Upper arm pain physiotherapyBy Nigel Chua
Upper arm pain refers to pain that is felt anywhere from just below the shoulder joint to just above the elbow (the entire upper arm area).
Upper arm pain can be caused by problems in the muscles, tendons, bones, or referred pain from elsewhere such as the neck or heart.
It may be a sign of
- wear and tear
- postural problems
- an injury.
CAUSES OF UPPER ARM PAIN
1) Rotator Cuff Tear
What Is It:
This is a common cause of pain in the upper arm that is typically caused by damage to one of the tendons of the rotator cuff muscles, which refers to a group of muscles that surround the shoulder joint. Their main function is to control the movement and ensure stability of the shoulder joint.
Rotator cuff injuries may be caused by gradual wear and tear over time from repetitive friction, or may also occur suddenly with an injury such as falling onto an outstretched arm or picking up something heavy.
Patients typically experience upper arm pain across the shoulder and down the upper arm, usually reporting:
- dull ache
- cracking/popping noises when moving the arm.
- Lying on the affected arm
- Lifting or twisting the affected shoulder in movement.
- Patients are medically required to rest from aggravating activities.
- Rotator cuff exercises will be prescribed by our senior physiotherapists to strengthen and stretch the shoulder.
- Patients may benefit from steroid injections.
- In severe cases, patients may be advised to undergo corrective surgery.
Rotator cuff tears are often slow to heal and it can take a few months to fully recover. If symptoms persist for more than 6 months, surgery may be recommended.
2) Fractured Shoulder Or Humerus (Broken Upper Arm)
What Is It:
A fractured shoulder typically refers to a break or crack in the upper arm bone known as a fractured shaft of the humerus.
A mild case can be a simple small hairline fracture, but a more severe case can be:
- a spiral fracture of the humerus
- a communited fracture of the humerus into 2, 3 or more pieces
- an open fracture where the sharp fractured fragment pierces through the skin.
Typically, this injury occurs from a direct blow to the upper arm, such as in
- sports injuries
- a fall onto the hand or outstretched arm
- road traffic accidents
- very strong or severe twisting of the arm with strong contraction (such as an over head or over hand throw in martial arts).
In some rare cases, where the bone has severely weakened due to disease (such as osteoporosis or low bone mass) and cancer, the bone may be very brittle.
Patients will know that they have a bad injury as they will experience severe upper arm pain. Symptoms may include:
- sharp pain
- obvious deformity (if the fracture has displaced there may be a bulge where the bone is out of place)
- shortening of the arm
- minimal arm movement (most of the time they won't want to move their arm due to the pain).
- Any arm movement
- Pressure or force at or over the fracture site.
Simple and minor fractures may be treated by immobilizing the arm in a cast for around 4 to 8 weeks. However, complex or major shoulder fractures will require surgery to realign (reduce) the bones and stabilize them back together using either a metal rod or metal plate and screws.
Most patients usually require between 4 to 8 weeks for the bone to grow and stick back together, and then another 4 to 8 weeks for it to strengthen.
That being said, for elderly patients, fracture healing is often slower.
Patients will require shoulder physical therapy to regain strength and movement in the arm, as shoulder stiffness and weakness is very common after injuries and especially after a fracture.
Please note that it can take up to 12 months or longer to fully recover from an arm fracture.
3) Shoulder Impingement
What Is It:
Shoulder impingement is a broad general term that refers to any condition that causes a decrease of the subacromial space in the shoulder. This causes pressure, friction and pain of the rotator cuff tendons and muscles.
It is a common cause of shoulder and upper arm pain. It is usually caused by repetitive overhead activities such as throwing (e.g. cricket, baseball, softball) and swimming. Aging, posture and genetics can also play a part.
- Typically patients experience a "slow and gradual" onset that gets progressively worse over time.
- It most frequently develops in patients who are middle-aged, between 45 to 65 years old.
- Shoulder and upper arm pain, usually on the outside of the arm which may extend down to the elbow, often described as feeling like a deep arm ache that is similar to a tooth ache in nature.
- Painful arc with a certain range of shoulder movement (as shown in picture), and shoulder weakness.
- Shoulder movement is not usually restricted initially, but over time, shoulder stiffness may develop due to lack of use.
- Reaching and lifting above your head
- Lying on the affected side
- Reaching behind your back
- Getting dressed.
- Rest from aggravating activities
- Cold therapy
- Rotator cuff exercises to strengthen and stretch the muscles
- Possibly steroid injections.
If the impingement is caused by small bone spurs in the subacromial space, the patient will likely need to undergo corrective surgery to remove them, known as a subacromial decompression surgery.
