Upper arm pain is common, and it doesn’t always come from the arm itself. The pain can arise from the shoulder, the elbow, or even the neck — which is why pinning down the cause matters. So what are the causes of upper arm pain, and how do we treat them? 

A quick word on warning signs

Most upper arm pain is musculoskeletal — from a tendon, joint, or nerve. But arm pain can occasionally be referred from elsewhere.

Seek emergency help if upper arm or shoulder pain comes on with chest tightness or pressure, breathlessness, sweating, nausea, or light-headedness — particularly on exertion. Arm pain can rarely be referred heart pain, and these symptoms need urgent assessment. This is uncommon, but important to rule out. Musculoskeletal arm pain, by contrast, is usually reproduced by moving or pressing on the arm and shoulder.

Rotator cuff problems

The rotator cuff is the group of tendons that move and stabilise the shoulder, and it’s one of the most common causes of upper arm pain. Excessive or repeated load causes rotator cuff tendonitis and, over time, a partial- or full-thickness (degenerative) tear. The pain is typically felt in the outer shoulder and upper arm, is worse when reaching overhead or behind the back, and often occurs at night. Most cases settle with physiotherapy and, where needed, a bursa injection; surgery is reserved for significant full-thickness tears.

Biceps tendonitis

The biceps tendon is a common, and often overlooked, cause of front-of-shoulder and upper-arm pain. There are two sites:

  • Long head of biceps tendonitis — inflammation of the biceps tendon where it runs through the shoulder, causing pain at the front of the shoulder that spreads into the upper arm. It often goes hand in hand with rotator cuff problems.

Simple treatment — ice, anti-inflammatories, and physiotherapy — is effective for most cases.

Tennis elbow

Tennis elbow is an overuse strain of the tendons on the outside of the elbow. Although the problem is at the elbow, the pain often spreads up into the lower part of the upper arm. It usually responds to load management, strengthening, and — in stubborn cases — shockwave therapy or an injection.

Referred pain from the neck

Not all upper arm pain comes from the arm. Pain can be referred from the neck:

  • A pinched nerve in the neck — a trapped or irritated nerve in the neck (cervical radiculopathy) can radiate pain, tingling, or numbness down into the upper arm.
  • Thoracic outlet syndrome — compression of the nerves and vessels as they pass from the neck into the arm, which can cause pain down the arm, sometimes with tingling or a heavy, tired feeling.

The clue that pain is referred: touching or moving the arm doesn’t fully reproduce it, and there may be neck symptoms or nerve-type tingling and numbness.

Other causes

Upper arm pain can also come from shoulder arthritis, a frozen shoulder, AC joint problems, or — after trauma — a fracture of the upper arm bone (humerus).

How is the cause of upper arm pain diagnosed?

Because the pain can come from the shoulder, elbow, or neck, a careful assessment is essential. Your doctor takes a history and examines the arm, shoulder, and neck to locate the source. Ultrasound is especially useful — it images the rotator cuff and biceps tendons directly, and it can guide an injection. MRI and, occasionally, nerve studies help where a neck or nerve cause is suspected. Our shoulder pain map can help you narrow down the likely source by location.

Frequently asked questions about upper arm pain

What is the most common cause of upper arm pain?

In active people, a rotator cuff problem or biceps tendonitis is among the commonest causes of shoulder pain — both cause pain at the outer or front of the shoulder that spreads into the upper arm, worse with overhead activity. But because the elbow and neck can also refer pain to the upper arm, an accurate diagnosis matters.

When should I worry about upper arm pain?

Seek emergency help if arm pain comes with chest tightness, breathlessness, sweating, or nausea — this can be referred heart pain. Otherwise, see a doctor for arm pain that’s severe, follows a significant injury, comes with weakness or numbness, or doesn’t settle within a couple of weeks.

Can upper arm pain come from the neck?

Yes — commonly. A pinched nerve in the neck or thoracic outlet syndrome can refer pain down into the upper arm, often with tingling or numbness. The clue is that moving or pressing on the arm doesn’t fully reproduce the pain, and there may be neck symptoms.

Why does my upper arm hurt at night?

Night pain is a classic feature of rotator cuff problems, because lying on the shoulder — or with the arm in certain positions — loads the irritated tendons. Persistent night pain in the shoulder and upper arm is worth getting assessed.

How is upper arm pain treated?

It depends on the cause. Most tendon problems respond to physiotherapy and, where needed, an ultrasound-guided injection; referred neck pain needs treatment aimed at the neck; and a fracture needs specific management. Getting the diagnosis right is what allows the right treatment.

Final word from Sport Doctor London about upper arm pain

Upper arm pain can come from the shoulder, the elbow, or the neck — so the single most important step is an accurate diagnosis. Most causes, from rotator cuff problems to biceps tendonitis, respond well to physiotherapy and, where needed, an ultrasound-guided injection. Seeing an experienced doctor who can assess all three areas is the key to getting the right treatment.

If you have persistent upper arm pain, Dr Masci can assess you in London, including an in-clinic ultrasound. Contact the team here or call +44 (0) 203 488 0350.

Related conditions:

 

Click on the picture below to find out about possible causes of upper arm and shoulder pain 

shoulder pain map
Clavicle pain AC joint pain Front of shoulder Biceps tendon pain Pectoralis pain Trapezius pain Chest wall pain

Clavicle pain

Trapezius pain