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Arm pain at night can be miserable.  The pain can interrupt your sleep and erode your quality of life. Irritability becomes increasingly more common.  What are the causes of arm pain at night?  When should I worry about arm pain at night?  What are the treatment options for arm pain at night?  Let’s dig in.

What Causes Arm Pain at Night

There are many causes of arm pain at night.  The most common causes are:

Cervical Disc Problems

The neck is composed of 7 boney building blocks numbered 1- 7.  Sandwiched between the bones is a disc that functions as an important shock absorber.  The cervical discs are susceptible to injury due to trauma, degeneration, repetitive motion, and surgery(1).  Common disc injuries include disc bulges, and herniations.  The injured disc can compress or irritate one or more nerves resulting in arm pain at night.  It can feel like pressure in the muscles like a blood pressure cuff.  Alternatively, there can be numbness, tingling, or electrical sensations down your arm. Arm pain at night is a warning signal that warrants your attention.

Cervical Stenosis

The spinal cord extends the entire length of the spine.  The spinal canal is a hollow passage formed by neck bones and spinal fluid.  The spinal cord travels the length of the spine within the spinal canal.  If the canal is narrowing at any point the spinal cord and exiting nerve roots can be compressed.  Narrowing of the spinal canal is called stenosis.  It can be caused by trauma, instability, disc protrusion, facet joint overgrowth, and thickening of spinal ligaments (2).  Compression of the spinal cord and nerve roots can cause arm pain at night.

Rotator Cuff Injury

The Rotator Cuff is a group of 4 tendons that provide support and stability to the shoulder.   A tendon is a band of connective tissue that connects muscle to bone. The Rotator Cuff tendons are the supraspinatus, infraspinatus, subscapularis, and teres minor tendons.  The Rotator Cuff is susceptible to injury as a result of trauma, overuse, impingement, and degeneration (3).    Risk factors for a Rotator Cuff tear include advancing age, female gender, smoking  and poor posture (4).  A Rotator Cuff injury can cause arm pain at night.

Bursitis

A bursa is a fluid-filled sac that allows tendons and muscles to smoothly slide over boney surfaces.  There are multiple bursae in the shoulder and elbow that can become inflamed or irritated.  Sleeping on your side can increase in the pressure on the bursae resulting in throbbing arm pain at night.

Thoracic Outlet Syndrome (TOS) 

Thoracic Outlet Syndrome is a group of disorders that involve the compression and irritation of the nerves, arteries, and veins in the lower neck and chest.  Pain is a major symptom and can be intermittent or constant and varies in severity and quality.  The pain can involve the lower neck, collar bone, arm, and hand.  Numbness in the hand is common.  Symptoms are typically worsened with lifting the arm overhead.

Referred Pain 

Referred pain is pain that is perceived or felt in an area that is different in location from where the actual tissue injury occurs.  A classic example is a heart attack.  The actual tissue injury is in the heart muscle. The pain from a heart attack however is oftentimes is referred or felt in the arm.   Arm pain at night can be referred pain and if it persistent warrants evaluation.

Autoimmune Diseases

Autoimmune diseases are where your own immune system attacks itself.  Common examples include Rheumatoid Arthritis and Lupus.  Pain is common and can occur at night.

When Should I Worry about Arm Pain at Night?

If arm pain at night is infrequent and mild it most likely is a result of overactivity and does not warrant worry or evaluation.  Warning signs that are concerning include.

  • Arm pain that progressed from intermittent to constant
  • Increase in the severity of the pain
  • Reduced range of motion
  • Numbness and tingling
  • Loss of muscle strength
  • Shrinkage of the muscles (atrophy)

Treatment Options for Arm Pain at Night

Identifying the underlying cause of the pain is key.  Conservative care in the form of physical therapy is always the best first line of treatment when possible.  At the Centeno-Schultz Clinic, we are experts in the management of many of the causes of arm pain at night.

Cervical disc injuries can be effectively treated with PRP or stem cells depending upon the severity of the injury.  PRP is rich in growth factors that can increase the blood flow in an area of tissue damage.  A patient’s own stem cells are powerful tools to accelerate healing and orchestrate healing.

