Causes of Severe Upper Arm Pain
Your upper arm is the meeting point of different bones, joints, muscles, arteries, and nerves. These all work together to keep your shoulder, arm, and hand functioning properly. But if something happens to any one of these parts, it can cause pain in the area—along with other symptoms like bruising, heat, visible deformities, burning or tingling sensations, and decreased strength.
Severe pain in the upper arm can be caused by trauma from an injury. These could include a fracture, muscle or tendon tear, nerve compression. Things like falling on an outstretched arm, a motor vehicle accident or bicycle fall, or a forceful pull trying to lift a heavy object.
But severe pain can also be caused by chronic conditions such as osteoarthritis and frozen shoulder. These can be in the arm or even in the neck and spine, which could cause pain to radiate down the arm. Bone spurs or bulging discs in the neck can put pressure on the nerves, causing severe shooting or electrical pain.
It can also be caused by repetitive activities, especially those that involve reaching over head like painting, stocking shelves, or lifting objects over shoulder level. These can cause irritation and inflammation of the shoulder tissues including the bursa and rotator cuff tendons
Sudden injuries may require you to seek medical treatments. In general, pain can be eased with ice, heat, and over-the-counter anti-inflammatories.
1. Frozen shoulder (adhesive capsulitis)
- Stiffness in the shoulder joint that gets worse over time
- Pain with movement
- Difficulty sleeping
Frozen shoulder is a condition where the shoulder gradually gets stiffer and stiffer. As the shoulder stiffens, it becomes painful when you try to move it. You may also have dull, aching pain at rest and pain that makes it difficult to sleep at night. Symptoms usually start gradually (freezing stage), stabilize (frozen stage), then gradually improve as your range of motion returns (thawing stage).
Treatment for frozen shoulder includes physical therapy, pain-relieving medications, and sometimes cortisone injections. It usually improves slowly over time, but it can take 12 to 18 months (or in some cases up to 3 years) for the range of motion to improve completely. Rarely, surgery may be necessary.
2. Shoulder arthritis (glenohumeral arthritis)
While it is more common to develop arthritis in the knee or hip, some patients can develop arthritis of the shoulder. Normally, the shoulder is the most mobile joint in the human body. However, arthritis can cause stiffness that limits shoulder motion. —Dr. Benjamin Schwartz
- Dull aching pain in the shoulder and outer arm
- Stiffness, making it difficult to raise your arm overhead
- A clicking or grinding sensation with movement
- Pain at night and difficulty sleeping
Arthritis is a wearing away of the smooth cartilage that normally lines the ends of the bones that make up a joint. As the cartilage wears away, the bones get closer together, and eventually, they can touch. While the hip and knee are the most common joints to be affected by arthritis, shoulder arthritis can develop with aging or if you have had a shoulder injury in the past.
Treatment of shoulder arthritis usually starts with physical therapy, modifying your activity, and pain-relieving medications. In some cases, your doctor may recommend a cortisone injection to help reduce pain and inflammation. In rare cases, surgery may be necessary when the pain and limitations become too great. The surgical treatment of shoulder arthritis is shoulder replacement where the arthritis is removed and replaced with metal and plastic parts.
3. Neck arthritis (cervical disc disease)
- Neck pain
- Pain that shoots into the back of the shoulder
- Pain that shoots into the arm
- Numbness or tingling in the arm
Neck arthritis causes narrowing of the discs that cushion the neck bones. This can cause the discs to bulge out from in between the bones. These bulging discs can then put pressure on the spinal cord or nerves that run into the arm.
Neck arthritis can also cause bone spurs to form around the nerves and spinal cord. These bone spurs can also place pressure on the nerves in the neck.
These “pinched nerves” can cause severe pain in the neck, shoulder, and arm. The pain can be a burning or lightning sensation and you may feel numbness or tingling in the arm.
Most cases of neck arthritis and pinched nerves respond to treatments such as physical therapy, regular use of NSAIDs (anti-inflammatory drugs), and modifying your activity.
In rare cases, neck arthritis can place severe pressure on the nerves or spinal cord leading to weakness in the arm or a condition called cervical myelopathy. This can cause difficulty walking, clumsiness, loss of balance, and urinary urgency. Contact your doctor immediately if you develop any of these symptoms.
