Severe pain in arm elbow hand
by Nathan Wei, MD, FACP, FACR
Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.
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Pain in the arm, elbow, and hand may have many different causes.
Patient symptoms often can provide the diagnosis. Pain in the elbow, wrist or finger joint when bending the arm or hand- if there is no redness or swelling- suggests tendonitis.
Pain in the arm at the outside or inside of the elbow that is aggravated by movement, gripping, twisting, or extension and flexion of the wrist indicates tendonitis of the elbow. Pain on the outside of the elbow is called “tennis elbow” and pain involving the inside of the elbow is called “golfer’s elbow.”
Pain in the arm or hand with numbness and tingling suggest nerve entrapment. If there is no history of injury, the patient should be worked up for carpal tunnel syndrome.
Pain in the arm associated with weakness may indicate disease or damage to the brachial plexus. This is the large trunk of nerves that enters the arm from the neck.
If there is severe pain in the arm or hand after trauma, then fracture or muscle or ligament injury is the probable cause. If there is deformity, fracture is the likely problem.
Arm pain occurring during exercise is ominous. This suggests lack of blood flow to the arm. Possible causes include arterial narrowing to the arm or possible heart disease. Immediate cardiology evaluation is recommended.
Diseases of the gall bladder and lung may also cause referred pain to the shoulder and arm.
Pain in the elbow, wrist, or finger, accompanied by swelling, redness, heat indicates inflammation. If there is fever, then infection is a strong possibility. The patient needs to be worked up for streptococcal or other infectious problem. If there is no fever or low grade fever, then inflammatory types of arthritis such as gout, pseudogout, psoriatic arthritis, and rheumatoid arthritis need to be considered.
Hand discomfort accompanied by color changes in the fingers also indicates a circulatory problem. Possibilities include Raynaud’s phenomenon or arterial problem in the arm. Vascular work up is advised.
If there is color and temperature change along with sweating of the arm and this has come on after trauma, then a diagnosis of reflex sympathetic dystrophy is suggested. A bone scan looking for a difference in blood flow between the affected and non-affected limb may be helpful for diagnosis.
Pain the arm or hand accompanied by numbness, tingling, and neck stiffness or pain points towards a possible problem with cervical radiculopathy (pinched nerve in neck). The diagnosis is made through careful physical examination and magnetic resonance imaging (MRI) of the neck and electrical studies to demonstrate nerve damage.
Pain in the fingers around the fingernail indicates a possible paronychia (infection of the base of the nail). This should be evaluated for possible incision and drainage.
Rarely, arm pain is due to malignancy such as osteosarcoma.
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