What Causes Shoulder Pain That Radiates Down The Arm
Ever felt a nagging sensation or ache in your arm?
Youre not the only one. Many specialists see persistent arm pain as one of the most common complaints.
You might find this a little strange, considering that we specialize in shoulders and knees. However, pain can be slippery. It doesnt necessarily mean that the problem is in your particular area. Doctors may refer it from another place.
Arm pain is similar. We often find that the shoulder is the cause of persistent arm pain. This can lead to confusion during an examination. People often ask, Why arent you focusing on me?Youre six feet too high! We understand your frustration.
Physician Blog By Edward J Bieber Md
Shoulder Pain Biceps Tendonitis
The biceps tendon is a common, though often overlooked, source of shoulder pain. Most people assume that they have arthritis or rotator cuff pathology when the biceps can be the primary source of pain. It is, however, often associated with the other reasons for shoulder pain such as rotator cuff tendonitis or tearing, arthritis, impingement or instability which is why the diagnosis is not made as easily. The primary symptom is pain in the front of the shoulder and radiating down the upper arm and associated with certain motions which is very similar to the pain associated with rotator cuff pathology.
The biceps anatomy is unusual in that the muscle has tendons at both ends of attachment. It has a single tendon in the elbow and two tendons in the shoulder region. The short head attaches to the coracoid process of the scapula and is rarely a source of pathology. The long head attaches at the top of the glenoid to the labrum and then runs between two of the rotator cuff tendons and then through the bicipital groove on the side of the humerus . The damage to the long head can occur within the shoulder joint or within the bicipital groove. There can be mechanical irritation, degenerative wear, inflammation or actual tearing of the tendon .
For more information or treatment, please make an appointment.
Edward Bieber, M.D.
Dr. Edward Bieber of OrthoBethesda is the areas most experienced total shoulder surgeon.
Rotator Cuff Injuries And Irritations
Your rotator cuff is a group of muscles and tendons that help tether your shoulder into the socket and allow you to move it in a circular motion. Some two million people visit a doctor each year for rotator cuffrelated issues, according to the American Academy of Orthopedic Surgery . Most problems with the rotator cuff fall into two categories: tears or inflammation. Suspect a rotator cuff problem if you have pain or stiffness in your shoulder when you lift your arm above your head to brush your hair or when you reach behind your back. You won’t be able to do a lot of things you want to do, such as put dishes in an upper cabinet, play tennis, or do garden pruning.
Rotator cuff impingement. A rotator cuff impingement happens when there is irritation, inflammation, or compression of the tendons or bursa in the shoulder. An impingement can be caused by an injury, but it can also just result from general wear and tear from daily life.
Rotator cuff tears. A tear in the rotator cuff will produce pain that is similar to an impingement but has one additional differentiating feature. If the pain is associated with weakness, it is likely caused by a tear, and if you just have pain, it may only be a rotator cuff impingement.
While you may be tempted to stop moving when you experience pain from osteoarthritis, doing so can actually make the problem worse because it allows the muscles to stiffen and shorten. This may ultimately make it even harder for you to move the way you want to.
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Who Is A Candidate For Arthroscopic Tenodesis
For mild to moderate biceps tendonitis, arthroscopic or open shoulder surgery is an option if your pain interferes with daily activities and does not respond to rest and over-the-counter pain relievers. Patients typically start considering surgery when symptoms stop them from working, exercising, or sleeping comfortably.
The most common symptoms of biceps tendonitis include:
- Audible popping or clicking near the shoulder
- A bulge in the biceps, known as a Popeye deformity, caused by the tendon no longer being able to keep the biceps muscle tight
- Cramping of the biceps muscle with use of the arm
- Difficulty turning the hand palm up or palm down
- Dull ache that radiates from the upper arm to the elbow
- Sudden, sharp pain in the upper arm
As we age, our tendons stiffen, making us more susceptible to tendonitis. You may be at increased risk of biceps tendonitis if you perform repetitive motions long term. We often see patients who do a lot of overhead lifting at work, as well as athletes particularly swimmers, tennis players, weightlifters, and baseball players.
