Symptom finder - The causes of arm pain
Symptom finder - The causes of arm pain
The common causes of pain in the arm are vascular lesions such as arterial thrombosis, subclavian artery stenosis, axillary venous thrombosis, embolism and myocardial infarction, brachial plexus, causes such as thoracic inlet syndrome, Pancoast’s tumor/malignant infiltration and cervical lesions such as tumor (vertebral bodies, nerves, meninges and spinal cord), cervical spondylosis, lesion of the disc, syringomyelia and infection causes such as tuberculosis and osteoitis. Other causes of pain in the arm are acute compartment syndrome ( crush injuries) or chronic compartment syndrome ( exertional causes), bone tumors, peripheral neuropathy, carpal tunnel syndrome and repetitive strain injuries. Angina or myocardial infarction may present as pain in the left arm.
Carpal tunnel syndrome is characterized by paraesthesia and pain in the index, thumb and middle finger. The pain and paresthesia are worse at night and can be relieved by hanging the arm out from the bed. Carpal tunnel syndrome is associated with amyloidosis, myxoedema, pregnancy, gout, rheumatoid arthritis, arteriovenous fistula at the wrist ( useful for hemodialysis) and anterior dislocation of the lunate.
Lesion of the brachial plexus may cause pain down the arm. Brachial plexus lesion mostly occur due to localized lesions such as thoracic inlet syndrome or cervical rib which causes extrinsic compression that affect T1 and leads to wasting of the small muscle of the hand as well as paraesthesia that present in a dermatomal distribution. ( the inner aspect of the upper arm).
Vascular surgery, vascular injury and crush injury may leads to compartment syndrome . Chronic causes of compartment syndrome may occur due to weight - lifting /exertion. Arm pain may be related to bone pain.The bone pain ( localized in nature ) may be due to primary tumors or secondary tumors ( where the primary tumors are prostate tumor, thyroid gland tumor, kidney tumor, bronchus tumor and breast tumor).These conditions may lead to pathological fracture of the bones.
Lesion of the cervical cord amy affect the neck. Cervical cord lesion may present as paraesthesia and pain from the neck radiating to the arm. Cervical cord lesion may lead to cervical cord compression. Any ‘ wear and tear’ of the cervical spine is associated with cervical spondylosis which is common after 60 years of age. Younger patient is predisposed to acute disc lesion. Claudication of the arm or pain of the arm which occur with exertion and relief by resting is associated with subclavian artery stenosis. Subclavian artery stenosis leads to inadequate blood supply. Stenosis may be associated with embolism or thrombosis which is due to cardiac or arterial disease such as atrial fibrillation. Axillary vein thrombosis is suggestive by sudden swollen of painful cyanotic limb.
Myocardial ischemia may present as pain on the central of the chest that brought on by exercise. The pain will radiates to the neck and left arm. Pain in the arm is also associated with peripheral neuropathy that occur due to vitamin B12 deficiency, liver failure , drugs ( vincristine, phenytoin), renal failure and abuse of alcohol. Repetitive strain injury due to occupation such as writing may also cause pain in the arm.
The common causes of pain in the arm are vascular lesions such as arterial thrombosis, subclavian artery stenosis, axillary venous thrombosis, embolism and myocardial infarction, brachial plexus, causes such as thoracic inlet syndrome, Pancoast’s tumor/malignant infiltration and cervical lesions such as tumor (vertebral bodies, nerves, meninges and spinal cord), cervical spondylosis, lesion of the disc, syringomyelia and infection causes such as tuberculosis and osteoitis. Other causes of pain in the arm are acute compartment syndrome ( crush injuries) or chronic compartment syndrome ( exertional causes), bone tumors, peripheral neuropathy, carpal tunnel syndrome and repetitive strain injuries. Angina or myocardial infarction may present as pain in the left arm.
Carpal tunnel syndrome is characterized by paraesthesia and pain in the index, thumb and middle finger. The pain and paresthesia are worse at night and can be relieved by hanging the arm out from the bed. Carpal tunnel syndrome is associated with amyloidosis, myxoedema, pregnancy, gout, rheumatoid arthritis, arteriovenous fistula at the wrist ( useful for hemodialysis) and anterior dislocation of the lunate.
Lesion of the brachial plexus may cause pain down the arm. Brachial plexus lesion mostly occur due to localized lesions such as thoracic inlet syndrome or cervical rib which causes extrinsic compression that affect T1 and leads to wasting of the small muscle of the hand as well as paraesthesia that present in a dermatomal distribution. ( the inner aspect of the upper arm).
