Pain in the outer upper arm

General

The pain on the outer upper arm is an unpleasant sensation that can develop for various reasons. Soft tissue such as muscles and bursae as well as nerves and bones can be damaged and thus be responsible for the pain.

The nature of the pain varies depending on the cause between stabbing, pulling or blunt. Often there is also a radiation of pain in the outer upper arm starting from the shoulder. In addition, the pain can occur selectively or over an area.

The localization of the pain on the outer upper arm is characteristic of some injury patterns or diseases, which are explained in more detail below.

Please also read: Upper Arm Pain - What Do I Have?

causes

The causes responsible for pain in the upper arm are very diverse.

Different structures can also be affected:

• Muscles,
• Annoy,
• Bursa
• or bones.

For muscular injuries (med .: Lesions) it is mostly about sore muscles, tension or torn muscle fibers.

On the outside of the upper arm, the deltoid muscle (lat .: Deltoid muscle) a relevant muscle.
In general, both muscles directly on the upper arm and muscles of the rotator cuff, i.e. the shoulder joint, can be affected, which can lead to the pain radiating to the outer upper arm.

Are considered a rare cause of muscular pain Myositis, so to call muscle inflammation.

If the pain originates from nerve structures, then there is either inflammation of certain nerves, i.e. neuritis, or, for example, a viral disease, shingles, which is dermatome-related. Those affected typically experience nerve pain as stabbing or prick-like. Nerves that run on the upper arm and can be affected would be, for example Radial nerve -and Axillary nerve.

In addition, inflamed bursa of the shoulder joint can be responsible for the pain in the outer upper arm. Due to the anatomical proximity to certain upper arm muscles, such as the deltoid muscle, the pain can spread through the muscle.

The deltoid muscle itself can also be the cause of pain due to a mass caused by the swelling of the inflamed bursa because it is compressed and narrowed.

Ultimately, bony injuries can also lead to pain in the upper arm. The fracture of the upper arm after a fall is worth mentioning as the best example.

Bursitis

Pain in the outer upper arm can be caused by inflamed bursae in the shoulder.
There are four larger relevant bursa in the shoulder. Functionally, they serve to cushion the surrounding muscles, tendons and nerves and to buffer the pressure or friction forces that act during stress. The buffering is possible because the bursa is filled with synovial fluid, the so-called Synovial fluid, are filled.

If the shoulder is subjected to very strong and long-lasting mechanical stress, these bursa can become infected.
The inflammation is associated with severe pain in the shoulder itself, but also in the upper arm.
As part of the inflammatory reaction, the bursa swell due to the increase in the synovial fluid they contain, in addition to the pain, so that they can constrict surrounding muscles or nerves.

Since muscles run or arise in this area that also extend to the upper arm, the pain can extend along these structures to the outer upper arm. This is how the radiation character of the pain can be explained. The best example here is the deltoid muscle (lat. Deltoid muscle). It arises at various points in the shoulder joint area and attaches to a roughened bone structure, the Humerus deltoid tuberosity ("Tuberosity" = protruding bone with a roughened structure; "Humerus“= Humerus). The deltoid runs directly over one of the outer bursa.

This spatial proximity is responsible, for example, for the transmission or transmission of the pain to the upper arm.

Read more about this at: Bursitis of the shoulder

Injuries to the triceps muscle

The triceps is a muscle with a functional effect on the shoulder and elbow joint.
Tensioning the muscle causes a Adduction, i.e. pulling the upper arm towards the trunk and stretching the elbow joint.

The triceps run along the back of the upper arm from the shoulder to the elbow. In addition to the biceps on the front of the upper arm, it is one of the large upper arm muscles. Due to its anatomical position and size, damage with pain in the upper arm can also manifest itself on the rear outer side.

Read more on the topic: Pain in the back of the upper arm

Sore muscles can be a harmless reason for the pain. Here the triceps has several tiny tears in the muscle fibers.

In more severe cases, however, tears or tears in the area of ​​the tendons of the triceps may occur. Those affected perceive this pain as much more intense than pure muscle ache.
Depending on the severity of the tear, there may be swelling due to the muscle belly slipping off and a bruise.