Smoking reduces nutrient supply to the tendons, increasing the likelihood of injury and reducing proper healing. Certain corticosteroid medications can increase the risk for tendonitis because they deplete collagen. Also, these medications can mask pain symptoms, leading to additional overuse.
What Is Bicep Tendonitis
As the long head of the tendon detaches from the bone, a patient may feel pain in that area as well as weakness or soreness in the shoulder or elbow. Bicep tendonitis typically develops simultaneously with other issues involving the shoulder.
These issues can include arthritis, complications from a dislocation, chronic pain/inflammation, issues with the rotator cuff, and general degeneration. If the muscle is being used often, such as in an athlete who plays a sport that requires overhead motions, the repetition can play a role in the injury as well. Similar to tennis elbow, bicep tendonitis can occur when the muscle is overworked.
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How Is Rotator Cuff Tendinitis Diagnosed
A physical examination of the shoulder by a qualified physician is the first step. This includes movement and strength testing to evaluate range of motion, pain, weakness and instability. X-rays are useful for ruling out other causes of shoulder pain, such as broken bones, arthritis and other bone diseases. If a cuff tear is suspected, magnetic resonance imaging may be used to visualize it. The MRI can detect even small partial tears of the rotator cuff. Another study called the arthrogram, in which dye is injected into the joint, may also be useful for diagnosis.
Pain Between The Shoulder And Elbow
In some cases, pain can be felt in both the area of the right shoulder and further down towards your right elbow. Some causes are:
- Rotator cuff disease: Pain can begin to radiate from your shoulder into the side of your upper arm.
- Torn rotator cuff: Shoulder pain may radiate down your arm to the area of the elbow.
- Dislocated shoulder: The pain from a dislocated shoulder can radiate down the upper arm.
- Upper arm fracture: A break in your upper arm can cause pain thats localized around the area of your shoulder and throughout your upper arm.
- Frozen shoulder: Pain from a frozen shoulder may also spread into your right bicep.
- Calcific tendinitis: Similarly to frozen shoulder, pain from calcific tendinitis can spread down into your bicep area.
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Treatment For The Left Shoulder And Arm Pain
Medication, symptom relief, and changes to your lifestyle that promote heart health may all be used as treatments for heart disease. Surgery may be necessary to open or bypass clogged arteries if you have advanced heart disease.
Broken bones need to be realigned and kept immobile while they mend. This typically necessitates many weeks of wearing a cast. Surgery may be necessary for severe breaks.
Raise and elevate your arm if it has a sprain or strain. Several times a day, ice the area. Splints or bandages might be useful.
The main therapies: include rest, pain and inflammation-relieving medications, physical therapy, occupational therapy, and:
Rotator cuff tears, herniated discs, pinched nerves, bursitis, tendinitis, and vascular lumbar spinal syndrome
Surgery or corticosteroids may be required in some circumstances.
What Are Distal Biceps Tendon Tears
While two tendons attach the biceps muscle to the bone at the shoulder, only one tendon attaches it to the elbow. This is called the distal biceps tendon.
Tears of the distal biceps tendon are unusual and most often result from an injury or lifting a heavy object. When this tendon tears, however, the tear is usually complete and the muscle is separated from the bone and retracted back. This causes weakness in powerful palm-up activities like tightening with a screwdriver with the right hand.
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Chronic Shoulder Pain Treatment Or Arm Pain Treatment
Through years of experience, weve figured out that good and long-lasting chronic shoulder pain and arm pain relief doesnt work unless all bases are covered.
The best pain management combines pain-reducing treatments with selected therapies like physical and psychological rehabilitation treatment.
TYPES OF TREATMENT
Medications to reduce the pain
These may be simple over the counter medications or can be medications prescribed by your pain specialist. Medications might include muscle relaxants or nerve pain medications . Sometimes analgesic compound creams are used to ease pain.