Vascular surgery, vascular injury and crush injury may leads to compartment syndrome . Chronic causes of compartment syndrome may occur due to weight - lifting /exertion. Arm pain may be related to bone pain.The bone pain ( localized in nature ) may be due to primary tumors or secondary tumors ( where the primary tumors are prostate tumor, thyroid gland tumor, kidney tumor, bronchus tumor and breast tumor).These conditions may lead to pathological fracture of the bones.
Lesion of the cervical cord amy affect the neck. Cervical cord lesion may present as paraesthesia and pain from the neck radiating to the arm. Cervical cord lesion may lead to cervical cord compression. Any ‘ wear and tear’ of the cervical spine is associated with cervical spondylosis which is common after 60 years of age. Younger patient is predisposed to acute disc lesion. Claudication of the arm or pain of the arm which occur with exertion and relief by resting is associated with subclavian artery stenosis. Subclavian artery stenosis leads to inadequate blood supply. Stenosis may be associated with embolism or thrombosis which is due to cardiac or arterial disease such as atrial fibrillation. Axillary vein thrombosis is suggestive by sudden swollen of painful cyanotic limb.
Myocardial ischemia may present as pain on the central of the chest that brought on by exercise. The pain will radiates to the neck and left arm. Pain in the arm is also associated with peripheral neuropathy that occur due to vitamin B12 deficiency, liver failure , drugs ( vincristine, phenytoin), renal failure and abuse of alcohol. Repetitive strain injury due to occupation such as writing may also cause pain in the arm.
Neurological and musculoskeletal as well as vascular examination should be performed. Neurological examination include identification of Horner’ s syndrome ( anhidrosis, enophthalmos, miosis and ptosis) due to Pancoast’s tumor. Look for any evidence of carpal tunnel syndrome , brachial plexus lesion and cervical cord lesions ( cervical spine present with limited movement). Compartment syndrome may present with paraesthesia, paralysis and swollen tender compartment of the forearm. Normal pulse will be absent later.
Musculoskeletal and vascular examination will focus on swelling and dilated veins or cyanosis in axillary vein thrombosis. Always remember to look for any signs of ischemia of the limb such as perishingly cold, pulseless, pallor, pain, paraesthesia and paralysis.
The investigations require are full blood count, ESR, CRP , cardiac enzymes, ECG, chest x ray, cervical spine x ray, MRI scan, CT scan, venography, arteriography, duplex doppler and nerve conduction test.
In full blood count, there will be a raise in white cell count due to infection such as cervical spine or osteomyelitis. Raised CRP and ESR are indication of infection, inflammation and malignancy. Cardiac enzyme and ECG may detect cardiac ischemia. Chest x ray is useful for detecting any cervical rib ( the present of 13th rib) , malignancy due to bone secondary or apical lung tumor/ Pancoast tumor spreading to involved brachial plexus.
MRI scan and CT scan are useful to detect any tumors or any cervical cord lesions. Arteriography may detect arterial lesion while venography may detect any lesion of the vein ( axillary vein thrombosis). Duplex doppler may detect both venous lesion and arterial lesion. Nerve conduction studies are performed for cases of carpal tunnel syndrome and peripheral neuropathy
Musculoskeletal and vascular examination will focus on swelling and dilated veins or cyanosis in axillary vein thrombosis. Always remember to look for any signs of ischemia of the limb such as perishingly cold, pulseless, pallor, pain, paraesthesia and paralysis.
The investigations require are full blood count, ESR, CRP , cardiac enzymes, ECG, chest x ray, cervical spine x ray, MRI scan, CT scan, venography, arteriography, duplex doppler and nerve conduction test.
In full blood count, there will be a raise in white cell count due to infection such as cervical spine or osteomyelitis. Raised CRP and ESR are indication of infection, inflammation and malignancy. Cardiac enzyme and ECG may detect cardiac ischemia. Chest x ray is useful for detecting any cervical rib ( the present of 13th rib) , malignancy due to bone secondary or apical lung tumor/ Pancoast tumor spreading to involved brachial plexus.
MRI scan and CT scan are useful to detect any tumors or any cervical cord lesions. Arteriography may detect arterial lesion while venography may detect any lesion of the vein ( axillary vein thrombosis). Duplex doppler may detect both venous lesion and arterial lesion. Nerve conduction studies are performed for cases of carpal tunnel syndrome and peripheral neuropathy
