Medically reviewed guide · Last updated: 26 October 2026 · Reading time: approx. 11 min

Arm Pain: Nerve, Muscle or Heart?

The most common causes compared

The causes in detail

This article covers pain in the arm itself — in the upper arm, the forearm or radiating along the whole arm. If the pain sits mainly in the shoulder joint, you will find guidance under shoulder pain; if pressure or stabbing in the chest is the main symptom, read the article on chest pain first. For complaints right at the joint, the articles on elbow pain and wrist pain will help.

Muscles: overuse, strains, sore muscles

Unaccustomed work such as painting, carrying moving boxes or a new strength training programme overloads the muscles of the upper arm and forearm. Typical is a pulling, dull pain that increases with movement and pressure and improves within a few days. Repetitive strain, for example at the mouse and keyboard, can keep forearm pain going that only eases after breaks. With a muscle strain, the pain came on suddenly during a movement. First step: reduce the strain but keep moving, using warmth or brief cooling, whichever feels better. More on this under muscle pain.

Tendons: from tennis elbow to the biceps tendon

The tendons of the forearm muscles attach at the elbow. If the outer attachment is irritated — tennis elbow — the pain often radiates into the forearm when gripping, lifting or twisting. The biceps tendon can hurt at the front of the shoulder or in the crook of the elbow. If the long biceps tendon ruptures, the muscle belly visibly slips towards the elbow; a tear in the crook of the elbow causes sudden pain with loss of strength when bending and twisting the forearm and should be seen promptly by a trauma surgeon or orthopaedic specialist.

The shoulder: pain that arrives in the upper arm

Many shoulder problems are felt not in the joint but on the outside of the upper arm, roughly at the level of the deltoid muscle. With impingement syndrome and calcific tendinitis, it typically hurts when you lift your arm out to the side and at night when you lie on the affected side. A frozen shoulder restricts movement in all directions. The first step is an examination of shoulder mobility, often supplemented by ultrasound.

Cervical spine: when a nerve root is irritated

The nerves for the arm leave the spine in the neck region. If they are pressed on by wear and tear, bony outgrowths or a herniated disc, cervical radiculopathy develops: a pulling, often electric pain from the neck over the shoulder and arm into specific fingers, frequently with tingling, numbness or reduced strength. Which fingers are affected gives a clue to the level — put simply, the thumb points more to the sixth, the middle finger to the seventh and the little finger to the eighth cervical nerve root. Many people also have neck pain, and turning the head or tilting it back makes the arm pain worse. According to the guideline, most symptoms improve with conservative treatment within weeks to a few months.

Nerve compression at the elbow and wrist

In carpal tunnel syndrome, the median nerve is compressed at the wrist. Typical signs are tingling at night and numb hands in the thumb, index and middle fingers; the pain can, however, pull up into the forearm and shoulder. Shaking out the hand often brings relief. At the elbow, the ulnar nerve can become irritated in its groove — with tingling in the ring and little fingers, made worse by bending the elbow for long periods or leaning on it. The first step is an examination at the GP practice; confirmation usually comes from a neurologist with a nerve conduction study.

The heart: pain that radiates into the arm

If the heart muscle receives too little blood, the pain can radiate into the left arm, but also into both arms, the right arm, neck, jaw, back or upper abdomen. In stable angina as part of coronary heart disease, the pressure typically comes on with exertion, cold or excitement and fades within a few minutes at rest. Sometimes the arm is the only place that hurts. In a heart attack, the symptoms persist, often with tightness, breathlessness, cold sweat, nausea or anxiety. Women, older people and people with diabetes more often have atypical symptoms. Arm pain that can be triggered precisely by pressing on the muscle or by a particular arm movement, on the other hand, points more to a mechanical cause.

Blood vessels: thrombosis and arterial occlusion

A thrombosis can also develop in the veins of the arm, especially with a venous catheter or port, with cancer or after unaccustomed, forceful overhead strain. Typical signs are swelling, a feeling of heaviness, bluish discolouration and visibly congested veins on the shoulder and chest. An arm vein thrombosis can also trigger a pulmonary embolism and should be seen by a doctor the same day. Much more rarely, a blood clot blocks an artery in the arm, for example in atrial fibrillation: the arm suddenly becomes painful, pale, cold and numb, and there is no pulse at the wrist — an emergency.

Bones, shingles and rheumatic conditions

After a fall onto the arm or shoulder, there may be a fracture, especially with osteoporosis — fractures near the top of the upper arm are among the typical osteoporotic fractures in older age. Burning, one-sided pain in a strip of skin that begins a few days before a blistering rash fits with shingles. Pain and stiffness on both sides in the shoulders and upper arms, especially in the morning and in people over 50, can point to polymyalgia rheumatica. After breast cancer treatment with removal of lymph nodes, lymphoedema can make the arm heavy and swollen.

Self-tests: first clues at home

These tests do not replace a diagnosis; they only point you in a direction. With arm pain and chest pressure, breathlessness or cold sweat: do not test, call 112 immediately.

• The pressure point search: can the pain be triggered precisely by pressing on a muscle or tendon attachment? That points to muscles or tendons. A deep, diffuse pain that cannot be reproduced by pressing fits less well.
• The hand-on-head test: place the hand of the painful arm on your head. If the radiating arm pain eases, this points more to an irritated nerve root in the cervical spine, because the nerve is relieved.
• The finger map: where does it tingle or feel numb? Thumb to middle finger at night fits carpal tunnel syndrome, the ring and little fingers fit the ulnar nerve, and a strip from the neck into one particular finger fits a nerve root.
• The side-by-side comparison: compare both arms in the mirror: is one thicker or bluer, or are the veins on the shoulder and chest more prominent? Is one arm colder or paler? These are signs of a blood vessel problem that should be seen by a doctor the same day.
• The strain log: for one week, note down when the pain comes. Pain with particular arm movements fits muscles, tendons or the shoulder. Pain when climbing stairs or walking uphill that disappears after a few minutes at rest should be assessed promptly by a cardiologist — do not keep testing it out.
• The medication timeline: have you recently started a statin, a fluoroquinolone antibiotic or an aromatase inhibitor, or had a vaccination? Note down the start date and dose.