Injection therapies can be used to target, diagnose and manage chronic pain caused by muscle, joint and nerve pain.
It includes interventional therapies like nerve blocks radiofrequency ablation , pulsed radiofrequency and epidural and nerve root steroid injections. Sympathetic nerve blocks can also be performed.
Some of these therapies can be focused on various structures that might be causing or making the pain worse like the glenohumoral joint, the acromio-clavicular joint, the subacromial bursae, muscle trigger points, the brachial plexus, the spinal nerve roots and other nerves around the shoulder. Platelet-rich plasma can also be used in some locations around this area.
Nerve stimulation or neuromodulation techniques
Most types of chronic pain treatment should be managed alongside some form of specialist rehabilitation. This is when the best results occur.
Is Treatment For Biceps Tendinitis Covered By Insurance Or Medicare
The cost of treating biceps tendinitis depends on the extent of the injury.
If rest, ice, and compression and perhaps changes to your exercise regimen or lifestyle are enough, treatment costs can be low. More severe tendinitis or tears in the tendon that require surgery can cost much more to treat.
The specific cost of surgery on your shoulder or biceps will depend on many factors, including:
- the extent of the injury
- what other health conditions you may have
- any complications you might develop
- where your surgery is performed
Industry estimates place the cost of biceps tendon repair between $4,290 and $18,586.
Most of the time, insurance or Medicare will cover treatment.
In the case of getting coverage for surgery or medication, you may need documentation from your doctor that youve already tried RICE therapy and that further treatment is medically necessary.
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Dont Let Your Pinched Nerve Ruin Your Routine
When you have cervical radiculopathy, many at-home remedies can help relieve the pain, but if it persists, you should see a medical professional. If you are located in Prescott, Arizona, you can always see us at VISP. We specialize in completing minimally invasive and low-risk procedures that will help you get back to your routine.
Every team member is professional, passionate, and experienced in this field, so you can have peace of mind when youre here. If you have any questions, you should call us at 771-8477.
Exercises To Help Biceps Tendinitis
Regardless of the extent of your tendinitis, physical therapy and specific exercises can help you reduce pain and inflammation. They can also help you regain mobility.
Your physical therapy plan or recommended exercises will depend on your specific injury and overall health, but they will probably involve:
- resistance exercises
- exercises to strengthen the shoulder
- flexibility exercises
These exercises can be as simple as moving your arm in different directions to using resistance bands or weights to increase pressure.
Stretches where you hold a position for 20 to 30 seconds, repeated 3 to 5 times, can be enough to help in some cases, too.
Consult your healthcare team about using weights or resistance bands after a tendon injury.
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What Kind Of Physical Therapist Do I Need
All physical therapists are prepared through education and clinical experience to treat a variety of conditions or injuries. You may want to consider:
- A physical therapist who is experienced in treating people with orthopedic, or musculoskeletal, injuries.
- A physical therapist who is a board-certified clinical specialist or who has completed a residency in orthopedic or sports physical therapy, as they will have advanced knowledge, experience, and skills that apply to an athletic population.
You can find physical therapists who have these and other credentials by using Find a PT, the online tool built by the American Physical Therapy Association to help you search for physical therapists with specific clinical expertise in your geographic area.
General tips when you’re looking for a physical therapist :
- Get recommendations from family, friends, or other health care providers.
- When you contact a physical therapy clinic for an appointment, ask about the physical therapists’ experience in helping people with shoulder pain.
- Be prepared to describe your symptoms in as much detail as possible, and report activities that make your symptoms worse.
How Is Biceps Tendonitis Treated
Although biceps tendonitis can be painful, if properly treated early it can usually be resolved completely.
- Cold packs or ice will reduce swelling and pain caused by tendonitis.
- Nonsteroidal anti-inflammatory medications such as aspirin or ibuprofen will help relieve swelling and pain.
- Your doctor may also recommend rest. It will be particularly important to avoid any heavy lifting, flexing at the elbow and over your head.
