What causes arm pain at night. How to identify the underlying condition causing nighttime arm discomfort. When should you be concerned about arm pain while sleeping. What are the most effective treatments for nocturnal arm pain.

Common Causes of Nighttime Arm Pain

Experiencing arm pain at night can significantly impact your sleep quality and overall well-being. Understanding the root causes is crucial for proper diagnosis and treatment. Here are some of the most common reasons for nighttime arm discomfort:

Cervical Disc Problems

The cervical spine, consisting of seven vertebrae, is susceptible to various injuries that can lead to arm pain. Disc bulges or herniations can compress or irritate nerves, causing discomfort that may worsen at night. This pain can manifest as pressure in the muscles, numbness, tingling, or electrical sensations down the arm.

Cervical Stenosis

Narrowing of the spinal canal, known as cervical stenosis, can compress the spinal cord and nerve roots. This compression may result from trauma, instability, disc protrusion, facet joint overgrowth, or thickening of spinal ligaments. Arm pain is a common symptom of cervical stenosis, particularly noticeable during nighttime hours.

Rotator Cuff Injury

The rotator cuff, comprising four tendons that support and stabilize the shoulder, is prone to injury due to trauma, overuse, impingement, or degeneration. Risk factors include advancing age, female gender, smoking, and poor posture. A rotator cuff injury can cause persistent arm or shoulder pain, often exacerbated during sleep.

Bursitis

Inflammation of the bursae, fluid-filled sacs that allow smooth movement of tendons and muscles over bony surfaces, can lead to nighttime arm pain. Sleeping on your side may increase pressure on these bursae, resulting in throbbing discomfort.

Understanding Thoracic Outlet Syndrome (TOS)

Thoracic Outlet Syndrome (TOS) is a complex condition involving compression and irritation of nerves, arteries, and veins in the lower neck and chest area. This syndrome can cause varying degrees of pain in the lower neck, collarbone, arm, and hand. Numbness in the hand is also common, and symptoms typically worsen when lifting the arm overhead.

Symptoms of TOS

• Intermittent or constant pain in the affected areas
• Numbness or tingling sensations in the hand
• Weakness in the arm or hand
• Discoloration of the hand (in severe cases)
• Swelling of the arm

Is Thoracic Outlet Syndrome always painful? While pain is a primary symptom of TOS, the intensity and frequency can vary greatly among individuals. Some may experience constant discomfort, while others might only notice symptoms during specific activities or positions.

Referred Pain: When the Source Isn’t Where It Hurts

Referred pain occurs when discomfort is felt in an area different from the actual site of injury or problem. This phenomenon can complicate diagnosis and treatment of nighttime arm pain. A classic example is arm pain resulting from a heart attack, where the actual injury is in the heart muscle, but the pain is felt in the arm.

Potential Sources of Referred Arm Pain

1. Cardiac issues
2. Gallbladder problems
3. Lung conditions
4. Liver disorders
5. Digestive tract issues

How can you distinguish between referred pain and direct arm pain? Referred pain often has a diffuse, hard-to-pinpoint quality and may be accompanied by other symptoms related to the source of the problem. Direct arm pain is usually more localized and may be associated with specific movements or positions.

Autoimmune Diseases and Nocturnal Arm Pain

Autoimmune diseases, where the body’s immune system mistakenly attacks its own tissues, can contribute to arm pain at night. Two common examples are Rheumatoid Arthritis (RA) and Systemic Lupus Erythematosus (SLE).

Rheumatoid Arthritis

RA primarily affects the joints, causing inflammation, pain, and stiffness. These symptoms can be particularly pronounced at night or early morning, leading to disrupted sleep and increased discomfort in the arms.

Systemic Lupus Erythematosus

SLE can affect various parts of the body, including joints and muscles. Arm pain may result from inflammation in the joints or muscles, or from nerve involvement in more severe cases.

Can autoimmune diseases cause arm pain exclusively at night? While autoimmune-related pain can occur at any time, many individuals experience increased discomfort at night due to factors such as reduced distraction, changes in hormone levels, and prolonged periods of inactivity.

