What are the main causes of arm and hand pain. How can repetitive motions lead to conditions like tendonitis and carpal tunnel syndrome. What role does aging play in developing arm and hand pain. How can neck issues contribute to pain in the arms and hands. What treatment options are available for different types of arm and hand pain.

Understanding Repetitive Motion Injuries in Arms and Hands

Repetitive motion is a common culprit behind arm and hand pain. When we perform the same movements repeatedly without adequate rest, it can put significant stress on the muscles, ligaments, and tendons in these areas. This repetitive stress often leads to inflammation and injury over time.

Tendonitis: A Common Repetitive Motion Injury

Tendonitis is one of the most frequent repetitive motion injuries affecting the arms and hands. But what exactly is tendonitis? It’s an inflammation of the tendons – the thick, fibrous tissues that connect muscles to bones. This condition can develop in various parts of the arm or hand due to repeated motions.

• Tennis elbow: Despite its name, this condition isn’t limited to tennis players. It can affect anyone who repeatedly uses their forearm muscles, such as painters, plumbers, or even office workers who frequently use a computer mouse.
• Golfer’s elbow: Similar to tennis elbow but affecting the inner part of the elbow.
• De Quervain’s tenosynovitis: This affects the tendons on the thumb side of the wrist.

How can tendonitis be treated? Treatment typically involves rest, ice or heat therapy, anti-inflammatory medications, and physical therapy. In severe cases, corticosteroid injections or surgery may be necessary.

Carpal Tunnel Syndrome: When Repetition Leads to Nerve Compression

Carpal tunnel syndrome is another condition often caused by repetitive motions. It occurs when the median nerve, which runs from the forearm into the palm, becomes compressed within the carpal tunnel – a narrow passageway in the wrist.

Who is at risk for carpal tunnel syndrome? People who perform repetitive hand movements, such as assembly line workers, typists, or cashiers, are particularly susceptible. Symptoms often include numbness, tingling, and weakness in the hand and wrist.

How is carpal tunnel syndrome diagnosed and treated? Diagnosis usually involves a physical examination and nerve conduction studies. Treatment options range from wrist splinting and lifestyle changes to surgery in severe cases.

The Impact of Aging on Arm and Hand Pain

As we age, our bodies naturally undergo wear and tear, which can contribute to various types of arm and hand pain. Understanding these age-related changes can help in managing and preventing discomfort.

Osteoarthritis: The Wear and Tear of Joints

Osteoarthritis is a common age-related condition that can cause pain in the arms and hands. But what exactly happens in osteoarthritis? Over time, the cartilage that cushions the joints wears down, allowing bones to rub against each other. This can lead to pain, stiffness, and reduced range of motion.

How does osteoarthritis affect the hands and arms? It commonly affects the small joints of the fingers, the base of the thumb, and the wrist. In the arm, it can impact the elbow and shoulder joints.

What are the treatment options for osteoarthritis in the hands and arms? Treatment typically involves a combination of pain management strategies, including medications, physical therapy, and lifestyle modifications. In severe cases, joint replacement surgery may be considered.

Rotator Cuff Tears: Age-Related Degeneration of Shoulder Tendons

Rotator cuff tears are another age-related condition that can cause arm pain. The rotator cuff is a group of tendons that stabilize the shoulder joint. As we age, these tendons can degenerate and tear, leading to pain and reduced function.

How do rotator cuff tears develop? While they can result from acute injury, many rotator cuff tears occur gradually due to normal wear and tear associated with aging. The dominant arm is often more affected.

What are the symptoms of a rotator cuff tear? Common symptoms include shoulder pain that may radiate down the arm, weakness in the arm, and difficulty with certain movements, such as reaching overhead.

How are rotator cuff tears treated? Treatment depends on the severity of the tear and may include rest, physical therapy, anti-inflammatory medications, and in some cases, surgery.

Neck Issues as a Source of Arm and Hand Pain

Surprisingly, the source of arm and hand pain isn’t always in the arm or hand itself. Sometimes, the pain originates in the neck and radiates down the arm. This is known as referred pain.

Cervical Radiculopathy: When Neck Problems Cause Arm Pain

Cervical radiculopathy occurs when a nerve in the neck is compressed or irritated at the point where it branches away from the spinal cord. This can cause pain that radiates along the nerve’s pathway into the arm and hand.