- In some cases, your doctor may refer you for physical therapy to help your shoulder or elbow recover.
- In severe cases of tendonitis without a tear, corticosteroid injections may offer relief of pain and halt the inflammatory process and get the tendon back on a path of healing.
Most patients who have had surgery for tendonitis can move their arms without pain and regain a full range of motion.
- Because most cases of tendonitis are caused by overuse, the best treatment is prevention. It is important to avoid or alter the activities that cause the problem. When doing physical activities, take it slowly at first and gradually build up your activity level, limit the number of repetitions you do and the amount of force you use, and stop if you feel any unusual pain. Be careful to avoid and then correct underlying conditions such as improper posture or poor technique in sports or work.
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Pain In Left Arm And Shoulder
Pain in Left Arm and Shoulder A common component of ageing is frequently experiencing minor pains and aches in the left arm. However, sudden or unexpected discomfort in the left arm could signal an infected condition. In the most extreme case scenario, it could be a heart attacks aftermath or a sign of an illness that needs medical attention.
Knowing the possible causes and symptoms of left arm discomfort might make it easier to understand how the body is responding and decide whether its time to contact a doctor.
How Long Is Rehabilitation After Rotator Cuff Repair
Rehabilitation usually begins the first week after arthroscopic surgery or an open rotator cuff repair. It is very important to follow the program that the surgeon recommends. The physical therapist will demonstrate how to do the exercises to increase range of motion and to build muscle strength. A typical program might start with stretching and some minor strengthening exercises with rubber bands and light weights. It might take up to several months before strength is back to normal, but with hard work and adherence to the recommended program, in most cases a full recovery is likely.
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How Can A Physical Therapist Help
Once biceps tendinitis has been diagnosed, your physical therapist will work with you to develop an individualized plan tailored to your specific shoulder condition and your goals. There are many physical therapy treatments that have been shown to be very effective in treating this condition. Your treatment may include:
Range-of-motion exercises. Often, abnormal motion of the shoulder joint may contribute to biceps tendinitis. Your physical therapist will assess your shoulder motion compared to the expected normal motion and to the motion of your other shoulder. Your physical therapist will guide you through exercises to improve your shoulders range of motion.
Muscle strengthening exercises. The muscles of the shoulder and upper back work together to allow for normal, coordinated upper-body motion. Based on the way the shoulder joint is designed , there are many directions in which the shoulder may move. Therefore, balanced strength of all the upper-body muscles is crucial to make sure the shoulder joint is protected and is moving efficiently. Your physical therapist will choose exercises to safely strengthen the muscles around your shoulder without causing more pain.
Manual therapy. Physical therapists are trained in manual therapy. Your physical therapist will gently move and mobilize your shoulder joint and surrounding muscles as needed to improve their motion, flexibility, and strength. These techniques can target areas that are difficult to treat on your own.
Warning Signs Of More Serious Arm & Shoulder Problems
In some instances, shoulder pain and arm pain can indicate more serious problems. These problems might include cancer, fractures, infection, severe nerve compression and ankylosis spondylitis.
If there is cancer in the bones of the spine, this usually means metastases .
Fractures of the spine can be caused by a direct hit, fall, accident but sometimes can occur without trauma, called spontaneous fractures. Spontaneous fractures, usually can occur in elderly people with osteoporosis or those who may be taking steroid medications that weaken the bone.
Infections of the spine tend to occur if patients have a weakened immune system from any cause or medical condition. Sometimes infections of the spine can occur if there is an infection elsewhere in the body. People with spinal infections usually feel unwell and can have sweats and a fever.
Nerve compression, called myelopathy, where there is a dangerous compression of the spinal cord in the neck. Myelopathy could cause symptoms that might include, weakness or problems with coordination in the arms, hands, legs, or even feet.
Ankylosing spondylitis is progressive arthritis of the spine and can cause widespread inflammation, pain and stiffness throughout the spine.
Seek urgent and specialist medical advice if:
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