Arm pain is a common complaint that may arise from various causes, ranging from minor injuries to more serious systemic conditions. The pain can originate from the bones, joints, muscles, tendons, ligaments, nerves, or skin. It may also be referred from other regions, such as the neck or heart.

Local Causes of Arm Pain

Hand Pain

• Dupuytren’s contracture

• Buerger’s disease

• Shoulder-hand syndrome (reflex sympathetic dystrophy)

• Sprain or strain

• Infection

• Ganglion

• Thoracic outlet syndrome

• Radiculopathy

• Carpal tunnel syndrome

• Arthritis

• Elbow tunnel syndrome

• Occlusive vascular disease

• Fracture

• Raynaud’s disease

• Trigger finger

Wrist Pain

• Fractures: Colles, Smith, scaphoid

• Tendonitis: Extensor and flexor tendons

• Ganglion cysts

• Nerve entrapment: Carpal tunnel syndrome

• Arthritis

Elbow pain

• Bursitis

• Ulnar neuritis

• Tendinitis

• Fracture

• Lateral epicondylitis (tennis elbow)

• Arthritis

• Dislocation

Shoulder pain

• Angina pectoris

• Dislocation

• Subphrenic abscess

• Clavicle fracture

• Perforated ulcer

• Shoulder-hand syndrome

• Bursitis

• Pneumothorax

• Cholecystitis or cholelithiasis

• Humeral neck fracture

• Pancoast’s syndrome

• Diaphragmatic pleurisy

• Gastritis

• Infection

• Tendinitis

• Adhesive capsulitis (frozen shoulder)

• Dissecting aortic aneurysm

• Arthritis

• Acute pancreatitis

• Acromioclavicular separation

• Ruptured spleen (left shoulder)

• Referred pain: From diaphragm, heart, or neck

History and Physical Examination

A thorough history should include:

• Onset, duration, and character of the pain

• History of trauma or overuse

• Associated symptoms: numbness, tingling, weakness, swelling

• Occupation and activities

• Systemic symptoms: fever, weight loss, night sweats

Physical examination should assess:

• Inspection: swelling, deformity, discoloration

• Palpation: tenderness, warmth, crepitus

• Range of motion

• Strength testing

• Neurovascular status: sensation and pulses

Major Associated Signs and Symptoms

• Numbness or tingling: Suggests nerve involvement

• Swelling: May indicate inflammation, infection, or vascular cause

• Redness and warmth: Suggest infection or inflammatory arthritis

• Weakness: May be due to nerve damage or muscle/tendon injury

• Limited motion: Joint pathology, tendon injury, or pain guarding

Common Causes and Associated Findings

Special Considerations

• Acute severe arm pain without trauma should raise suspicion for myocardial infarction, especially in older adults or those with cardiovascular risk factors.

• Arm pain with neurologic deficits suggests possible cervical spine pathology or nerve entrapment.

• Sudden swelling and pain may indicate deep vein thrombosis or compartment syndrome.

Patient Counseling

• Reassure for minor injuries and explain expected healing course

• Emphasize importance of follow-up if symptoms worsen or persist

• Educate about ergonomic practices to avoid overuse injuries

• Counsel on the risks of ignoring symptoms suggestive of systemic causes (e.g., chest pain radiating to arm)

Pediatric Pointers

• Consider non-accidental trauma in young children

• Common causes include supracondylar fractures, pulled elbow

• Joint or bone infections (e.g., osteomyelitis, septic arthritis) must be ruled out in febrile children with arm pain

Geriatric Pointers

• Higher risk of fractures from minor trauma (osteoporosis)

• Consider polymyalgia rheumatica in older adults with bilateral arm pain and stiffness

• Watch for atypical presentations of myocardial infarction

References

1. Tintinalli JE, et al. Tintinalli's Emergency Medicine: A Comprehensive Study Guide. 9th ed. McGraw Hill; 2020.

2. Long B, Koyfman A. Evaluation and management of arm pain in the emergency department. J Emerg Med. 2018;54(3):393-404.

3. American Academy of Orthopaedic Surgeons. Arm and Elbow Pain. OrthoInfo. https://orthoinfo.aaos.org

4. Ferri FF. Ferri’s Clinical Advisor 2022. Elsevier; 2022.

5. ULY Clinic. Maumivu ya Mkono: Visababishi na Ushauri. https://www.ulyclinic.com