What causes cervical radiculopathy? Common causes include herniated discs, bone spurs, or spinal stenosis in the neck.

What are the symptoms of cervical radiculopathy? Symptoms can include pain, numbness, tingling, or weakness that travels from the neck into the shoulder, arm, and sometimes the hand and fingers.

How is cervical radiculopathy diagnosed and treated? Diagnosis often involves a physical examination, imaging studies, and sometimes nerve conduction studies. Treatment may include physical therapy, medications, cervical traction, and in some cases, surgery.

Unusual Causes of Arm and Hand Pain

While repetitive motion injuries and age-related conditions are common causes of arm and hand pain, there are some less obvious culprits that shouldn’t be overlooked.

Ganglion Cysts: Benign Lumps That Can Cause Discomfort

Ganglion cysts are noncancerous lumps that often develop along the tendons or joints of the wrists or hands. While they’re typically harmless, they can sometimes cause pain, especially if they press on a nerve.

What causes ganglion cysts? The exact cause is unknown, but they may result from trauma, arthritis, or joint or tendon irritation.

How are ganglion cysts treated? Many ganglion cysts go away on their own. If treatment is necessary, options include immobilization, aspiration (draining the fluid), or surgical removal.

Acute Injuries: When Pain Follows a Fall or Impact

Sometimes, arm and hand pain can result from a sudden injury, such as a fall or direct impact. These acute injuries can range from minor sprains to more severe fractures or dislocations.

Why is it important to seek medical attention after an injury? Even if you don’t think you’ve broken a bone, an injury can damage tendons, ligaments, or muscles. Proper diagnosis and treatment can prevent further damage and ensure optimal healing.

What are common acute injuries to the arm and hand? These can include sprains, strains, fractures, dislocations, and in some cases, rotator cuff tears.

Diagnosis and Treatment Approaches for Arm and Hand Pain

Given the wide range of potential causes, diagnosing the exact source of arm and hand pain often requires a comprehensive approach. Healthcare providers typically use a combination of methods to pinpoint the cause and determine the most effective treatment.

Diagnostic Techniques for Arm and Hand Pain

How do doctors diagnose the cause of arm and hand pain? The diagnostic process usually involves several steps:

1. Medical history: The doctor will ask about your symptoms, when they started, and any activities that worsen or alleviate the pain.
2. Physical examination: This involves assessing range of motion, strength, and checking for any visible abnormalities.
3. Imaging studies: X-rays, MRI, or CT scans may be used to visualize bones, soft tissues, and nerves.
4. Nerve conduction studies: These tests can help diagnose conditions like carpal tunnel syndrome or cervical radiculopathy.
5. Blood tests: In some cases, blood tests may be ordered to check for systemic conditions that could be causing the pain.

Treatment Options for Different Types of Arm and Hand Pain

What are the common treatment approaches for arm and hand pain? Treatment strategies vary depending on the underlying cause but often include:

• Rest and activity modification
• Physical therapy and exercises
• Medications (anti-inflammatories, pain relievers)
• Hot or cold therapy
• Splinting or bracing
• Corticosteroid injections
• Surgery (in severe cases or when conservative treatments fail)

How is the most appropriate treatment determined? The choice of treatment depends on several factors, including the specific diagnosis, the severity of symptoms, and the patient’s overall health and lifestyle needs.

Prevention Strategies for Arm and Hand Pain

While not all causes of arm and hand pain can be prevented, there are steps you can take to reduce your risk of developing certain conditions or exacerbating existing problems.

Ergonomic Considerations for Preventing Repetitive Motion Injuries

How can ergonomic adjustments help prevent arm and hand pain? Proper ergonomics can significantly reduce the risk of repetitive motion injuries. Consider these tips:

• Adjust your workstation to maintain proper posture
• Use ergonomic keyboards and mice
• Take regular breaks and stretch
• Alternate tasks to avoid prolonged repetitive motions

Lifestyle Modifications for Long-Term Arm and Hand Health

What lifestyle changes can promote arm and hand health? Several habits can contribute to overall arm and hand wellness:

• Regular exercise to maintain strength and flexibility
• Maintaining a healthy weight to reduce stress on joints
• Proper nutrition, including adequate calcium and vitamin D for bone health
• Quitting smoking, which can impair healing and increase inflammation

By understanding the various causes of arm and hand pain and implementing preventive strategies, you can take proactive steps to maintain the health and function of these essential body parts. Remember, if you experience persistent or severe arm and hand pain, it’s important to seek medical attention for proper diagnosis and treatment.