AC Joint Impingement: A Common Shoulder Culprit

AC (Acromioclavicular) joint impingement is a painful condition that occurs when the space beneath the acromion bone narrows, potentially irritating the rotator cuff tendons and bursa. This narrowing can lead to inflammation and, in severe cases, tears in the rotator cuff tendons.

Symptoms of AC Joint Impingement

• Pain with arm elevation
• Discomfort while lying on the affected shoulder
• Weakness in the arm
• Reduced range of motion
• Clicking or popping sensations in the shoulder

Why does AC joint impingement often cause pain at night? Sleeping on the affected shoulder can increase pressure on the already irritated structures, leading to increased pain. Additionally, lack of movement during sleep may cause stiffness and discomfort.

Cervical Radiculopathy: When Nerves Are the Problem

Cervical radiculopathy, often referred to as a “pinched nerve,” occurs when nerves in the neck become irritated or compressed. This condition can affect individuals of any age, with peak prevalence between 40-50 years old.

Common Symptoms of Cervical Radiculopathy

1. Neck pain
2. Arm pain radiating from shoulder to fingers
3. Numbness or tingling sensations
4. Weakness in the affected arm
5. Reduced reflexes

How does cervical radiculopathy differ from other causes of nighttime arm pain? Cervical radiculopathy typically presents with a specific pattern of pain and neurological symptoms that follow the distribution of the affected nerve root. The pain may be sharp or burning and is often exacerbated by certain neck movements or positions.

When to Seek Medical Attention for Nighttime Arm Pain

While occasional arm discomfort at night may not be cause for concern, certain symptoms warrant prompt medical evaluation:

• Sudden, severe arm pain, especially if accompanied by chest pain or shortness of breath
• Persistent pain that doesn’t improve with rest or over-the-counter pain relievers
• Visible deformity or swelling in the arm
• Loss of sensation or movement in the arm
• Pain that significantly interferes with daily activities or sleep

Should you wait to see if nighttime arm pain resolves on its own? While minor discomfort may improve with self-care measures, persistent or severe pain should be evaluated by a healthcare professional to rule out serious underlying conditions and prevent potential complications.

Diagnostic Approaches for Nighttime Arm Pain

Accurately diagnosing the cause of nighttime arm pain often requires a comprehensive approach. Healthcare providers may use a combination of the following diagnostic tools:

Physical Examination

A thorough physical exam can reveal valuable information about the source of arm pain. The healthcare provider will assess range of motion, strength, reflexes, and sensation in the affected arm and surrounding areas.

Imaging Studies

• X-rays: To visualize bone structures and identify potential fractures or arthritis
• MRI (Magnetic Resonance Imaging): Provides detailed images of soft tissues, including muscles, tendons, and nerves
• CT (Computed Tomography) scan: Offers cross-sectional images of bones and soft tissues

Electrodiagnostic Tests

Electromyography (EMG) and nerve conduction studies can help assess nerve function and identify areas of compression or irritation.

Blood Tests

Blood work may be ordered to check for signs of inflammation, infection, or autoimmune disorders that could contribute to arm pain.

How long does it typically take to diagnose the cause of nighttime arm pain? The diagnostic process can vary depending on the complexity of the case. Some conditions may be identified quickly through a physical exam and basic tests, while others may require more extensive evaluation over several weeks.

Treatment Options for Nighttime Arm Pain

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

Conservative Treatments

• Rest and activity modification
• Ice or heat therapy
• Over-the-counter pain relievers (NSAIDs or acetaminophen)
• Physical therapy exercises
• Ergonomic adjustments to sleeping position and work environment

Medications

Prescription medications may be recommended for more severe or persistent pain:

• Muscle relaxants
• Stronger pain relievers
• Corticosteroids (oral or injected)
• Disease-modifying antirheumatic drugs (DMARDs) for autoimmune conditions

Interventional Procedures

For certain conditions, minimally invasive procedures may be beneficial:

• Epidural steroid injections
• Nerve blocks
• Ultrasound-guided injections for bursitis or tendinitis

Surgery

In cases where conservative treatments are ineffective, surgery may be considered:

• Rotator cuff repair
• Cervical disc surgery
• Decompression procedures for nerve impingement

What is the most effective treatment for nighttime arm pain? The most effective treatment varies depending on the underlying cause and individual factors. A personalized treatment plan, developed in consultation with a healthcare provider, typically yields the best results.

