Take arms against perplexing pain

Brushing your hair, turning a steering wheel, or lifting a bag of groceries are simple tasks that feel a lot harder when your shoulder, elbow, or wrist hurts. But when this pain seemingly strikes from nowhere — without injury from a mishap or accident — confusion may join discomfort.

For doctors, however, the scenario is often not at all mysterious. Our arms are constantly in use, so they're vulnerable to a variety of short-term or chronic problems that produce pain, says Dr. Tamara Rozental, chief of Hand and Upper Extremity Surgery at Harvard-affiliated Beth Israel Deaconess Medical Center.

"The vast majority of people we see don't have an obvious injury," says Dr. Rozental. "It's not an unusual situation."

Pain "buckets"

Pain that arrives without trauma falls into many different "buckets" — some more common in women — depending on whether it affects the shoulder, elbow, wrist, or a combination of arm joints, Dr. Rozental says.

To some extent, we're prone to this pain simply by aging. Other risk factors include prior overuse injuries; conditions such as diabetes, which can thicken tendons and connective tissues surrounding joints; and occupations that involve vigorous use of the hands and arms or vibrating tools.

Dr. Rozental highlights these common causes:

Arthritis. The wear-and-tear version called osteoarthritis — which affects half of adults 65 and older — is a highly likely culprit in shoulder, elbow, or wrist pain as cartilage breaks down with age and use. Less-common rheumatoid arthritis stems from an overactive immune system attacking joint linings. Both arthritis types are more prevalent in women, according to the CDC.

Bursitis. Frequently propping your elbow on a desk or other hard surfaces makes this joint more susceptible to bursitis, inflammation of the small, fluid-filled sacs called bursae that protect and lubricate bones, tendons, and muscles. But the condition can occur in just about any joint, as bursae are located throughout the body.

Frozen shoulder. Most common in women 40 and older, frozen shoulder (known medically as adhesive capsulitis) can literally develop overnight. It happens when connective tissue surrounding the shoulder capsule thickens and tightens, triggering shooting pain with various arm movements. Over time, your shoulder can stiffen and "freeze" for months or longer.

Rotator cuff tear. Aging or doing tasks that require overhead arm motion — such as painting or yard work — raise the odds of a tear in the rotator cuff, a group of four muscles that stabilize the shoulder joint. Tears can start small and worsen over time, leading to throbbing pain that can even make it difficult to sleep.

Tendinitis. "Tennis elbow" and "swimmer's shoulder" are apt nicknames for tendinitis, irritation in tendons attaching muscle to bone near these joints. That's because these repetitive activities can stress the tendons bit by bit, leading to pain and tenderness.

Carpal tunnel syndrome. This nerve compression syndrome, which is three times as common in women as in men, produces pain or tingling in the arm or hand. It stems from pinching of the median nerve where it passes through the carpal tunnel, a narrow passage of ligament and bones in the wrist.

Cubital tunnel syndrome. Carpal tunnel's cousin, this type of nerve compression occurs at the elbow. It may be triggered by pressure from long periods of bending your elbow. The space around the nerve may also narrow over time.

Spectrum of treatments

With careful listening, a doctor can often readily diagnose many of the causes of shoulder, elbow, or wrist pain. "We can usually tell what's wrong just by hearing a patient's story and understanding which activities are causing pain," Dr. Rozental says. However, "repetitive stress injuries are much harder to diagnose — there's no clear underlying problem you can identify."

First, Dr. Rozental recommends at-home measures such as the RICE (rest, ice, compression, elevation) approach; over-the-counter anti-inflammatory pain relievers such as ibuprofen (Advil) or naproxen (Aleve); or a splint or brace that allows the arm to rest until pain eases. If a few weeks of these remedies don't spell relief, Dr. Rozental advises a visit with your primary care doctor.

Ultrasound is a common diagnostic tool, allowing doctors to inexpensively visualize painful areas. Next steps may include physical therapy or steroid injections (using ultrasound guidance when needed) into affected areas to reduce inflammation and pain.

Surgery is typically a last resort if conservative treatments fail. The procedure would aim to repair the specific problem, whether it's a torn rotator cuff, a narrowed carpal tunnel, or damaged cartilage.

"It's hard to talk about arm pain as a big bucket," Dr. Rozental says. "But most of the time, my advice is to try more invasive treatments only after you've tried all the home measures and still are experiencing persistent discomfort."

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