Physical Medicine, Rehabilitation, and Pain Management

Any part of your body is susceptible to pain. Though you may expect to experience pain after an injury, sometimes the discomfort develops from an unknown cause. Arm and hand pain, for example, can occur without an injury from many different causes. Because you rely on your arms and hands to do many things, from writing to typing to carrying the groceries into your house, the pain can be a bit distressing and keep you from doing the things you need to do.

Here, at CHOICE Pain & Rehabilitation Center, we specialize in arm and hand pain and want you to know some of the common causes of pain in these areas of which you may not be aware.

Repetitive motion

Doing the same motion over and over again, with few breaks in between, can really tax the muscles, ligaments, and tendons in your arm or hand. There are some common conditions that affect the arm or hand that develop from repetitive motion, including:

Tendonitis

Tendonitis refers to inflammation of your tendons, which are the thick fibrous tissues that hold your muscles to your bone. Repeating the same motion over and over again can lead to inflammation in any of the tendons found in your arm or hands.

Tennis elbow, for example, develops from the constant back and forth motion of your forearm as you play your game. Tennis players, however, aren’t the only ones prone to this condition; painters, butchers, and plumbers can also develop tennis elbow. You may also be prone to the inflammation if you spend all day moving your computer mouse up and down.

Carpal tunnel syndrome

Carpal tunnel syndrome is a common source of both hand and arm pain that develops when the median nerve that provides sensation to the thumb, index, middle, and ring finger gets compressed as it moves through the carpal tunnel in your wrist. Repetitive motion, which may occur if you work in an assembly line, may cause the tendons in your wrist to swell, leading to nerve compression and pain.

You may be able to prevent arm and hand pain from repetitive motion by altering the way you do things, if possible, to prevent the repeated stress. Our specialists here at CHOICE Pain & Rehabilitation Center can help you figure out how to alter your movements to prevent the pain.

Wear and tear that comes with aging

You may gain wisdom with age, but aging also affects joint health. You may experience arm or hand pain due to the wearing down of the cartilage that separates your joints that occurs over time, allowing the bones to rub together. This condition is more commonly known as osteoarthritis.

It isn’t just your cartilage and joints, however. You can also develop tears in your rotator cuff, which are a group of tendons that hold your arm and shoulder in place, due to degeneration of the tissue. A rotator cuff tear can cause pain in the shoulder that travels down the arm and may affect your ability to use your arm. The degeneration usually affects your dominant hand, too.

Maybe it’s your neck

Your arm or hand pain may not be directly related to your extremities. The sensations you feel running down your arm and into your hands may generate from conditions that affect your necks, such as a herniated disc or spinal stenosis. These conditions can irritate the nerves that send signals down your arm and hands. If you’re experiencing any numbness or tingling in your hands or arms, you should also have your neck evaluated.

That funny bump on your wrist

That funny bump may be a ganglion cyst, which is a noncancerous tumor filled with the lubricating fluid from your joint. These tiny bumps aren’t usually painful, but if they press on a nerve, they can cause pain and be difficult to live with. Treatment for the cyst may involve immobilization, drainage of the fluid, or complete removal of the cyst.

Bad fall

Maybe you didn’t break a bone, but a bad fall can injure the tendons, ligaments, or muscles in your arm or hand and lead to pain. You may be tempted to ride it out at home with rest, over-the-counter pain relievers, and an ice pack. But knowing the underlying cause of your pain can help you get the most effective treatment for a quick recovery. For example, if you’ve torn a rotator cuff after a fierce fall to the ground during a tackle at football practice, not getting the right care may cause the tear to worsen.

Arm and hand pain can develop from many causes. Identifying the underlying cause of your pain can help you get the most effective treatment. To find out what’s causing your discomfort, call CHOICE Pain & Rehabilitation Center today, or request an appointment online.

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Symptom Checker: Hand, Wrist, Arm Problems

Pain and other problems in the hands, wrists and arms can be caused by injury, certain activities or other health problems. Follow this chart for for more information.

Back to Symptoms

Step 2

Answering Questions

• Did you hit, twist, or fall on your arm, hand, or wrist?