Preventing Nighttime Arm Pain: Strategies for Better Sleep

While not all causes of nighttime arm pain can be prevented, certain strategies may help reduce the risk or severity of discomfort:

Sleep Position Optimization

• Use supportive pillows to maintain proper alignment of the neck and spine
• Experiment with different sleeping positions to find the most comfortable one
• Consider using a body pillow for additional support

Lifestyle Modifications

1. Maintain good posture throughout the day
2. Practice regular stretching and strengthening exercises
3. Take frequent breaks during repetitive activities
4. Manage stress through relaxation techniques or meditation
5. Maintain a healthy weight to reduce strain on joints and muscles

Sleep Hygiene Improvements

• Establish a consistent sleep schedule
• Create a comfortable sleep environment (cool, dark, and quiet)
• Avoid caffeine and electronic devices close to bedtime
• Practice relaxation techniques before sleep

Can nighttime arm pain be completely prevented? While it’s not always possible to prevent arm pain entirely, especially in cases of underlying medical conditions, implementing these strategies can significantly reduce the frequency and severity of nighttime discomfort for many individuals.

Long-Term Outlook for Nighttime Arm Pain

The prognosis for nighttime arm pain varies depending on the underlying cause and the effectiveness of treatment. Many individuals experience significant improvement with appropriate management, while others may require ongoing care.

Factors Affecting Prognosis

• Severity and duration of the condition
• Adherence to treatment plans
• Age and overall health status
• Presence of complicating factors or comorbidities
• Lifestyle modifications and preventive measures

What is the typical recovery time for nighttime arm pain? Recovery time can range from a few weeks for minor injuries to several months or longer for more complex conditions. Chronic conditions may require ongoing management to maintain symptom control and prevent flare-ups.

In conclusion, nighttime arm pain can stem from various causes, ranging from minor muscle strains to more serious underlying conditions. Proper diagnosis and tailored treatment are essential for effective management and improved quality of life. If you experience persistent or severe arm pain at night, consult with a healthcare professional to determine the best course of action for your specific situation.

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

Show More

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

FREE eBook Download (Click the Book Cover)

Ready to get help for your Arm Pain at Night?

Get Help

Six causes and what to do

There are several reasons why a person may experience pain in their right shoulder and arm. In many cases, the pain will occur as a result of muscle overuse, injury, or nerve damage.

Shoulder pain is the third-leading muscle and bone complaint in the United States. Researchers estimate that shoulder injuries account for 4.5 million doctor visits and $3 billion in healthcare costs in the U.S.

Sometimes, shoulder and arm pain have nothing to do with exercise or injury. Unexplained shoulder and arm pain can be a symptom of a heart attack.

Read on to discover the possible causes of right shoulder and arm pain and their associated treatment options.

Right shoulder pain varies depending on the cause. The pain may be constant or occur only when moving or lifting the shoulder. Sometimes, shoulder pain can be severe enough that it interferes with everyday activities.

Conditions such as shoulder impingement syndrome can cause pain in the top, outer part of the shoulder. This condition, along with tendonitis and brachial neuritis, can also cause weakness in the arm and aching at night.

If nerve damage is contributing to shoulder pain, it can cause numbness and tingling in the arm.

Shoulder pain may be severe and sudden for injuries such as a fracture or sprain or conditions such as frozen shoulder. Stiffness and reduced range of motion may also develop. Sometimes, shoulder pain can extend into the neck as well.

Swimmer’s shoulder describes a range of different shoulder injuries that may occur due to swimming. Swimmers are at increased risk of shoulder injuries due to the high number of swim stroke repetitions they perform during training.

