Shoulder or arm pain is the third most popular muscle and bone complaint in the United States, contributing to $3 billion of annual healthcare costs. The pain usually appear on the outside of the shoulder that may radiate further down your arm or elbow. Causes of shoulder and arm pain include injuries, overuse conditions and pain that travels to the arm.
Overuse conditions that can cause shoulder and arm pain include tendinitis, bursitis, tennis elbow or rotator cuff tears. Tennis elbow is the result of irritation of the tendons that can cause pain in the lower portion of the arm or outside of the elbow joint. A rotator cuff problem can also cause a deep aching sensation outside or further down the arm. This pain usually occur when you lift the arm up overhead or sleep at night.
Traumatic Conditions such as fractures, muscle contusions, dislocation of elbow or shoulder can cause significant shoulder and arm pain. If you suffer from a fall or significant injury, you’d better see your doctor as soon as possible.
Sometimes, other conditions such as angina, thoracic outlet syndrome or a heart attack can also lead to pain radiating down the arm. Another common cause of radiating pain may be a result of a ‘trapped’ or ‘pinched’ nerve. This problems can cause tingling, numbness and shoulder pain that radiate down your arm.
What Is A Trapped Nerve?
A trapped nerve is a non-scientific term used to describe the pressure exerted on a nerve by either bone, soft tissue or a herniated disc. If you’re suffering from a trapped nerve, its essential to understand the causes as well as any potential treatment options available.
First, let’s take a look at what causes the problem.
Pinched Nerves:Causes of Shoulder Pain Radiating Down Your Arm
There are two common causes of pinched nerves: degenerative changes through ageing, or injury.
Your spinal column consists of 24 bones stacked on top of each other, called vertebrae. The cervical spine contains seven small vertebrae that begin at the base of the skull and form the neck. The job of the spinal column is to protect your delicate, spinal cord. The spinal cord is a network of electrical cables carrying signals up and down the body-a human being’s control centre.
As our body ages, the vertebrae in our spine shorten and swell, drying out in the process. As the length of the vertebrae shortens, they move closer to each other. The body reacts by forming extra bone to reinforce the region around the disc, often trapping nerve endings in the process.
This degenerative process is often referred to as arthritis and is usually not cause for alarm. Arthritis is a common occurrence in an ageing body, and for the most part, will affect nearly everyone in their lifetime. Rest assured that worn discs occur in almost half of the middle-aged population, and for most, they cause few issues.
In younger patients, a herniated disc is usually a result of injury associated with awkward movements, such as lifting objects that are too heavy. Here, the centre of the vertebrae pushes against the outside of the disc. This process puts external pressure on the nerve ending, which causes discomfort and weakness in the area.
Typical Symptoms of Pinched Nerve
The common symptoms of a pinched nerve include shoulder pain or electrical ‘shooting’ sensations down the arm. They can consist of muscle weakness or a numb feeling, aches or a tingling sensation (pins and needles). The severity of the pain varies based on the location and cause of the trapped nerve. A common complaint from some patients is waking up with a sore or ‘frozen’ neck.
A pinched nerve usually only causes pain in one shoulder. Often, it’s a sharp pain as opposed to a dull ache or discomfort similar to that you may experience when you’ve overworked your muscles.
Tests the Shoulder Pain Radiating Down Your Arm at Home
Before visiting a medical professional, you can conduct a few, easy to do tests at home to self diagnose the issue. Please remember that these tests do not replace a medical diagnosis, and you should always discuss with a qualified medical practitioner to obtain an accurate diagnosis.
Test 1: Neck Stretching
This test will determine whether relieving tension on the nerve reduces or relieves your symptoms.
First, tilt your head to the side that does not cause discomfort. With your other arm, hold your head in this position for a minute or two, stretching the neck muscle.
Does this relieve your symptoms, including a reduced sense of numbing or warming sensation in the arm? If yes, move on to test 2.
Test 2: Arm Tension
First, establish your normal range of movement by taking this test with your non-painful arm.
Holding your arm out in front of you, rotate your palm outward to face away from your body. Slowly move your arm to the side, as far as it will comfortably go.
Using the arm causing you discomfort, repeat the process. If you notice an increase in symptoms, decreased range of movement or pain, stop the exercise and move on to test 3.
Test 3: Neck Compression
Starting again with the side that is not causing you pain, turn your head to one side, so your ear is almost touching your shoulder. Rotating your head slightly, look backwards over your shoulder and hold for a minute. Once complete, reperform the test on the painful side.
If you feel any sort of pain radiating down your arm, an increase in numbing or tingling, move onto the final test.
Test 4: Turning your head
Turn your head to the side that is not painful and hold it there for a few seconds. You shouldn’t notice any restricted movement or pain. Next, turn your head in the opposite direction and hold for a few seconds. If you experience restricted movement or an element of pain radiating down your arm, then you have a positive result for this test.
If you have gone through each test and reached the end, you are likely suffering from a trapped or pinched nerve. The next step is to gain a comprehensive diagnosis from a medical practitioner.
How Is It Diagnosed?
As with any potential medical issue you are facing, you should always seek the advice of a qualified medical professional. If your shoulder pain is caused by a pinched nerve, you will need a thorough physical examination of your neck and shoulder to diagnose the issue.