• Is the affected area deformed or swollen?

• Does the pain get worse when you move your arm, hand, or wrist?

• Does the pain get worse with repetitive movement (e.g., while working or playing a sport)?”

• Is it painful to grip a doorknob, and does the pain start on the outside of your elbow and move down your arm to your wrist?

• Do you have numbness or pain in your fingers, hand, wrist, or arm, especially when you flex your wrist (i.e., bend your palm toward your forearm)?

• Do you have a firm lump or swelling near your wrist or finger joints?

• Do you have redness, swelling, or pain in the skin around a cut or wound, or is there a red streak anywhere on your arm or hand?

• Are one or more joints swollen and tender? Do you have a fever?

• Does your thumb hurt with gripping, typing, or writing with a pencil or pen?

Back to Questions

Step 3

Possible Causes

• Diagnosis

  You may have a FRACTURED bone.

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  Self Care

  URGENT
  See your doctor right away. Apply ice packs to the affected area. Use a sling to help hold the arm still and reduce pain. Use an over-the-counter pain medicine, such as ibuprofen, to relieve pain and reduce swelling.

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  Start Over

• Diagnosis

  If there is no fracture, the limb may be SPRAINED.

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  Self Care

  Avoid activities that cause pain. Apply ice and don’t move your arm. Use an over-the-counter medicine such as ibuprofen to relieve pain and reduce swelling. See your doctor if the pain gets worse.

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  Start Over

• Diagnosis

  If there is no fracture, the tendons (a cord of tissue connecting muscle to bone) or ligaments (tissue connecting bones to each another) around the joint may be SPRAINED or STRAINED.

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  Self Care

  Avoid activities that cause pain. Apply ice and a compressive bandage or sleeve. Use an over-the-counter medicine, such as ibuprofen, to relieve pain and reduce swelling. See your doctor if the pain gets worse or does not improve with rest.

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  Start Over

• Diagnosis

  You may have LATERAL EPICONDYLITIS (i.e., tennis elbow).

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  Self Care

  Avoid activities that cause pain. Apply ice and a compressive bandage or sleeve. Use an over-the-counter medicine, such as ibuprofen, to relieve pain and reduce swelling. See your doctor if the pain gets worse or does not improve with rest.

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  Start Over

• Diagnosis

  You may have CARPAL TUNNEL SYNDROME, a compression of the median nerve in the wrist and hand.

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  Self Care

  Use anti-inflammatory medicine, such as ibuprofen, to reduce pain and swelling. A wrist splint worn at night may also ease pain and numbness. If your symptoms don’t improve, see your doctor.

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  Start Over

• Diagnosis

  You may have a GANGLION CYST, a common non-cancerous cyst.

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  Self Care

  See your doctor if the cyst causes pain or begins to grow rapidly.

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  Start Over

• Diagnosis

  These are all signs of INFECTION in the hand, wrist, or arm.

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  Self Care

  URGENT
  See your doctor right away. Use an antibiotic ointment (like bacitracin) on infected cuts.

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  Start Over

• Diagnosis

  You may have RHEUMATOID ARTHRITIS, an inflammatory joint condition. You may also have GOUT, or an INFECTION (with fever) of the joint or bone.

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  Self Care

  See your doctor right away. Use an anti-inflammatory medicine, such as ibuprofen, to relieve pain and reduce swelling.

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  Start Over

• Diagnosis

  You may have CARPAL TUNNEL SYNDROME or de QUERVAIN’S TENOSYNOVITIS.

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  Self Care

  For CARPAL TUNNEL SYNDROME, use an anti-inflammatory medicine, such as ibuprofen, to reduce pain and swelling. A wrist splint worn at night may also ease pain and numbness. If your symptoms don’t improve, see your doctor.

  For de QUERVAIN’S TENOSYNOVITIS, your doctor may prescribe, or you can purchase an over-the-counter splint that does not allow your thumb to move. See your doctor if the pain worsens or does not improve with rest.

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  Start Over

• Self Care

  For more information, please talk to your doctor. If you think the problem is serious, call your doctor right away.

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  Start Over

familydoctor.org editorial staff
December 1, 2020October 6, 2016

Pain in the arms: causes, consequences, methods of treatment

Pain in the arm is one of the most common complaints of patients who turn to a neurologist or orthopedist. This symptom is not specific, as it can indicate the development of several diseases at once – arthritis, arthrosis, osteochondrosis, hernia, localized in the cervical or thoracic spine.

