What causes upper right arm pain at night. How to identify the underlying conditions. When should you seek medical attention for nighttime arm pain. What are the most effective treatments for arm pain that disrupts sleep.

Common Causes of Arm Pain at Night

Experiencing arm pain at night can be a frustrating and sleep-disrupting issue. There are several potential causes for this discomfort, ranging from minor muscle strains to more serious underlying conditions. Understanding these causes is crucial for proper diagnosis and treatment.

Cervical Disc Problems

The cervical spine, consisting of seven vertebrae, is susceptible to various injuries that can lead to arm pain. Disc bulges, herniations, and other disc-related issues can compress or irritate nerves, resulting in nighttime arm discomfort. This pain may manifest as pressure in the muscles, numbness, tingling, or electrical sensations traveling down the arm.

Cervical Stenosis

Narrowing of the spinal canal, known as cervical stenosis, can compress the spinal cord and exiting nerve roots. This compression often leads to arm pain, especially at night. Causes of stenosis include trauma, instability, disc protrusion, facet joint overgrowth, and thickening of spinal ligaments.

Rotator Cuff Injury

The rotator cuff, comprising four tendons that support and stabilize the shoulder, is prone to injury. Trauma, overuse, impingement, and degeneration can all contribute to rotator cuff tears. Risk factors include advancing age, female gender, smoking, and poor posture. A rotator cuff injury can cause persistent arm or shoulder pain, particularly noticeable during nighttime hours.

Bursitis

Bursae, fluid-filled sacs that allow smooth movement of tendons and muscles over bony surfaces, can become inflamed or irritated. This condition, known as bursitis, can cause throbbing arm pain at night, especially when sleeping on the affected side.

Thoracic Outlet Syndrome (TOS)

TOS involves compression and irritation of nerves, arteries, and veins in the lower neck and chest area. It can cause intermittent or constant pain in the lower neck, collarbone, arm, and hand. Numbness in the hand is common, and symptoms often worsen when lifting the arm overhead.

Understanding Referred Pain and Its Impact on Nighttime Arm Discomfort

Referred pain is a phenomenon where pain is perceived in an area different from the actual site of injury. For instance, a heart attack may cause pain in the arm rather than the chest. Persistent arm pain at night could be a sign of referred pain and should be evaluated by a medical professional.

Autoimmune Diseases and Arm Pain

Autoimmune diseases, such as Rheumatoid Arthritis and Lupus, can cause widespread pain throughout the body, including the arms. This pain may be more pronounced at night, disrupting sleep patterns and overall quality of life.

Diving Deeper: Specific Conditions Causing Nighttime Arm Pain

While general causes of arm pain at night are important to understand, specific conditions can provide more insight into the nature of the discomfort and potential treatment options.

AC Joint Impingement

AC joint impingement occurs when the space beneath the acromion bone narrows, leading to irritation of the rotator cuff tendons and bursa. This condition typically causes pain during arm elevation and when lying on the affected shoulder.

Cervical Radiculopathy

Often referred to as a “pinched nerve,” cervical radiculopathy involves irritation or compression of nerves in the neck. Symptoms include neck pain, arm pain radiating down to the fingers, numbness, tingling, and weakness. This condition can affect individuals of any age but is most common between 40-50 years old.

When Should You Worry About Arm Pain at Night?

While occasional arm discomfort at night may not be cause for immediate concern, certain symptoms warrant prompt medical attention. Is persistent arm pain at night always a sign of a serious condition. Not necessarily, but it’s important to be aware of red flags that indicate a need for professional evaluation.

• Sudden, severe pain accompanied by weakness or numbness
• Pain that persists for more than a few days and interferes with daily activities
• Visible swelling or redness in the arm
• Pain accompanied by fever or other systemic symptoms
• Arm pain associated with chest pain or difficulty breathing

If you experience any of these symptoms, it’s crucial to seek medical attention promptly to rule out serious underlying conditions.

Diagnosis and Evaluation of Nighttime Arm Pain

Proper diagnosis of arm pain at night involves a comprehensive approach. How do healthcare providers determine the cause of nighttime arm discomfort. The process typically includes:

1. Detailed medical history
2. Physical examination
3. Imaging studies (X-rays, MRI, CT scans)
4. Nerve conduction studies and electromyography (EMG)
5. Blood tests to check for inflammatory markers or signs of autoimmune diseases

The specific diagnostic tools used will depend on the suspected underlying cause and the severity of symptoms.

