to assess and eliminate all damage to the joint, restore damaged ligaments and muscle tendons, clean hardened tissues and salt deposits in one go. The traumatologist monitors the progress of the operation on the monitor screen with multiple magnification. This method has significant advantages: it is less traumatic and gentle, the incision sites heal quickly. New technologies make it possible to qualitatively and accurately assess the condition of the joint, even in places where this is not possible when performing a conventional surgical operation. The operation lasts up to 1.5 hours – it depends on the volume and complexity of the damage. It is performed on an outpatient basis at the ARS Day Hospital under general anesthesia. The next morning the patient can return home. The hand is freely suspended in a kerchief bandage, which protects against accidental movements.

Gentle rehabilitation

For the shoulder to be in a state of rest, it takes 4-6 weeks to wear a bandage for the arm. Then, under the supervision of a physiotherapist, therapeutic exercises begin. Rehabilitation lasts about 3 months, pain after surgery can last up to 3-4 months.