Injuries associated with swimmer’s shoulder include:

• Impingement syndrome: A tendon in the shoulder rubs and catches on surrounding tissue when a person lifts their arm.
• Labral injuries: A tear occurs in a piece of cartilage called the labrum, which sits inside the shoulder socket.
• Shoulder instability: The structures around the shoulder joint are not effective in keeping the upper arm bone in the shoulder socket.
• Peripheral neuropathy: Damage occurs to one of the peripheral nerves, which generally causes numbness or weakness.

Rotator cuff tendonitis (RCT) refers to irritation or inflammation of the rotator cuff. This condition is particularly common among elite athletes and people who regularly play certain sports.

The rotator cuff is a group of muscles and tendons surrounding and supporting the shoulder joint. Together, they help hold the upper arm bone firmly in the shoulder socket.

Some causes of RCT include:

• poor overhead throwing technique in sports such as baseball and javelin
• direct trauma to the rotator cuff
• falling on a straight arm

Overuse can cause damage and inflammation to the muscles in the arm and shoulder. This can result in muscle pain and fatigue, but a person may not experience these symptoms until hours after overexerting the muscles.

A 2018 review suggests that massage therapy can be the most effective treatment for fatigued muscles.

Other techniques that may relieve muscle inflammation and fatigue include compression garments and cold-water immersion.

Frozen shoulder, or adhesive capsulitis, is an inflammatory condition in which the shoulder becomes painful and difficult to move for months or years. It occurs when the tissue around the shoulder joint stiffens.

It is unclear why frozen shoulder occurs in some people. People aged 40–60 are most likely to develop frozen shoulder, and it is four times more common in females than males. People with a frozen shoulder may be more likely to have:

• diabetes
• thyroid issues
• stroke
• heart disease
• Parkinson’s disease
• cancer
• an injury or surgery that immobilizes the shoulder

Frozen shoulder involves three stages:

• stage 1 (freezing): The shoulder will feel painful and lose range of motion. This stage lasts from around 6 weeks to 9 months.
• stage 2 (frozen): For around 4–6 months, pain may improve, but the shoulder will remain stiff and hard to move.
• stage 3 (thawing): The shoulder will gradually become easier to move. However, it may take 6 months to 2 years to fully return to normal.

After experiencing a frozen shoulder, around 15% of people will develop the condition again in their opposite shoulder within 5 years.

A shoulder fracture, or broken bone, may involve the collarbone, shoulder blade, or humerus (the bone extending from the shoulder to the elbow).

A broken collarbone or humerus may occur from a fall or a car accident. While a shoulder blade is more difficult to fracture, the condition can result from a high-speed car accident.

Depending on the type of fracture, symptoms may include:

• pain
• swelling
• limited range of motion
• bruising

A shoulder sprain occurs when a ligament in the shoulder is stretched or torn. Ligaments are the connective tissues between bones.

An acromioclavicular joint injury is a shoulder sprain where ligament damage can lead to separation of the collarbone and the bone at the top of the shoulder, called the acromion. This condition makes up over 40% of all shoulder injuries and may result from a fall, car accident, or a sporting activity such as a skiing accident.

Symptoms may include:

• pain that can extend to the neck
• swelling
• bruising
• reduced range of motion

Disuse syndrome is a general term for conditions that result from a period of immobility or physical inactivity. It typically involves muscle atrophy or wasting.

People who have recently undergone a period of bed rest are at particular risk of developing disuse syndrome.

A person may experience the following symptoms even after a short period of physical inactivity:

• muscle stiffness
• muscle shrinkage and wasting
• muscles that are weak and susceptible to injury

The Physical Activity Guidelines for Americans recommend that adults perform at least 150 minutes a week of moderate-intensity aerobic activity.

However, some people have chronic conditions limiting their mobility or physical activity levels. People who have these conditions may find it helpful to talk with a physical therapist. They will work with the person to create an appropriate exercise program.

Brachial neuritis is a type of peripheral neuropathy that affects the following parts of the body:

• chest
• shoulders
• arms
• hands

Peripheral neuropathy is a disease of the nerves that transmit signals between the central nervous system and other parts of the body. Nerve pain and a loss of function in affected body parts characterize the condition.