Rotator cuff damage

The term rotator cuff encompasses four muscles of the deep shoulder muscles.

These are the:

• M. infraspinatus,
• M. supraspinatus,
• Subscapularis muscle
• and M. teres minor.

They all arise from bony structures in the area of ​​the shoulder joint and are attached to the large and small bones, Greater tuberosity and Lesser tuberosity, of the humerus.
The deep muscles of the rotator cuff encircle the shoulder joint and therefore perform the task of holding the joint in place.

If the rotator cuff is injured as a result of falls, excessive strain or inflammation, the pain can radiate along the muscles to the upper arm.
Here again, the muscle attachments on the outside of the upper arm are responsible for the transmission of the pain.

In addition to the pain, there is a restriction of movement or instability of the shoulder joint, especially when moving.

Read more on the topic: Rotator cuff tear

Nerve inflammation

Also by a nerve inflammation (lat .: neuritis) pain can occur. Depending on which nerves in the shoulder and arm area are affected, the pain can be projected onto the outer upper arm.

In general, the pain due to nerve inflammation is much more intense and severe than pain due to muscular damage.
Those affected describe the pain in the upper arm as pulling along the nerve.

With a nerve inflammation, however, not only the inflamed nerve itself hurts, but possibly also the surrounding muscles supplied by the nerve.
In addition, the pain in the upper arm is often accompanied by a tingling sensation on the outside.

Because the pain is so intense, those affected are very limited in their daily mobility; especially when moving overhead, for example when putting on tops or when combing hair.
Reasons for a nerve inflammation in the area of ​​the outer upper arm can be improper or excessive strain, strong mechanical irritation or entrapment.

Especially the shoulder area in the transition to the upper arm is a frequent manifestation of nerve inflammation.Nerves such as the axillary and radial nerves run in the nerve bundle in the shoulder and armpit area and then pull to the outside and back of the upper arm. This bundle of nerves Brachial plexus, can be pinched by certain posture. An inflammation of the nerves running in it can then be the result.

In this case one speaks of a thoracic outlet syndrome.

Shingles

Stitch-like pain on the outside of the upper arm can be seen as a typical first sign of shingles.

This is the skin manifestation of a viral disease with the Varicella zoster virus (VZV), the trigger for chickenpox. At the beginning, in addition to the stinging pain, symptoms such as fatigue and fever occur.

A few days later, the characteristic skin rash with blistering, which is called shingles, develops. This rash always manifests itself along a circumscribed area of ​​skin that is supplied by the affected nerve.

In addition, there is an increased sensitivity to pain in the affected area. Even otherwise painless touches are perceived as painful. One speaks here of one Allodynia.

Read more on the topic: Shingles pain

Upper arm pain after a fall

A fall on the arm is usually absorbed by the impact of the elbow or shoulder.

Nevertheless, the outside of the upper arm can also be affected in such a fall.
Subsequent pain can develop from injuries to the humerus, muscles, or nerves.

A radiation of pain triggered by an injury to the shoulder is also possible. Such an injury could include damage to one or more rotator cuff muscles or bony injuries.

The functionality of individual muscles can be tested using various clinical tests.
In this way, conclusions can be drawn as to whether muscles, for example, were torn or completely torn during the fall.

If pain on the outer upper arm can be triggered particularly intensely at a single point, this can be an indication of a bruise.

In any case, in addition to the pain, bruising and swelling of the upper arm can occur.
Furthermore, the humerus can break if you fall. This goes with severe pain and possibly certain signs of fractures such as unnatural mobility, visible pieces of bone in an open fracture and Crepitations, so rubbing noises of the bones. Owing to the multitude of causes, pain on the outer upper arm after a fall requires precise diagnosis.

Concomitant symptoms

Outer upper arm pain is rarely the only symptom. The pain occurs much more frequently in combination with other complaints, depending on the cause.

Muscular damage in the form of torn muscles usually results in a bruise and swelling. In addition, the pain in such cases is movement-dependent.
Depending on the severity of the injury, this can lead to restricted mobility or disability for those affected, which leads to everyday problems such as getting dressed.

If a bursa is inflamed in the shoulder area and pain is radiated into the upper arm, swelling and overheating of the entire shoulder joint typically occur at the same time.