Treatment Options for Arm Pain at Night

Effective treatment of arm pain at night depends on accurately identifying the underlying cause. What are the most common approaches to managing nighttime arm discomfort. Treatment options may include:

Conservative Treatments

• Rest and activity modification
• Ice or heat therapy
• Over-the-counter pain medications (NSAIDs)
• Physical therapy and targeted exercises
• Ergonomic adjustments to sleeping position and workspace

Medical Interventions

• Prescription pain medications or muscle relaxants
• Corticosteroid injections
• Nerve blocks
• Chiropractic care or osteopathic manipulation

Surgical Options

In severe cases or when conservative treatments fail, surgical intervention may be necessary. The specific surgical approach will depend on the underlying condition causing the arm pain.

Preventing Arm Pain at Night: Lifestyle and Ergonomic Considerations

While not all causes of arm pain at night are preventable, certain lifestyle changes and ergonomic adjustments can help reduce the risk of developing or exacerbating arm discomfort. How can you minimize the likelihood of experiencing arm pain during sleep.

• Maintain good posture throughout the day
• Use an ergonomic pillow and mattress
• Practice proper lifting techniques
• Engage in regular stretching and strengthening exercises
• Take frequent breaks during repetitive arm activities
• Manage stress through relaxation techniques or meditation

Implementing these strategies can contribute to better arm health and potentially reduce the occurrence of nighttime pain.

The Impact of Sleep Position on Arm Pain

Sleep position plays a crucial role in the development and exacerbation of arm pain at night. Can changing your sleep position alleviate arm discomfort. In many cases, yes. Here are some considerations:

Side Sleeping

Side sleeping is a common position but can put pressure on the shoulder and arm. To minimize discomfort:

• Use a pillow between your arms to reduce pressure on the bottom shoulder
• Ensure your mattress provides adequate support to maintain proper spinal alignment
• Consider using a body pillow for additional support

Back Sleeping

Sleeping on your back can help distribute weight evenly and reduce pressure on the arms. To optimize this position:

• Use a supportive pillow that keeps your neck in a neutral position
• Place a small pillow under your knees to reduce lower back strain
• Keep arms at your sides or slightly elevated on pillows

Stomach Sleeping

While stomach sleeping is generally not recommended due to potential neck strain, if you prefer this position:

• Use a thin pillow or no pillow to minimize neck extension
• Place a small pillow under your hips to reduce lower back strain
• Alternate which side you turn your head to avoid prolonged pressure on one arm

Experimenting with different sleep positions and pillow arrangements can help identify the most comfortable setup for minimizing arm pain at night.

Complementary and Alternative Therapies for Nighttime Arm Pain

In addition to conventional medical treatments, many individuals find relief from arm pain at night through complementary and alternative therapies. What non-traditional approaches can help manage nighttime arm discomfort.

Acupuncture

This traditional Chinese medicine technique involves inserting thin needles into specific points on the body to promote healing and pain relief. Some studies suggest acupuncture may be effective in managing various types of arm pain.

Massage Therapy

Regular massage can help reduce muscle tension, improve circulation, and alleviate arm pain. Different massage techniques may be employed depending on the underlying cause of the discomfort.

Yoga and Stretching

Gentle yoga practices and targeted stretching exercises can improve flexibility, reduce muscle tension, and potentially alleviate arm pain at night. It’s important to work with a qualified instructor to ensure proper form and avoid exacerbating any existing conditions.

Herbal Remedies and Supplements

Some individuals find relief from arm pain through the use of herbal remedies or dietary supplements. Common options include:

• Turmeric for its anti-inflammatory properties
• Ginger to reduce pain and inflammation
• Omega-3 fatty acids for overall joint health
• Glucosamine and chondroitin for joint support

It’s crucial to consult with a healthcare provider before starting any new supplement regimen, as some may interact with medications or have contraindications for certain health conditions.

The Role of Mental Health in Arm Pain at Night

The connection between mental health and physical pain is well-established. How does psychological well-being impact the experience of arm pain at night. Several factors come into play:

Stress and Anxiety

High levels of stress and anxiety can increase muscle tension and exacerbate existing pain conditions. Additionally, the anticipation of pain can lead to a cycle of increased anxiety and worsened pain perception.

Depression

Individuals with depression may experience heightened pain sensitivity and have difficulty coping with chronic pain conditions. Depression can also impact sleep quality, potentially worsening nighttime arm discomfort.

Sleep Disorders

Conditions such as insomnia or sleep apnea can contribute to increased pain sensitivity and make it more difficult to manage arm pain at night. Addressing underlying sleep disorders may help alleviate arm discomfort.

Incorporating stress-reduction techniques, seeking mental health support when needed, and prioritizing good sleep hygiene can all contribute to better management of arm pain at night.