Warning signs: when not to wait

• Arm pain with pressure, tightness or burning in the chest, breathlessness, cold sweat, nausea or anxiety — even without chest pain, if the pain occurs at rest or lasts longer than a few minutes
• Arm pain that reliably comes on with exertion and goes at rest, especially with cardiovascular risk factors
• A suddenly cold, pale, numb arm, or a suddenly weak, paralysed arm, possibly with a drooping corner of the mouth or speech problems
• One-sided swelling, heaviness and bluish discolouration of the arm, especially with a port, catheter or cancer
• Increasing loss of strength, such as dropping things, or numbness that spreads
• Misalignment, severe swelling or inability to move after a fall
• Fever with red, hot, swollen skin, arm pain with known cancer, or pain at night with unintended weight loss

The treatment pathway: step by step

Without warning signs, the assessment usually moves from the simple to the more elaborate.

1. Assess and rest in moderation. With fresh overuse, cut back on the triggering activity for a few days, but keep moving the arm. Warmth often helps tense muscles, cooling more often fresh strains. Keep a short pain diary at the same time.
2. Examination at the GP practice. A conversation, examination of the cervical spine, shoulder, elbow and wrist, testing of strength, sensation and reflexes, and pulses in both arms. If the heart is suspected, an ECG and possibly blood tests; if thrombosis is suspected, an ultrasound of the veins.
3. Specialist care depending on the findings. Shoulder or tendons: orthopaedics. Nerve root or nerve compression: neurology with a nerve conduction study; with paralysis or suspected spinal cord involvement, a prompt MRI of the cervical spine. Suspected angina: cardiology with an exercise test or imaging.
4. Conservative treatment. For muscle and tendon pain and most nerve root pain, movement, targeted physiotherapy and adjusting the strain are the foundation. In carpal tunnel syndrome, a wrist splint worn at night can help.
5. Procedure if needed. With increasing paralysis, persistent nerve compression or a confirmed narrowing of the coronary arteries, surgery, release of the carpal ligament or catheter treatment may be options. Whether and when a procedure makes sense is always decided by the practice treating you, together with you.

The medication angle: when treatment pulls into the arm

Some medicines cause muscle, tendon or joint pain that makes itself felt in the arm. If arm pain starts without a clear reason, it is worth taking a look at your medication plan.

Statins: take muscle pain seriously, but do not overrate it

Cholesterol-lowering medicines such as atorvastatin or simvastatin can cause muscle pain and muscle weakness, usually on both sides in the upper arms, shoulders, thighs or calves. In studies, however, such complaints are about as common with a statin as with a placebo — so not every muscle pain comes from the statin. Very rarely, serious muscle damage occurs with marked weakness and dark urine; report this to a doctor immediately. Interactions, for example with certain antibiotics or grapefruit juice, can increase the risk. Do not stop statins on your own: switching the active substance or the dose often helps.

Fluoroquinolones: tendons under stress

Antibiotics such as ciprofloxacin or levofloxacin can trigger tendon inflammation and tendon ruptures — most often in the Achilles tendon, but also in the shoulder, elbow and hand. The risk rises with age and with simultaneous cortisone. Following the 2019 Red-Hand Letter (a drug safety notice in Germany), the rule is: at the first sign of tendon pain, avoid strain and speak to the practice straight away.

Aromatase inhibitors, bisphosphonates and vaccinations

Aromatase inhibitors such as anastrozole after breast cancer often cause joint and muscle pain, including in the hands and arms, and can encourage carpal tunnel syndrome. Bisphosphonates for osteoporosis can trigger bone, joint and muscle pain. And after a vaccination into the upper arm muscle, pain and swelling at the injection site are normal for one to three days; if severe shoulder pain persists for weeks after a vaccination, it should be examined by a doctor.

Painkillers: limited benefit, limited duration

With muscle strains, tendon irritation or shoulder pain, anti-inflammatory painkillers such as ibuprofen, naproxen or diclofenac gel can help in the short term. With nerve pain, their effect is often limited. Without medical advice, the package leaflet generally says: no longer than three to four days in a row. Together with blood thinners, the risk of bleeding rises, and caution is needed with kidney, stomach or heart problems. The painkiller comparison gives an overview; which treatment is right is always decided by the practice treating you. And importantly: a painkiller for arm pain that could be coming from the heart only delays the diagnosis.

How to prevent arm pain

• Increase the strain gradually — build up new sports, strength training or unaccustomed work step by step and plan in breaks, instead of doing everything in one weekend.
• Set up your workstation — rest your forearms at desk height, screen at eye level, mouse close to your body. Regular short breaks take the strain off the neck, shoulders and forearms.
• Strengthen your shoulders and neck — strong shoulder blade and core muscles take the load off the shoulder joint and cervical spine. Physiotherapy can show you suitable exercises.
• Tackle heart risk factors — stopping smoking, exercise and well-controlled values for high blood pressure, diabetes and cholesterol lower the risk of angina and heart attack.
• Keep your medication plan up to date — note down a statin, antibiotic or vaccination with the date. That way a connection in time can be checked quickly later on.

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