Pain in My Upper Arm: What Is Actually Causing It?

The sore part is the arm itself, between the shoulder and the elbow, often on the outside about where a shirt sleeve ends. And when somebody asks about your shoulder, you tell them the shoulder feels fine. The upper arm is a destination far more often than an origin, which is why people spend months treating an arm that was never the problem.

First, the arm pain that is not an arm problem

The arm is a classic place for a heart to send its signal, so this goes first.

Call 911 if arm pain arrives with pressure or tightness in the chest, shortness of breath, a cold sweat, nausea, lightheadedness, or pain spreading into the jaw, neck or back. That is not a muscle, a tendon or a joint. It is more often the left arm, but the right arm counts and so do both.

In women, a heart attack shows up as back pain, nausea and trouble breathing more often than as the gripping chest pain that films have trained everybody to expect. "This is not how I thought it would feel" is the thought that keeps people sitting still, and sitting still is the part that costs.

One supporting detail, and supporting is all it is. Pain from muscles, tendons and joints can usually be provoked: move the arm a certain way or press the sore area, and the pain answers. Heart pain generally does not. Do not turn that into a home test. Pain you cannot reproduce proves nothing by itself, and pain you can reproduce does not cancel out chest pressure, sweating or breathlessness alongside it. If those are there, call 911.

Where the pain stops is the useful clue

Ask how far down it travels.

Pain that stops above the elbow points upward, toward the shoulder as the source. That boundary is a real pattern rather than folklore, and it is the most useful thing on this page. Pain that carries past the elbow into the forearm or hand points elsewhere, usually the neck, especially with numbness, pins and needles, or a weakened grip. Neither is a diagnosis, but both are worth noticing early.

The four usual sources

• The shoulder, referring down. The most common by a distance. An irritated rotator cuff tendon often announces itself as a deep ache in the outer upper arm rather than at the shoulder, and it stops above the elbow. Worse reaching overhead, worse lying on that side. See shoulder pain and shoulder pain at night.
• The neck, referring down. A nerve root at the base of the neck produces genuine arm pain, and it travels further, past the elbow and sometimes into the hand. Neck stiffness, an ache near the shoulder blade, numbness, tingling or weakness often come with it. See numbness and tingling in the hands and arms.
• The biceps tendon at the front of the shoulder. Pain down the front of the upper arm in a narrow line, sore reaching forward or lifting with the palm turned up.
• A strain of the arm muscle itself. The least common of the four, despite being most people's first guess. A real strain has an event behind it, usually a heavy lift or a hard pull, and it settles over a few weeks.

How Tradewinds sorts it out

At Tradewinds Chiropractic & Wellness in Charlotte Amalie, St. Thomas, the exam starts with where the pain ends and what makes it fire. Then the shoulder: range of motion, cuff strength muscle by muscle, the biceps tendon at the front. Then the neck, because a neck that feels fine still has to be ruled in or out. The arm muscle is pressed last, the least likely culprit.

Dr. Keys is the Chair of the Virgin Islands Board of Chiropractic Examiners, a member of the Virgin Islands Chiropractic Society, and the International Chiropractors Association representative for the U.S. Virgin Islands.

Care follows the finding, not the location of the ache: adjustment of the shoulder, collarbone and upper back joints, neck care when the neck is the source, soft tissue work along the tendons, and rehab for the cuff and shoulder blade. Our services page lists the methods. A shoulder that is stiff rather than sore is frozen shoulder and rotator cuff. How badly it is damaged is the call made on tear or just soreness. Elbow pain starts with tennis and golfer's elbow.

When you should see someone else

Call 911 for arm pain with chest pressure, breathlessness, sweating, nausea, or pain spreading to the jaw, neck or back.

Go to the nearest emergency room for:

• Sudden severe arm pain after a serious fall, crash or hard blow, particularly with visible deformity or an arm you cannot use
• An arm that is cold, pale, dusky, or losing feeling
• Fever with a hot, red, swollen arm

See a physician or an orthopedist for arm weakness getting worse week over week, or arm pain alongside fever, night sweats, or unexplained weight loss.

Visitors, crew and cruise passengers

Winch grinding and a week of overhead work land people here. Tell us your departure date.

Getting seen

Call (340) 690-4994 to get the arm examined. We take walk-ins and same-day appointments. We are in the VI Medical Foundation Building, Suite 202, 9150 Estate Thomas, St. Thomas, USVI 00802, just east of Charlotte Amalie. Hours are Mon, Wed, Thu: 10:00 am to 1:00 pm and 3:00 pm to 7:00 pm. Tue, Fri: 7:00 am to 2:00 pm. Closed Sat and Sun. New patient forms are at forms. Tradewinds Chiropractic has more than 180 five-star Google reviews.

Questions patients ask

What causes pain in my upper arm?

Four things account for most of it. An irritated rotator cuff tendon in the shoulder, which classically refers a deep ache into the outer upper arm and stops above the elbow. A nerve root in the lower neck, which usually sends pain further down, past the elbow, often with numbness or tingling. The biceps tendon at the front of the shoulder, felt down the front of the arm and sore when you lift with the palm up. And a genuine strain of the arm muscle, which is the least common of the four and almost always follows a specific event.

Why does my upper arm ache when my shoulder feels fine?

Because the shoulder often refers its pain rather than keeping it. Rotator cuff tendons send the ache down into the outer upper arm, so the arm is where you feel it while the shoulder itself may feel unremarkable when you are sitting still. That is one of the main reasons upper arm pain gets treated in the wrong place for months.

How do I know if my upper arm pain is coming from my neck?

Watch where the pain ends. Pain that stops above the elbow points toward the shoulder. Pain that carries past the elbow into the forearm or hand points toward the neck, particularly when it comes with numbness, tingling, weakness, neck stiffness, or an ache near the shoulder blade. Pain that changes when you turn or tip your head also points that way. An exam settles it.

Can upper arm pain be a heart attack?

It can. Arm pain that comes with chest pressure or tightness, shortness of breath, sweating, nausea, or pain spreading into the jaw, neck or back is a 911 call, not an appointment. It is more often the left arm but can be either. In women it more often presents as back pain, nausea and trouble breathing than as the gripping chest pain people expect, so it may not feel the way you assume it should.

My upper arm pain gets worse when I move the arm. Does that mean it is not my heart?

No. Pain from muscles, tendons and joints can usually be provoked by moving or pressing the area, and pain from the heart usually cannot, but that is a supporting sign and not a test you can run on yourself. Do not use it to talk yourself out of calling for help. If there is chest pressure, breathlessness, sweating or nausea in the picture, call 911 regardless of what happens when you move the arm.

Is upper arm pain ever just a pulled muscle?

Sometimes, and when it is, there is usually an obvious moment behind it: a heavy lift, a hard pull, catching something as it fell. A true arm strain is tender to press right on the muscle, hurts when you contract it, and improves over a few weeks. Pain with no event behind it, or pain that has hung around for a month, is more likely referred from the shoulder or the neck.