An aching pain in the upper arm can be surprisingly hard to place. It is one of those symptoms that often has nothing to do with the arm itself: the shoulder and neck both refer pain into the upper arm, so a careful assessment usually looks above the painful area to find the real cause.
Aching that starts at the shoulder itself is covered in PhysioHub's guide to front shoulder pain.
A deep, hard-to-localise ache in the upper arm is classic referred pain. The rotator cuff commonly refers pain down into the outer upper arm, and the neck can send symptoms down the arm too. That is why pressing the arm often does not reproduce it and why the source is usually the shoulder or neck. The NHS page on shoulder pain reflects how often the two are linked.
Treatment follows the source. Shoulder-referred pain responds to progressive rotator cuff and shoulder-blade strengthening. Neck-referred pain needs the neck restored and strengthened. A genuine muscle overload settles with a graded return to loading. Because the causes differ, an accurate assessment saves you weeks of treating the wrong area. Our guides to rotator cuff injury and tennis elbow cover related arm problems.
An aching upper arm gets treated as an upper arm problem, which is exactly why it drags on for months. At PhysioHub in Uckfield most of it turns out to be referred from somewhere else, and the weeks spent massaging and stretching the arm itself were never going to reach it.
The upper arm holds very few structures that hurt in their own right, and it is a common referral zone for several that do. A rotator cuff problem refers into the deltoid insertion, the neck refers down the outside of the arm, and the long head of biceps is often felt lower than it actually sits. Resisted shoulder testing alongside a neck and nerve screen will usually reproduce the ache and name the driver in one session. Weakness, spreading numbness or a recent significant injury change the priority and get looked at before anything else.
To find out which driver is behind yours, book an assessment.
Should I be worried about upper arm pain?
Most is musculoskeletal. Seek urgent care if arm pain comes on with chest tightness, breathlessness or feeling unwell, as that needs different, immediate attention.
Why is it worse at night?
Rotator cuff pain classically disturbs sleep, especially lying on that side, because of how the tendon is loaded in those positions.
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