Usually, people with brachial neuritis experience pain and weakness in the shoulder and arm on one side of their body. In 60% of these cases, it will occur on their dominant side.

Most people will experience pain on the outside part of the shoulder. It generally comes on suddenly and may worsen at night.

After a few days, the pain may disappear. A person can then experience the following symptoms in their shoulder and arm:

• weakness
• changes in reflexes
• loss of sensation

Many people associate a heart attack with pain in the left arm. However, some people may feel pain in the right shoulder and arm or on both sides of the body.

Learn more about the symptoms of a heart attack here.

In some instances, gallbladder disease can cause pain in the right shoulder. This occurs in more than a third of gallbladder inflammation cases.

Learn more about gallbladder inflammation here.

People should call 911 immediately if they experience unexplained arm and shoulder pain alongside any of the following symptoms:

• chest pain or discomfort, which may feel like pressure, burning, tightness, or sharpness
• pain radiating to the jaw on one or both sides
• shortness of breath
• nausea
• vomiting
• dizziness
• a rapid heartbeat
• excessive sweating

Sports injuries, such as swimmer’s shoulder and RCT, may require medical attention if rest and ice do not alleviate symptoms. A doctor can prescribe pain relief and refer the person to a physiotherapist for further treatment.

Similarly, if other shoulder pain or stiffness develops that does not improve with rest or home treatments, it is important to see a doctor.

People with a fractured shoulder should seek urgent treatment. While minor shoulder sprains may not need medical evaluation, more severe sprains and dislocation typically require immediate treatment.

People with brachial neuritis may consult their doctor for a diagnosis and pain relief. However, there are few other treatment options available. The condition generally resolves on its own.

Pain in the right shoulder and arm is often due to muscle, tendon, or ligament damage. It can also occur as a result of damage to the peripheral nerves in those areas.

Unexplained shoulder and arm pain can sometimes be a warning sign of a heart attack, which is a medical emergency.

People should see a doctor if they are concerned about pain in their right shoulder and arm or if the pain is not improving. The doctor will work to diagnose the underlying issue and provide appropriate treatment.

Read the article in Spanish.

Pain in the right hypochondrium in front or behind: causes and treatment

Pain in the right hypochondrium can be associated with various conditions caused by damage to the liver, kidneys, pancreas, gallbladder.

What is the right hypochondrium? If you mentally “divide” the anterior abdominal wall into four parts (draw a vertical line, and then a horizontal line at the level of the navel), its upper quarter on the right side will be the right hypochondrium (or upper quadrant). Many important organs are located in this part, including the liver, gallbladder, the upper pole of the right kidney with the adrenal gland, the bend of the ascending and transverse colon. Since the abdominal organs are supplied with nerves from the spinal cord, pain in the right hypochondrium may be associated with pathologies of organs of another localization: pancreas, stomach, etc.

Causes of pain in the right hypochondrium

Acute cholecystitis (inflammation of the gallbladder) is the most commonly diagnosed cause of pain in the right hypochondrium. It is characterized by prolonged (more than 4-6 hours) pain in the right hypochondrium and epigastrium (upper abdomen), bloating, nausea, and vomiting.

Biliary colic (or hepatic colic) is a characteristic clinical manifestation of cholelithiasis, less often – biliary dyskinesia. It is characterized by severe pain in the right hypochondrium or epigastrium with irradiation to the right shoulder blade, collarbone, shoulder, neck; an attack of biliary colic can be confused with an attack of angina pectoris. Accompanied by bloating, nausea, vomiting, increased sweating. The attack lasts from 30 minutes to several hours, if it lasts longer, the development of a complication is likely – acute cholecystitis.

Acute cholangitis (inflammation of the intrahepatic or extrahepatic bile ducts) is accompanied by severe pain in the right hypochondrium, a sharp increase in temperature, chills, increased sweating, jaundice. As the pathological process develops, nausea, vomiting join, confusion may be noted. The disease may have atypical manifestations in the elderly or immunocompromised patients.