A spine specialist can usually identify the issue by assessing your symptoms and a thorough physical exam. The doctor can also perform an examination of your reflexes. As part of the process, it is usual practice for your doctor to ask you to perform specific movements which are designed to cause you discomfort. Allowing your doctor to visibly see what is causing you pain will lead to a quicker and more accurate diagnosis.
After a physical examination, various additional tests could be conducted. An x-ray will typically be taken to take a look at the structure of your bones – specifically your spine. This is useful to determine any misalignment of the vertebrae, one of the signs of a trapped nerve.
A CT scan may be more appropriate, which is much more detailed than a traditional x-ray. A CT scan is particularly useful when determining whether extra bone has been formed in your spine.
An EMG scan (electromyography) can be used to detect the electrical signals in muscles when resting and through exertion. It can be used to diagnose irregular nerve functions. It can be used to rule out other problems that affect the nerves, including diabetes.
An MRI scan is fantastic at analysing internal soft tissues. Although daunting, MRI scans will allow a doctor to detect whether your pain is caused by damage to the soft tissue in your spine. It is also helpful to determine any damage to nerve endings or your spinal column.
Treatments For Shoulder Pain Radiating Down Your Arm
Thankfully, many patients who suffer from trapped or pinched nerves go on to recover fully and do not need any form of treatment.
In most cases, pinched nerves usually get better without the need for surgery, and some don’t require treatment at all. In the most extreme of circumstances, your doctor may conclude a formal treatment plan, and this can exist in various forms.
1. Ice application
Ice application is an effective home remedies that can help reduce inflammation, pain and prevent swelling in the affected area. You can wrap some ice with cloth and apply it to the shoulder and arm region. Make sure you don’t place ice cubes directly on the skin, as this will hurt the skin.
Doctors will often do all they can to avoid prescribing medication. Still, in some cases, it is the most appropriate option. There are two most common groups of medicines doctors will often diagnose to treat pinched nerves:
- Anti-Infammatories: This includes common over the counter medications, designed to reduce any inflammation and provide pain relief.
- Corticosteroids: Another medicine which reduces inflammation, a short course of this oral medication can be useful in alleviating some of the underlying symptoms of trapped nerves.
Physiotherapy using prescribed exercises can lead to a reduction in pain and firming up of the underlying muscles that support the neck. It is also important in recovery, and we will discuss this further later on.
4. Foam Neck Collar
You will probably be familiar with this treatment as it is very visible and often used to treat whiplash injuries for those involved in car accidents.
Here, a padded foam material is wrapped around the neck and secured with Velcro. This device allows the muscles in your neck to rest, reducing the burden of the head on the underlying vertebrae. The result can decrease any pinching or trapping of nerves in the cervical spine.
Such collars should only be worn for short periods to prevent any long term effects on the muscles in your neck, so please follow the guidance of your doctor.
5. Steroid Injections
Steroids are an effective treatment for trapped nerves. When injected around the area concerned, the steroid can reduce inflammation. The goal here is to minimise the swelling for long enough so that the nerve can recover, providing long term relief.
6. Surgical Treatment
Having worked through several other options, or if your case is adequately severe, surgical intervention may be recommended. Depending on the severity of your situation and any underlying health conditions, there are a variety of surgical procedures available to you. Your case will be thoroughly assessed by your doctor and a recommendation made as to most appropriate treatment.
When to See Your Doctor
There are serious symptoms that you should see a doctor immediately.
- Severe pain due to injuries such as fractures or dislocations
- Pain cannot be relieved after simple treatment at home
- Pain lasts for a long time or even severe at night
- Severe swelling or redness appear around the pain area
- Unexplained pain or you wonder it is the symptoms of a heart attack
As with any form of surgery, there are associated risks you should be aware of before undergoing treatment. Thankfully, the chance of any serious complications is low. Still, you should always go into surgery with an understanding of the potential risks.
Potential risks include:
- Further nerve injury
- Excessive bleeding
- Further injury to the spinal column
- Adverse reaction to anaesthetics
- Nerve sac damage
- Life-threatening complications with the heart or lungs
Post-surgery, you will usually stay in the hospital for a day or two. However, this varies depending on the extent of the surgery you have undergone. In usual cases, eating and walking is possible the day after surgery. Still, it’s normal to feel some discomfort swallowing for a few weeks after surgery.
To help the healing process, you may need to wear a foam collar to alleviate some of the pressure on your neck vertebrae. If you have undergone spinal fusion, your body may take up to a year to fully recover while the bones solidify.
You may need certain restrictions to prevent further complications, such as avoiding any strenuous activities like lifting heavy objects or intense workouts. Light exercise, such as walking, is excellent and is essential to rebuild your muscle strength.
Post Surgical Physiotherapy
After sufficient healing time, you will usually need to perform a daily strength-building routine. It’s essential to stick to this to speed up recovery time. Physiotherapy will typically include some basic movements you can do at home, with the guidance of a professional.
When Can You Return To Work?
If you suffer from shoulder pain radiating down your arm, you can return to light duties (including desk-bound jobs) a few days or weeks after surgery, depending on the severity. Usually, patients can resume their full, daily routine after a few months. This should always be done on the advice of your doctor to avoid any complications.
All being well, an overwhelming majority of patients experience a full and favourable outcome after surgery. With pain and other symptoms subsiding, most patients can lead a complete and full life.