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Arm Pain at Night

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?  When should I worry about it?  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.

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 and/or shoulder 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 the 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 is 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.

Deep Dive Into the Conditions Cause Arm Pain in the Night

AC Joint Impingement

AC joint Impingement is a painful condition that occurs when the space beneath the acromion bone is narrowed.   This narrowing can result in irritation of the rotator cuff tendons and bursa.  A bursa is a fluid-filled sac that reduces the friction on tendons and muscles as they cross bony surfaces.  A tendon is thick collagen tissue that connects muscles to bones.  The rotator cuff tendons provide important support and enable movement in the shoulder.   If severe,  impingement can cause tears in the rotator cuff tendons.  Patients with AC joint impingement typically have pain with elevation of the arm and or while lying on the shoulder.

Read More About AC Joint Impingement

Cervical Radiculopathy

Common Cervical Radiculopathy symptoms include neck pain, arm pain, shoulder pain radiating down arm to fingers, numbness, tingling, and weakness. Cervical Radiculopathy is a clinical condition in which a nerve or nerves in your neck become irritated or compressed. It is also known as ” a pinched nerve,” The causes are discussed below. It can affect individuals of any age with peak prominence between ages 40-50 years of age. Cervical Radiculopathy is due to spinal nerve inflammation, irritation, or compression. The most common causes of Cervical Radiculopathy are: Disc Injury – The disc is an important shock absorber. Unfortunately, it is susceptible to injury.

Read More About Cervical Radiculopathy

Craniocervical Instability

Craniocervical Instability is a medical condition characterized by injury and instability of the ligaments that hold your head onto the neck. Common symptoms of Cranial Cervical Instability include a painful, heavy head, headache, rapid heart rate, brain fog, neck pain, visual problems, dizziness, and chronic fatigue.CCI or neck ligament laxity treatment options depend upon the severity of the instability and clinical symptoms. When appropriate, conservative care should always be the first-line treatment. Craniocervical Instability Surgery is often recommended when conservative care fails. This involves a fusion of the head to the neck which is a major surgery that is associated with significant risks and complications…

Read More About Craniocervical Instability

Frozen Shoulder

Frozen shoulder, also known as adhesive capsulitis, is a painful loss of shoulder movement and range in motion.  The incidence of frozen shoulder is 3-5% in the general population and up to 20% in those with diabetes.  The peak incidence is between 40-60 years of age.  The exact mechanism is poorly understood.  In general, the capsule becomes inflamed, thickened, and contracted with pain and significant restriction in range of motion. causes are poorly understood but risk factors include trauma, prolonged immobility, systematic diseases such as diabetes, stroke, connective tissue disease, and heart disease.  Other causes include post-surgery, chronic inflammation causing stimulation of myofibroblasts

Read More About Frozen Shoulder

Lateral Epicondylitis / Tennis Elbow

Lateral epicondylitis otherwise known as tennis elbow is an overuse injury involving the extensor muscles that originate on the bony prominence (epicondyle) on the outside (lateral) aspect of the elbow. It is more properly termed tendinosis that specifically involves the origin of the extensor carpi radialis brevis muscle. In a study, Nirschl and Pettrone attributed the cause of lateral epicondylitis to be tearing in the origin of the extensor carpi radialis brevis (ECRB) muscle (1). The extensor carpi radialis brevis (ECRB) muscle originates from the lateral epicondyle. It functions to move the wrist so that the hand moves away from the palm and towards the thumb.

Read More About Lateral Epicondylitis / Tennis Elbow

Medial Epicondylitis / Golfer’s Elbow

Golfer’s elbow involves tears in the ulnar collateral ligament and pain or soreness on the inside of the elbow. The bony bump you feel there is the medial epicondyle of the humerus (upper arm bone). There are five forearm muscles that attach at this point, all of which are involved in helping to flex or rotate the forearm and wrist. Pain can get worse when you throw a ball, grip a dumbbell, turn a screwdriver, and other movements that involve the fingers, hand, wrist, and/or elbow. Tennis elbow is similar, however, it refers to the outside of the elbow, at the lateral epicondyle.