Long-term Management and Prognosis for Nighttime Arm Pain

Managing arm pain at night often requires a multifaceted, long-term approach. What can individuals expect in terms of long-term outcomes and management strategies.

Ongoing Monitoring and Adjustment

Regular follow-ups with healthcare providers are essential to monitor progress and adjust treatment plans as needed. This may involve:

• Periodic imaging studies to track changes in underlying conditions
• Adjustments to medication regimens
• Modifications to physical therapy or exercise programs
• Reassessment of ergonomic factors and sleep environment

Lifestyle Modifications

Long-term management often involves ongoing lifestyle adjustments, such as:

• Maintaining a healthy weight to reduce stress on joints and muscles
• Engaging in regular, low-impact exercise to improve overall strength and flexibility
• Practicing good posture and ergonomics in daily activities
• Managing stress through relaxation techniques or counseling

Prognosis

The long-term outlook for individuals experiencing arm pain at night varies depending on the underlying cause and the effectiveness of treatment. Many individuals find significant relief through a combination of medical interventions and lifestyle modifications. However, some conditions may require ongoing management to maintain comfort and functionality.

It’s important for individuals to work closely with their healthcare providers to develop a comprehensive, personalized plan for managing arm pain at night. By addressing both the physical and psychological aspects of pain, many people can achieve improved sleep quality and overall well-being.

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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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: Causes – “Sensitive”

Various specialists are seen at the Yeysk Medical Center, so with us you are guaranteed to undergo a full examination with a consultation with a doctor of the required specialization. One of the most common reasons for visiting a doctor is pain in the right hypochondrium, the causes of which may be different, as this is a symptom of a number of diseases. By itself, pain in the right hypochondrium cannot be the basis for a diagnosis, but is the basis for a comprehensive diagnosis.

The cause of pain in the right hypochondrium can be strong physical activity (running), overeating. And these are situations in which the pain goes away on its own, without being accompanied by any other symptoms. But often it can be caused by diseases of the genitourinary system, gastrointestinal tract, biliary tract.

When it hurts in the right hypochondrium in healthy people

Doctors of the medical center Yeysk “Sensitive” note that the physiological cause of pain in the right hypochondrium can be:

1. Exercise: occurs as a result of a sudden increase in blood flow to the liver in case of exercise or overeating. Doesn’t pose a danger.
2. Pregnancy: in the third trimester of pregnancy, the uterus begins to put pressure on organs, including the liver, and progesterone (the hormone that preserves pregnancy) expands the bile ducts, and pain appears during exercise. It also poses no danger.
3. Menstruation: with a sharp imbalance between estrogen and progesterone at the end of the cycle, a spasm of the biliary tract can occur, which causes pain in the right hypochondrium.

Pathologies that cause pain in the right hypochondrium

In the upper right square of the abdomen there is a part of the diaphragm, liver, gallbladder, right kidney, duodenum and pancreas. Any of these organs during the development of the disease can make itself felt with pain in the right hypochondrium. Most often, the cause of pain in the right hypochondrium is a liver disease, but this symptom can also manifest itself under such conditions:

1. Bile duct obstruction. This is cholecystitis, which is accompanied by sharp acute pain, most often at night, as well as biliary dyskinesia. The symptom occurs due to the fact that the gallbladder is in increased tone, the frequency and strength of its contractions increase. If these symptoms appear, you should contact the Yeysk “Sensitive” medical center
2. Urolithiasis. With this disease, pain in the right hypochondrium radiates to the lower back or down the abdomen due to the fact that stones begin to move in the urinary system. In this case, the pain will intensify with each movement.
3. Renal colic. The situation is similar to the previous case.
4. Peptic ulcer. Heartburn, belching, vomiting, intestinal dysfunction are added to the pain syndrome, the heartbeat also quickens, and a breakdown occurs. This is dangerous for the life of the patient and requires urgent surgical intervention.
5. Pancreatitis. This is an inflammation of the pancreas, in which there is a throbbing intense girdle pain. This is a dangerous condition that may require surgery.
6. Intercostal neuralgia. It is characterized by sharp severe pain, which is associated with a dagger strike. The pain is accompanied by a pulsation in this area and also a strong spasm, tension.

Other causes of pain in the right hypochondrium

Shingles causes pain in the right hypochondrium, which is accompanied by skin rashes and itching. Also, with pyelonephritis, in case of damage to the right kidney, the pain will radiate to the right hypochondrium, and be accompanied by high fever. Pneumonia and bronchitis in fluffy forms can cause such pain due to the fact that when coughing, muscle strain occurs, spasms of the respiratory system. Also, if a person has heart failure, then with stagnation of blood in the liver, this will be a causal pain in the right hypochondrium.

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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.