Shooting pain in joints

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.

Click here: Second Opinion Arthritis Treatment Kit

Almost any type of joint disease can cause shooting pains.

Inflammatory forms of arthritis are the ones that are most likely to cause shooting pains. Shooting pains may also be caused by nerve related problems.

Examples of inflammatory arthritis that can cause shooting pains include rheumatoid arthritis, crystal induced arthritis, psoriatic arthritis, ankylosing spondylitis, and Reiter's disease.

For example, cervical radiculopathy, which is pain originating from a problem in the neck can cause shooting pain down the arms. A similar problem, called lumbar radiculopathy, is due to a low back problem that causes shooting pain into the legs.

The reason this condition occurs is that nerves can be pinched as they exit the spinal cord in the neck and the low back.

Objective signs like loss of sensation or muscle weakness is caused by direct compression of a nerve root.

The diagnosis can be suspected by a detailed history and clinical examination.

On inspection, one may note the presence of stiffness and muscle spasm. On palpation, one can feel the spasm and palpate the spine for localized tenderness. The trapezius muscle may exhibit tender spots and tender nodules along the attachment of the muscle to the spine of the scapula. The base of the neck may have painful areas. Movements of neck flexion, extension and lateral bending must be tested and any painful limitation noted.

Examine the shoulder joint for painful limitation of movements and tender points.

The neurological examination must be done first.

Causes of shooting pain in the arm coming from the neck include poor posture, sprains or strains, herniated disc, arthritis, tumors, fractures, and anatomic abnormalities (accessory [cervical] ribs).

Symptoms similar to those caused by cervical rib, can also be produced by the abnormal insertion of the scalenus anterior or scalneus medius muscle, which produce compression of the lowest trunk of the brachial plexus and the subclavian vessels as they cross the first rib. These are referred to as Scalene syndrome or Thoracic outlet syndrome.

Shoulder pathology that can lead to shooting pains include arthritis, bursitis, and tendonitis.

Shooting pain can also arise from referred pain such as a heart attack causing left arm pain and gall bladder disease causing right arm pain.

Metabolic disorders such as diabetes may lead to shooting pains – usually the leg from femoral nerve damage. This condition is called mononeuritis multiplex.

Sciatica is pain that runs along the sciatic nerve that extends from the low back down through the buttocks and along the back of the leg. It is a relatively common form of back pain that also causes shooting pain down the leg. Pain along the sciatic nerve is usually caused by pressure on the nerve from a herniated disc or pinched nerve. Common symptoms may include: pain in the buttocks and/or leg that is worse when sitting, burning or tingling down the leg, weakness, numbness or difficulty moving the leg or foot, constant pain on one side of the buttocks or shooting pain that makes it difficult to stand.

Carpal tunnel syndrome can be caused by compression of the median nerve at the wrist, which can lead to pain and weakness in the hand. The median nerve supplies sensation to the thumb and first two fingers, and also to some of the muscles of the hand.

The carpal tunnel is composed of a floor and a roof. The floor consists of the bones of the wrist and the roof is a thick ligament located on the palm side of the wrist. The tendons which flex the fingers (to form a fist) and the median nerve pass through this tunnel.

Certain conditions like wrist fractures and over-use syndromes can cause swelling in the carpal tunnel. Sometimes there is no identifiable cause. Because the walls of the tunnel are rigid, e swelling increases pressure. When the median nerve is compressed, the muscles it supplies become weak and the skin over the thumb, index, and middle fingers becomes painful, tingly, or even numb.

The diagnosis is made clinically and confirmed by nerve conduction velocity testing.

Non-surgical treatment should be tried first. This includes anti-inflammatory medications, wrist splints, occupational therapy, and workplace modification. If this fails to improve symptoms, an injection of steroids into the carpal tunnel may be helpful.

If the results of the test are consistent with carpal tunnel syndrome, carpal tunnel release surgery can be considered.

More recently, ultrasound guided percutaneous needle release has been very successful in treating carpal tunnel syndrome without the risk and downtime due to surgery. Contact the Arthritis Treatment Center ( for more information.

Post herpetic neuralgia is a condition that is caused by nerve damage that occurs as a result of a shingles infection.

There are three primary components to the discomfort associated with post herpetic neuralgia:

1. constant burning pain
2. shooting pain
3. sharp, radiating pain that is elicited by very light stimulation

Immunosuppression, either associated with a disease or drug-induced, is a risk factor, and the incidence increases with age.

Myofascial pain is a condition that causes pain in muscle overlying the shoulder blades and spine.

Symptoms include trigger points that when touched can produce a shooting pain that travels down the shoulder into the arm.

It is caused by the strain or improper use of a muscle.

Treatment Options

• Braces or slings
• Exercise
• Heat/cold
• Medications: Corticosteroids, NSAIDs
• Rest

Shooting pain in the arm or leg may also be due to a condition called peripheral neuropathy. This is a problem where the small nerves in the limb are damaged. There are many potential causes including infections, diabetes, nutritional deficiencies, and metabolic disorders.

Get more information about shooting pain in joints as well as...

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Click here Second Opinion Arthritis Treatment Kit

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