At the stage of diagnosis, the nature of the pain, which can be burning, aching or shooting, and the place of its localization are of great importance. In some cases, pain in the shoulders and upper limbs is only a consequence of problems with the back or neck, in others it indicates inflammation of the joints (in the elbows and wrists).

When should I see a doctor?

Practice shows that the vast majority of patients practice self-diagnosis, traditional medicine and uncontrolled use of painkillers. This approach always leads to one result: a neglected disease requires more serious, long-term and expensive treatment.

We strongly recommend that you see a specialist if you have any of the following symptoms:

• The pain persists for 3 days and is aggravated by any physical activity.
• The arm is swollen.
• Pain in the arm reduces its strength. Patients note the inability to perform the usual actions, stiffness of movements.

The sooner the diagnosis is made, the more effective the treatment will be. Our goal is to find and eliminate the cause, relieve a person from pain, and restore mobility.

What does arm pain indicate? The most common diseases

Does your arm hurt? There may be several reasons. In this article, we will talk about the most serious and common of them:

• Arthritis – inflammation of the joints and periarticular space.

The main symptoms are pain, swelling, deterioration of mobility, local hyperemia or hyperthermia, reaction to weather changes. Lack of treatment leads to joint deformity, changes in cartilage, ligaments and capsule. At the initial stage, arthritis affects the hands, feet, elbow and shoulder joints, then descends to the pelvis and knees. In the presence of several foci of inflammation, a diagnosis of polyarthritis is made. This pathology develops against the background of injuries, bruises and other damage to the ligamentous apparatus, infections, deficiency of bone or cartilage tissue, poor heredity, and disorders in the immune system. At risk are the elderly.

• Arthrosis – destruction of cartilage and joint capsule.

At risk are people over 45 years of age. Today, arthrosis occurs in every tenth inhabitant of the planet, so it is important to diagnose the disease in time and contact specialists. Main symptoms: inflammation, swelling, swelling, crunching in the joints, pain in the hands, elbows, feet, knees, hips and lower back. Primary arthrosis is an independent disease that occurs due to the fact that the cartilage tissue wears out faster than it is restored. If the pathological process occurs after injuries, against the background of endocrine disorders, osteoporosis, varicose veins, hormonal imbalance, physical inactivity and other problems, arthrosis is called secondary.

• Thoracic osteochondrosis is a disease in which intervertebral discs, joints and ligaments are destroyed.

Attack-like or shooting pain is the most striking symptom that occurs against the background of pinched spinal nerves. Among other manifestations, the most common paresis, “goosebumps”, a tingling sensation and muscle tension on palpation. Symptoms of osteochondrosis are similar to the manifestation of coronary heart disease, so we do not recommend postponing a visit to a specialist on the back burner. The disease develops for a number of reasons, including due to spinal injuries, posture disorders and periodic hypothermia, it can be combined with cervical osteochondrosis, one of the manifestations of which is pain in the right arm.

• Herniated disc in the thoracic spine.

A rather rare disease with serious consequences. The thoracic spine begins with the collar zone and ends with the lumbar lordosis. The spinal nerve fibers located in this area activate the upper limbs, the respiratory center, the anterior chest wall, affect the functioning of the liver, esophagus, reproductive and urinary systems. By pinching the nerve roots, intervertebral hernias cause severe pain, as well as dysfunction of the organs listed above. The main reason for the formation of a hernia is the wear of the disc tissues against the background of advanced osteochondrosis. Main symptoms: shooting, aching or dull pain in the chest and between the shoulder blades; tingling sensation, numbness of the extremities and muscle weakness.

This is important!

According to statistics, cervical disc herniation occurs in 8% of cases, thoracic hernia – in 1%. The permanent “leader” among diseases of the spine is protrusion in the lumbar region. The top five, along with osteochondrosis, includes arthritis, in particular, humeroscapular periarthritis – a reactive inflammatory process in the movable joint that connects the arm bone with the scapula.

In the absence of adequate treatment, in about 40% of cases, the pain syndrome becomes chronic, every fifth patient inherits severe vertebral neurological disorders.