Cervical stenosis can arise from different causes. X-ray guided injections of PRP can reduce disc or facet swelling and tighten lax spinal ligaments thereby improving clinical symptoms. To learn more about spinal stenosis please click on the video below.

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There are different types of Rotator Cuff tendon tears.   The three principal RC tears are partial-thickness tears, full-thickness tears, and full-thickness tears with retractions. PRP and a patient’s own stem cells can be injected directly into the tear under MSK ultrasound.  Our recent midterm analysis of a multi-year shoulder Rotator Cuff randomized controlled demonstrated exciting results. It demonstrated that precise injection of high dose bone marrow-derived stem cells into damaged Rotator Cuff tendons helped patients avoid surgery (5).

A common treatment for bursitis is the injection of steroids.  This should be avoided as the steroids are toxic.  Steroids are very powerful anti-inflammatory agents but are also toxic to the cartilage, tendons, and ligaments (6).  PRP is an effective alternative to steroid injections as it promotes healing.

Thoracic Outlet Syndrome is often treated by surgery which is very invasive with poor long term results.  At the Centeno-Schultz Clinic we examine the many causes of nerve, vein, and artery compression and provide the best regenerative option.  Orthobiologics are used instead of steroids.  Orthobiologics are biological substances naturally found in the body that are used to promote quicker healing of muscle, tendon, and bone injuries.  They have been reviewed in a previous blog. To better understand orthobiologics please click on the video below.

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In Conclusion

Arm pain at night can erode one’s sleep and well being.  There are many different causes of arm pain at night.  The most common include injuries of the cervical spine or Rotator Cuff, cervical stenosis, bursitis, Thoracic Outlet Syndrome, referred pain, and autoimmune diseases.   Arm pain at night is a warning signal that you have a problem that requires attention.  Warning signs that warrant evaluation include an increase in the frequency or severity of pain, reduced range of motion, numbness and tingling, loss of muscle strength, and muscle atrophy. Treatment starts with identifying the underlying cause of the arm pain. The Centeno-Schultz Clinic physicians are expert in the management of many of the causes of arm pain.  Steroids should be avoided.  PRP and a  patient’s own stem cells are effective treatment options for cervical disc injuries, Rotator Cuff tears, mild to moderate forms of cervical stenosis, and bursitis.

Arm pain at night is a warning sign.  If left untreated it can become a much larger problem which includes muscle shrinkage, permanent nerve damage, massive Rotator Cuff tears, and impaired arm and hand function.  Schedule Telemedicine consults from your home or cabin where a board-certified physician will review your history, current imaging, and treatment to date.  Learn what is causing your arm pain at night and the best regenerative treatment option. It is time to stop the sleepless nights!

 

References

1.Peng B, DePalma MJ. Cervical disc degeneration and neck pain. J Pain Res. 2018;11:2853-2857. Published 2018 Nov 14. doi:10.2147/JPR.S180018

2.Meyer F, Börm W, Thomé C. Degenerative cervical spinal stenosis: current strategies in diagnosis and treatment. Dtsch Arztebl Int. 2008;105(20):366-372. doi:10.3238/arztebl.2008.0366

3.Sambandam SN, Khanna V, Gul A, Mounasamy V. Rotator cuff tears: An evidence based approach. World J Orthop. 2015;6(11):902-918. Published 2015 Dec 18. doi:10.5312/wjo.v6.i11.902

4.Yamamoto A, Takagishi K, Kobayashi T, et al. The impact of faulty posture on rotator cuff tears with and without symptoms. J Shoulder Elbow Surg. 2015;24(3):446-452. doi:10.1016/j.jse.2014.07.012

5. Centeno CJ, Fausel Z, Stemper I, Azuiike U, Dodson E. A Randomized Controlled Trial of the Treatment of Rotator Cuff Tears with Bone Marrow Concentrate and Platelet Products Compared to Exercise Therapy: A Midterm Analysis. Stem Cells International. 2020 Jan; 2020. https://doi.org/10.1155/2020/5962354

6.Wernecke C, Braun HJ, Dragoo JL. The Effect of Intra-articular Corticosteroids on Articular Cartilage: A Systematic Review. Orthop J Sports Med. 2015;3(5):2325967115581163. Published 2015 Apr 27. doi:10.1177/2325967115581163