Severe Pain Under Right Arm: Possible Causes and Solutions - Internal Medicine

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Severe pain under the right arm, especially when associated with exertion and difficulty in sleeping, can be indicative of several underlying issues. Given your description, it is essential to consider both musculoskeletal and neurological causes.

1. Musculoskeletal Issues: The pain you are experiencing could be related to muscle strain or injury, particularly in the muscles surrounding the shoulder and upper arm. Conditions such as rotator cuff injuries, tendinitis, or bursitis can lead to pain that radiates to the area under the arm. These injuries often occur due to repetitive overhead activities or trauma, such as a car accident, which you mentioned in your previous correspondence.
2. Nerve Compression or Injury: Another possibility is that the pain is due to nerve compression, particularly from the cervical spine or brachial plexus. Conditions such as cervical radiculopathy, where a nerve root in the neck is compressed, can cause pain that radiates down the arm and may be exacerbated by certain movements or positions. This could explain the severe pain during exertion and difficulty sleeping.

3. Referred Pain: Sometimes, pain in the shoulder or arm can be referred from other areas, such as the heart or lungs. Given your previous mention of a small opacity in the lung field, it is crucial to rule out any serious underlying conditions, especially if you experience additional symptoms like shortness of breath or chest pain.

4. Other Considerations: Conditions such as thoracic outlet syndrome, where blood vessels or nerves are compressed in the space between the collarbone and the first rib, can also cause pain under the arm. Additionally, muscle spasms or trigger points in the upper back or shoulder region can lead to referred pain in the arm.


Recommended Actions:
- Medical Evaluation: It is crucial to consult with a healthcare provider for a thorough evaluation. A physical examination, along with imaging studies such as X-rays or MRI, may be necessary to identify the exact cause of your pain.

- Physical Therapy: If the pain is musculoskeletal, physical therapy can be beneficial. A physical therapist can design a rehabilitation program that includes stretching and strengthening exercises tailored to your condition.

- Pain Management: Over-the-counter pain relievers, such as NSAIDs (e.g., ibuprofen), may help alleviate pain and reduce inflammation. However, it is essential to follow the dosage instructions and consult with a healthcare provider if you have any underlying health conditions.

- Activity Modification: Avoid activities that exacerbate the pain. If lifting or certain movements trigger discomfort, it may be wise to modify your activities until you receive a proper diagnosis.

- Follow-Up: Keep track of your symptoms and follow up with your healthcare provider, especially if the pain persists or worsens. Early intervention can prevent further complications and promote better recovery.

In conclusion, while there are several potential causes for the severe pain under your right arm, a comprehensive evaluation by a healthcare professional is essential to determine the underlying issue and appropriate treatment plan. Do not hesitate to seek medical attention, especially if you experience any new or worsening symptoms.