Causes and consequences

The reasons for the development of diseases of the spine are different:

• Old age. Organs and systems age with us. Bones become more fragile, cartilage wears out.
• Genetic predisposition. Let’s just say that this is not a diagnosis. An active lifestyle, the rejection of bad habits, the right diet can delay or prevent the development of pathology.
• Spinal injuries. There are circumstances beyond our control, such as an accident or an unfortunate fall on ice, but in most cases we endanger ourselves: we perform physical exercises without prior stretching, ride tubing – high-speed, dangerous and uncontrollable, jump into the lake from a springboard without thinking that you can break your neck. Your health is in your hands!
• Posture disorders. Don’t hold back? Know that your muscles are in constant tension. Kyphosis, scoliosis, lordosis – this is not a “cosmetic problem”, but constant pain and disruption of the internal organs.

Among other factors, it is worth noting excessive physical activity, overweight, refusal to treat other chronic diseases.

Why go to the doctor?

Early diagnosis and proper treatment significantly improve the prognosis and increase your chances, if not for a complete recovery, then for slowing down the development of the pathological process, getting rid of pain, returning joint mobility and, as a result, improving the quality of life.

How to treat?

What should I do if my arm hurts?

• The first stage of treatment is aimed at removing swelling, spasms, inflammation and pain. For this purpose, the patient is prescribed painkillers, non-steroidal anti-inflammatory, decongestants and muscle relaxants. High efficiency in the fight against the consequences of intervertebral hernia, osteochondrosis, neuralgia, myositis and spinal injuries was shown by therapeutic drug blockade and plasmolifting.
• Treatment of spinal diseases is not limited to drugs and injections. You can relieve pain, accelerate tissue regeneration, restore metabolic processes with the help of acupuncture, magnetotherapy on the BTL 49 device20 Smart, interstitial electrical stimulation according to Gerasimov, hardware spinal traction and kinesio taping. In most cases, the patient is prescribed a course of procedures, but relief comes after the first session.

Despite the fact that the methods of treatment listed in this article have a minimum of contraindications, consultation with a specialist is required!

You can make an appointment with an orthopedist on the website or by calling 7 (347) 216 00 22. 0001

Pain in the hands: sources of the problem, symptoms, complications

Unpleasant sensations in the area from the wrist to the shoulder are commonly called “pain in the arm.” The source of what hurts the hand is an infection or injury to the bone, muscle tissue, tendon-ligamentous apparatus, arteries, veins, nerve endings. Prolonged discomfort requires a visit to the doctor to determine the causes of the pain syndrome.

Sources of discomfort

The root cause of pain in the arm is trauma, infection, degenerative, neurological pathologies:

• elbow dislocation;
• fractures, bruises, wounds;
• rupture, stretching of ligamentous-muscular tissues;
• infected wounds, osteomyelitis, septic arthritis;
• bursitis, spinal stenosis;
• compression of nerve endings;
• osteoarthritis, peripheral nephropathy, tendinitis;
• benign, malignant neoplasms;
• myocardial infarction.

The hand can hurt due to damage to the nervous tissue as a result of a blunt injury to the upper limb.

Clinical signs

In addition to the main symptom in the form of pain in the arm, secondary manifestations may occur. Additional signs of the pathological process are presented:

• discomfort in the cervical, shoulder, back;
• burning in the upper limb;
• sleep problems;
• fever, sore throat, cough, headache;
• soreness in the articular apparatus, muscle spasm, loss of sensation;
• decreased range of motion at the elbow;
• the appearance of hematomas and inflammation on the skin;
• a sharp decrease in body weight for no apparent reason.

There are a number of symptoms that require immediate medical attention. Their appearance signals serious problems, up to a threat to the life of the patient. These include:

• deformity of the upper limb;
• change in the hue of the mucous or skin to a bluish tint – the deviation is best seen on the lips and under the nail plates;
• fainting, lack of adequate response to external stimuli;
• non-standard behavior – a state of delirium, hallucinations, falling into lethargy;
• pain syndrome in the retrosternal space with irradiation to the left side – limb, cervical, shoulder, lower jaw;
• critical body temperature – more than 38-39 degrees;
• upper limb movement problems;
• extraneous sound at the moment of hand injury;
• broken capillaries around the injury site;
• problems with the work of the respiratory center – increasing shortness of breath, extraneous whistling when inhaling, sudden cessation of breathing.