If, on the other hand, the pain in the upper arm is based on damage to nerve tissue, for example in the case of nerve inflammation, those affected also complain of abnormal sensations in the form of a tingling sensation.

If the symptoms of shingles, which should be taken seriously, are responsible for the pain, typical accompanying symptoms are fever, fatigue and a skin rash with grouped blisters.

With fractures of the upper arm, accompanying unsafe or certain signs of fracture can develop.

• Uncertain symptoms include the pain, swelling, bruising and restricted mobility already mentioned.
• Sure signs are abnormal mobility of the upper arm, visible pieces of bone in the case of an open fracture, Crepitations, so to name friction noises and an obvious misalignment of the upper arm. In general, the accompanying symptoms are designed individually depending on the cause of the pain.

diagnosis

Further diagnostics for pain in the outer upper arm is very important, as a variety of causes can be responsible for the pain.

First of all, a detailed doctor-patient consultation should take place in order to obtain information about possible falls, previous illnesses or injury mechanisms and thus to be able to narrow down the diagnosis somewhat.

This is followed by a thorough clinical examination of the upper arm. Here the tenderness and mobility are checked.
Some special tests are also done to check the functionality of any muscles in the upper arm and shoulder. Here, for example, the suspicion of a muscle tear can already harden.

In order to rule out a fracture of the upper arm, the doctor will also examine for signs of fractures as part of the clinical examination. If the suspicion is confirmed, an X-ray can be made afterwards. In order to assess soft tissue such as muscles, eyes or bursa, an ultrasound can be performed first.

In the specific case of a bursitis, a puncture to obtain the synovial fluid provides information about whether the inflammation is due to a bacterial infection.

In most cases it can already be determined what the cause of the pain is. Very rarely it may be necessary to carry out more detailed investigations, such as a CT or MRI image.

treatment

Treatment for pain depends on the cause.

In general, it is important to protect the upper arm and keep it still. The so-called PECH rule can be applied here. This describes initial measures after an injury.

Read more about this at: PECH rule

Muscle inflammation or tears logically require a much shorter immobilization than fractures. In the event of a break, such immobilization can be supported by a plaster cast or splint.

In any case, the administration of painkillers is indicated. This can be done in the form of tablets, ointments, or injections.
Pain relievers from the substance group NSAIDs (“non-steroidal anti-inflammatory drugs”) are particularly suitable, as they have both pain and inflammation relieving effects.
In the case of inflammatory causes, active ingredients such as diclofenac, ibuprofen or ASA are very helpful. For example, the pain ointment Voltaren® contains the active ingredient diclofenac.
For the sole treatment of pain without inflammatory processes, painkillers such as paracetamol or Novalgin® can also be effective.

Other medications can be antibiotics, for example in the case of bursitis caused by a bacterial infection.

Viral shingles can also be treated with a virostat such as acyclovir.
Another conservative measure reported is that acupuncture has a positive effect on nerve pain. Physiotherapeutic treatment always makes sense if mobility is only possible to a limited extent for a longer period of time or if you have to carefully get used to a reloading after immobilization.

This would be the case with more severe muscle lesions and fractures of the upper arm. Surgical treatment for pain in the upper arm may also be necessary, depending on the cause.

If the fractures are complicated, they have to be treated surgically with the help of osteosynthesis, for example.

In the case of a pronounced muscle tear, the torn tendons must be sewn together again in a surgical procedure.

The treatment concept ultimately depends largely on the exact cause of the pain.

Duration of pain

A general statement about the duration of pain in the outer upper arm is not possible.

The duration varies enormously depending on the cause of the pain. Harmless reasons can be associated with a very short healing time, while more serious illnesses or damage can lead to complaints that last for months.

With sore muscles as a pain trigger, those affected usually only suffer from their symptoms for a few days. A muscle strain only lasts a few days longer.

The same applies, for example, to a bursitis. If, for example, muscle tears, fractures or shingles are responsible for the pain in the outer upper arm, the healing process can take several weeks to months.

Those affected have a major influence on the duration. Adhering to prescribed therapeutic measures, patience and optimism have a positive effect on the healing process.