4. Bruised upper arm muscle
- Constant upper arm pain
- Known injury to the affected area—back of the arm (tricep) or front of the arm (bicep)
- Swelling of one arm
- Upper arm bruise
A bruised muscle is when there is trauma to the area that damages the blood vessels that return blood to the heart (the capillaries and veins). This causes blood to pool, which is why you get a blue or purple colored bruise. A bruise will stay visible until the blood is either absorbed by the surrounding tissue or cleared by the immune system.
If your tricep is bruised, the back of your upper arm muscle will feel tender and probably have a visible bruise on the skin. In the case of a bruised bicep, the front of the arm is painful.
Treatment involves RICE (rest, ice, compression, elevation).
Other possible causes
Pain in the upper arm usually is often caused by problems with the neck or shoulder but may also come from the bones or muscles in the arm. —Dr. Schwartz
A number of conditions may also cause severe upper arm pain, though these are either rare or severe upper arm pain is not usually the defining symptom. They include:
- Complex Regional Pain Syndrome: Unexplained severe pain that usually occurs after an injury or prior surgery.
- Brachial plexopathy: Upper arm nerve pain as a result of excessive stretching of upper arm nerves.
- Septic arthritis: Sudden and severe shoulder pain often associated with fevers, chills, and warmth. Any motion of the shoulder is extremely painful.
- Osteomyelitis: An infection in the upper arm bone that usually occurs after a severe injury or from prior surgery on the shoulder or upper arm.
When to call the doctor
You should contact your doctor if you have any of the following symptoms of upper arm pain:
- Pain that worsens or does not respond to 3 to 6 weeks of conservative treatment
- Severe loss of shoulder motion
- Worsening weakness or numbness in the arm
Should I go to the ER for severe upper arm pain?
You should go to the emergency department if you have any of these signs of a more serious problem:
- Severe pain with any attempt to move the shoulder or upper arm.
- Upper arm or shoulder pain associated with fevers, chills, or redness.
- Difficulty walking, loss of balance, and loss of bowel/bladder control associated with severe neck and shoulder pain.
Severe upper arm pain treatments
In orthopedics, we consider the arm (sometimes referred to as the upper arm) to be the area from the shoulder down to the elbow. The area from the elbow to the wrist is called the forearm. —Dr. Schwartz
- Low-impact exercise, yoga, or meditation may be helpful in resolving pain.
- Over-the-counter pain relievers such as ibuprofen (Motrin, Advil), naproxen (Aleve), or acetaminophen (Tylenol).
- Ice or heat. One is not better than the other, but ice is good for reducing pain and swelling and heat is good for loosening tight muscles and joints.
- Resting the arm or avoiding activities or motions that cause pain can help relieve discomfort.
Other treatment options
- Surgery may be necessary to remove bone spurs or disc bulges in the cervical spine that could be causing symptoms.
- Prescription medications including antibiotics for infections or steroids for severe inflammation.
- Physical therapy or rehabilitation to help you restore range of motion, strength, and stability to your shoulder, especially after an injury.
- Acupuncture to help control severe pain.
- Injections of cortisone into the shoulder joint or around pinched nerves in the neck can reduce local inflammation.
Dr. Schwartz is a board-certified Orthopedic Surgeon and Member of the Buoy Medical Advisory Board. He graduated Magna Cum Laude from the College of William and Mary (1998) with a B.S. in Biology, then obtained his medical degree from the Medical College of Virginia (2002) where he was elected to the Alpha Omega Alpha Medical Honor Society. After completing his Orthopedic Surgery Residency at Boston Medical Center (2007), Dr. Schwartz performed a fellowship in Adult Reconstruction at the Anderson Orthopedic Clinic in Alexandria, VA (2008). As a private practice surgeon, Dr. Schwartz specializes in the treatment of hip and knee arthritis including joint replacement surgery.
On a national level Dr. Schwartz serves several leadership positions including as an Editorial Board Member of the Journal of Arthroplasty, a member of the Practice Management Committee of the American Association of Hip and Knee Surgeons, and a member of the Hip and Knee Content Committee for the American Academy of Orthopedic Surgeons. With a keen interest in healthcare technology, Dr. Schwartz has served as a mentor for several digital health incubators and as an advisor for health tech startups. He joined Buoy as a content writer in 2019 and became a member of the Medical Advisory Board in 2020.