Dysfunction of the sphincter of Oddi (dysmotility of its structures and patency of the bile and pancreatic ducts) is characterized by recurrent pain in the right hypochondrium or epigastrium, radiating to the back or shoulder blade. An attack of high intensity, usually occurs at night, often 2-3 hours after a meal, lasts 30 minutes or more, may be accompanied by nausea, vomiting, intolerance to a particular food (most often fatty).

Acute hepatitis (hepatitis A, alcoholic, drug) is characterized by pain in the right hypochondrium, loss of appetite, weakness, fatigue, nausea, vomiting, jaundice.

Liver abscess (limited cavity in the liver filled with pus) is characterized by dull, aching pain in the right hypochondrium radiating to the right shoulder blade or shoulder. The condition at different stages may be accompanied by fever, nausea, bloating, diarrhea, increased sweating, tachycardia, jaundice, weight loss, ascites.

Other causes of pain in the right hypochondrium include: liver cancer, preeclampsia, Budd-Chiari syndrome, portal vein thrombosis, urinary tract infections, liver, kidney, pancreatitis, indigestion, gastritis.

When should I see a doctor for pain in the right hypochondrium?

If you experience pain in the right hypochondrium for several days or more, make an appointment with your doctor to determine the cause. Emergency medical attention is needed for acute pain, fever, persistent vomiting, blood in the stool, tarry stools, jaundice, ascites, unexplained weight loss.

Which doctors should I contact for pain in the right hypochondrium?

To determine the causes of pain in the right hypochondrium, diagnose the condition and treat it is necessary to contact a therapist (pediatrician), gastroenterologist, hepatologist, surgeon.

Author:

Amelicheva Alena Alexandrovna
medical editor

Publication date: September 27, 2022

Update date: March 21, 2023

Pain in the right hypochondrium – General information, Causes. Tomsk

Symptoms and diseases

Return
to the clinic website
Get
online consultation

Symptom index:
A
|
B
|
IN
|
G
|
D
|
E
|
AND
|
W
|
AND
|
Y
|
TO
|
L
|
M
|
H
|
ABOUT
|
P
|
R
|
WITH
|
T
|
At
|
F
|
X
|
C
|
H
|
W
|
E
|
YU
|
I

General information

Pain in the right hypochondrium may occur spontaneously against the background of general well-being. And this is an alarming sign that indicates the presence of a pathology of one or more abdominal organs. Pain is a natural protective function of the body. When pain occurs, the body tells the person that something is wrong. In the region of the right hypochondrium are organs such as the gallbladder, liver, right side of the diaphragm, and some of the intestines. Violations in any of these organs can provoke pain. Pain in the right hypochondrium are of different nature and severity. So distinguish the following types of pain in the right hypochondrium:

• acute pain;
• burning pain;
• dull pain;
• drawing pain;
• aching pain;
• arching pain;
• throbbing pain.

Of course, there are many more types of pain, but these are the most frequently described by patients. It is the nature of the pain that often helps to make a preliminary diagnosis, and sometimes to conduct a differential diagnosis.

Most diseases accompanied by pain in the right hypochondrium provoke other symptoms, such as fever and nausea.

Causes

Pain in the right hypochondrium can be the result of many pathological processes. Each of them has its own character of pain. The most common cause of pain can be:

• Injury to the abdominal organs. Injury to organs may be accompanied by acute pain in the right hypochondrium. The consequences of some injuries can be extremely dangerous, so you should immediately consult a doctor.

• Diseases of the gallbladder and bile ducts (acute and chronic). In the event of obstruction of the biliary tract, with acute cholecystitis, sudden sharp pains in the right hypochondrium may occur. With an increase in the tone of the gallbladder, the pain is rather sharp and short-term. Often, with such pathologies, pain can radiate (give) to the right hand. Chronic cholecystitis is characterized by dull pain.

• Diseases of the duodenum (acute or chronic duodenitis). In ulcerative duodenitis associated with the bacterium Helicobacter pylori, there is a feeling of stabbing pain (mainly at night), which subsides when food enters the digestive tract.