It can take about 3 to 6 months for upper arm pain to settle with shoulder impingement syndrome, with or without surgery.
4) Frozen Shoulder
What is it:
Also known as adhesive encapsulitis, frozen shoulder refers to the thickening and tightening of the joint capsule, which is a fluid filled sac that surrounds the glenohumeral (shoulder) joint.
Patients typically experience a gradual onset over time (weeks and/or months). It is most commonly experienced in patients who are between the ages of 40 to 70, and moreso in females compared to males.
Currently the medical and scientific community have not found a direct or obvious cause, but it can develop after a shoulder injury or surgery.
There are three phases to a frozen shoulder, each with different symptoms:
- Phase 1: Shoulder and upper arm pain that gets gradually worse.
- Phase 2: Increasing restriction of shoulder movement in what is known as a capsular pattern – lateral rotation most limited, then flexion and medial rotation least affected.
- Phase 3: The pain gradually subsides but stiffness remains for a number of months.
The pain is often worse at night.
- Any forms of arm movement, particularly above head height or twisting movements.
Initially focuses on pain management, e.g.
- shoulder physiotherapy and frozen shoulder physiotherapy
- steroid injections.
Once the pain has settled, a shoulder physiotherapy exercise program is prescribed to patients to strengthen and stretch the shoulder to regain full movement. If symptoms fail to improve after six months, surgery may be recommended (shoulder manipulation under anesthesia).
Unfortunately, it can take up to two years to fully recover from a frozen shoulder. Each phase can last for a number of months.
5) Biceps Injury (Tendon Rupture)
What is it:
Inflammation and thickening (tendonitis) of the biceps tendon, or a tear, of the long head of the biceps tendon. It is often associated with other shoulder problems such as impingement and arthritis.
People who do lots of heavy lifting overhead are at a much increased risk of biceps injuries.
These types of injuries may develop
- gradually over time from overuse (natural wear and tear)
- suddenly with an injury such as a fall or lifting heavy weights.
- Tendonitis – achy upper arm muscle pain, mostly at the front of the shoulder where the tendon is, and especially when the arm is overhead.
- Tendon tear – sudden, sharp upper arm pain, sometimes accompanied by an audible pop, and bruising from the mid upper arm to the elbow. Sometimes if there is full tendon tear, patients may notice that there may be a bulge in the upper arm, known as a “Popeye Muscle”.
The upper arm pain may in both cases extend down to the elbow
- Heavy lifting, raising your arm above your head.
- In the early acute stage: lots of rest, cold therapy, mobilization exercises, and possibly steroid injections.
- In persistent cases of tendonitis, or severe tendon tears, patients may require corrective surgery, after which patients will need to wear a sling initially and start seeing our senior physiotherapists for a rehab program of strengthening and stretching exercises.
It typically takes between 3 to 6 months to fully recover from a biceps injury.
OTHER CAUSES OF UPPER ARM PAIN
In some cases, upper arm pain may actually be a symptom of a problem elsewhere.
- A condition where the blood supply to the heart is restricted which can cause upper arm pain.
- The pain typically gets worse with stressful and/or exertive activities, and eases with rest.
This happens when a blood clot blocks the blood supply to the heart. This is a medical emergency. If your upper arm pain is experienced in the left arm, and is accompanied by
- chest pain (may feel like a squeezing sensation or pressure)
- shortness of breath
- light-headedness or
call for an ambulance immediately!
- Pressure on the nerves that run from the neck across the shoulder and down the arm can cause pain in the upper arm.
- Our nerves may get pinched where they exit the spine or anywhere along its path, which then causes pain and other abnormal sensations.
- Nerve pain is often accompanied by pins and needles and/or numbness in the arm, or burning shoulder pain.
If the pain seems to be moreso across the front of the shoulder and chest, it may indicate a problem with your collarbone - visit our collar bone pain article for information to help you to work out what is going on.
If it's radiating to the shoulder blades or across your upper back, visit the shoulder blade pain section.
If none of these is sounding quite like your pain, it may be that there is something else going on, such as shoulder bursitis or a problem in the shoulder joint itself.
SHOULDER PAIN PHYSIOTHERAPY
Patients may receive the following physiotherapy treatment modalities:
- cold therapy
- moist heat paraffin wax therapy
- radio-frequency Indiba physiotherapy to accelerate soft tissue healing
- joint mobilization
- stretching exercises
- strengthening exercises
- scar management
- hands-on manipulation and mobilization (manual therapy)
- computerized spinal decompression traction
- soft tissue management
- heat therapy, heat treatment and heat packs to relieve tight muscles and joints
- ultrasound therapy to accelerate soft tissue healing
- exercise therapy
- acupuncture and/or dry needling
- deep tissue release.