Read More About Medial Epicondylitis / Golfer’s Elbow

Rotator Cuff Tear

Are you plagued by shoulder pain that has now transitioned from intermittent to constant and keeps you up at night? Are daily shoulder movements, such as dressing and reaching for objects in the kitchen cabinets, painful? Is your range of motion decreasing as your pain is increasing? You may have a full- or partial-thickness rotator cuff tear. Has conservative therapy in the form of heat, ice, stretching, rest, and acupuncture failed to provide significant relief? Has an MRI demonstrated a full-thickness or partial-thickness tear of the rotator cuff? What to do? If left untreated, full-thickness and 26% of partial-thickness tears will progress.

Read More About Rotator Cuff Tear

Shoulder Impingement Syndrome

Pain is the most common symptom.  It typically occurs with the elevation of the arm, forced movement overhead, and when lying on the shoulder.  Impingement can also cause shoulder pain when reaching across the body. Narrowing of the subacromial space is the most common cause of shoulder impingement syndrome (6).  The subacromial space is the area between the top of the arm bone (humerus) and the AC joint.   This narrowing compresses or pinches the rotator cuff tendons and bursa.  If left untreated the rotator cuff tendons can become inflamed, damaged, and or torn.Bursa and tendons can not be seen on x-ray.  An x-ray may demonstrate…

Read More About Shoulder Impingement Syndrome

Shoulder Labral Tears

The labrum is a cartilaginous cup that circles the shallow shoulder socket (the glenoid) to make the socket deeper. The labrum supports and stabilizes the shoulder joint. Causes of Shoulder Labral Tears Injury to the labrum typically occurs from repetitive trauma in overhead throwers, such as in baseball. It can also occur from a traction injury to the arm, such as lifting a heavy object off the ground or getting your arm jerked. Symptoms of Shoulder Labral Tears. Typical symptoms include pain in the front of the shoulder or deep inside the joint. Treatment options initially include physical therapy which is designed to restore range of motion and strength to the shoulder.

Read More About Shoulder Labral Tears

Slipping Rib Syndrome

Slipping Rib Syndrome can be incredibly painful and is often misdiagnosed. It is also known as rib dislocation, rib subluxation, Tietze syndrome, Davies–Colley’s syndrome, rib-tip syndrome, painful rib syndrome, costochondral separation, and clicking or moving rib syndrome. It is very common for athletes involved in contact sports to get a slipped rib. Trauma causes stretching and sometimes tearing of the ligament attachments of the rib, creating instability. We also see this in many of our motor vehicle accident patients, caused by the seat belt and/or airbag. Once damaged, it can take several weeks to resolve (4-12 weeks). After 3 months, if the rib continues to…

Read More About Slipping Rib Syndrome

Thoracic Outlet Syndrome

The thoracic outlet is an area around the collar bone where the nerves that come from your neck meet up with the blood vessels from your heart and together supply the entire upper extremity (shoulder and arm). These blood vessels (subclavian artery and vein) and nerves (brachial plexus) travel from the base of your neck to your armpit (axilla) and are considered the “thoracic outlet”. Now that you know what the thoracic outlet is, what is thoracic outlet syndrome? Simply listening to a patient’s history and completing a physical examination is all that is needed to diagnose TOS. But more involved imaging such as X-rays…

Read More About Thoracic Outlet Syndrome
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When Should I Worry about Arm Pain at Night?

If arm pain 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

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.

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.

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.

In Conclusion

Arm pain at night can erode one’s sleep and well-being.  There are many different causes of arm pain.  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 experts in the management of many of the causes of arm pain.  While 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.

Again, arm pain 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 a telemedicine consult from home, 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

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