Arm and Shoulder Pain: Possible Causes and Next Steps

Pain in the back of the arm?

Hello, doctor...
At the beginning of December, I started experiencing soreness in my shoulder, arm, and chest muscles.
It hurts when pressed, but only feels achy when not pressed.
I later visited a rehabilitation specialist who performed no tests, only a physical examination, and diagnosed me with acromioclavicular joint arthritis.
I took medication for three days, and my shoulder condition has improved significantly.
However, pressing hard still causes soreness.
The arm soreness persists, mostly in the right arm, with occasional soreness in the left.
In the past week, I've also started feeling soreness in both scapulae.
When I press on the sore spot of the right scapula, my entire arm goes numb.
Additionally, the area between the scapulae, which should be the spine, is also very sore when pressed.
I would like to ask what might be the issue and what kind of examinations should I undergo.
Thank you.

Wu Xiansheng, 30~39 year old female. Ask Date: 2015/12/30

Dr. Gao Chunde reply Neurology

You may have pressed on a trigger point located on the scapula, which can cause numbness and discomfort throughout the entire arm.
This typically occurs in muscles that have been subjected to poor posture, lack of exercise, and sleep disturbances, leading to dysfunction in the muscle itself.
When pressed, it can trigger soreness in a whole area of the muscle.
This can usually be confirmed and treated in rheumatology and rehabilitation clinics.

Reply Date: 2015/12/30

More Info

Hello! Thank you for reaching out with your concerns regarding your arm and shoulder pain. Based on your description, it seems that you are experiencing a combination of shoulder and arm discomfort, which may be related to several underlying conditions. I will outline some possible causes and recommend next steps for evaluation and treatment.

Possible Causes
1. Shoulder Impingement Syndrome: This occurs when the tendons of the rotator cuff become irritated and inflamed as they pass through the shoulder joint. Symptoms often include pain when lifting the arm or reaching overhead, and tenderness in the shoulder area.

2. Rotator Cuff Injury: Given your history of shoulder pain, a rotator cuff tear (partial or complete) could be a possibility. This injury can lead to weakness, pain, and limited range of motion in the shoulder.

3. Acromioclavicular (AC) Joint Arthritis: Inflammation or degeneration of the AC joint can cause pain at the top of the shoulder, especially when lifting or reaching.

4. Cervical Radiculopathy: Since you mentioned pain radiating down your arm and into your fingers, this could indicate nerve compression in the cervical spine. A herniated disc or degenerative changes in the cervical spine can lead to symptoms in the shoulder and arm.

5. Myofascial Pain Syndrome: Trigger points in the muscles around the shoulder blade and neck can cause referred pain, leading to discomfort in the shoulder and arm.

6. Thoracic Outlet Syndrome: This condition occurs when blood vessels or nerves in the space between your collarbone and your first rib are compressed, leading to pain, numbness, or weakness in the arm.

Recommended Next Steps
1. Comprehensive Evaluation: Since your symptoms have persisted and evolved, it would be beneficial to have a thorough evaluation by a healthcare provider. This may include a physical examination and a detailed history of your symptoms.

2. Imaging Studies: Depending on the findings from the physical examination, imaging studies such as X-rays, MRI, or CT scans may be warranted. These can help visualize any structural abnormalities in the shoulder, cervical spine, or surrounding tissues.

3. Physical Therapy: Engaging in a structured physical therapy program can help improve strength, flexibility, and range of motion in the shoulder. A physical therapist can also provide specific exercises to address any muscle imbalances or weaknesses.

4. Pain Management: Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) can help reduce pain and inflammation. If your pain persists, your doctor may consider corticosteroid injections or other pain management strategies.

5. Lifestyle Modifications: Avoiding activities that exacerbate your pain, maintaining good posture, and incorporating ergonomic adjustments in your daily activities can help alleviate symptoms.

6. Follow-Up: Regular follow-up with your healthcare provider is essential to monitor your progress and adjust your treatment plan as necessary.

Conclusion
Your symptoms of shoulder and arm pain, along with the recent development of scapular discomfort, warrant further investigation to determine the underlying cause. It is crucial to address these issues early to prevent further complications and improve your quality of life. I recommend scheduling an appointment with a specialist, such as an orthopedic surgeon or a neurologist, who can provide a comprehensive assessment and guide you through the appropriate diagnostic and therapeutic steps.

Please take care, and I hope you find relief from your symptoms soon!

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