Ache in left arm that you should not ignore

Ache in left arm that you should not ignore
September 7, 2015 8:37 AM

Having pain in your left arm? What do you think is the reason for this pain? Well it sounds frightening because sometimes this type of pain may be an alarming signal of coming heart attack. Therefore, it is something that should not be ignored or overlooked. Have a look at this article to get a detail about all possible causes of left arm pain and the ways to differentiate them on the basis of their symptoms.

But does that necessarily mean that any ache in left arm is always heart related? The answer is NO. There may be several other causes of ache in left arm that you might not be aware of. This pain can vary from mild pain of muscle sprain to serious shooting pain of a heart attack. So, nothing can be said with certainty about the possible cause of pain in left arm unless you go to see your doctor and get your ECG and blood examined.

However, among all causes of left arm pain, heart related pain is the most serious one (1, 2). So, whenever you get a pain in your left arm, do not ignore it and get a medical checkup just to exclude the risk of heart attack. 

Here are some of the causes of ache in left arm along with their differentiating symptoms;

Heart attack

Heart attack or myocardial infarction is an emergency condition that must be diagnosed and treated in time to prevent serious consequences. Myocardial infarction occurs when blood supply to the heart muscles is extremely reduced, causing ischemia of heart muscles. Heart is an active organ that keeps pumping blood to the whole body throughout your life. This continuous working of heart is possible only when it receives adequate amount of blood supply and oxygen. In myocardial infarction the blood supply to heart muscles is reduced due to the blockage of coronary blood vessels supplying the heart. Obesity, hypertension, high cholesterol level and diabetes are the major risk factors for heart attack. People having any of the above conditions are more likely to get a heart attack. In these people, cholesterol remains high and starts depositing in the coronary heart vessels. Cholesterol keeps on building up gradually until a plaque is formed that completely obstructs the heart vessels, thus cutting off the blood supply. Once the blood supply is reduced to a critical level, heart muscles become ischemic and start dying that triggers the onset of heart attack.

How to recognize the symptoms of heart attack?

Myocardial infarction takes time to develop because blockage of coronary vessel is not a sudden process. Rather it takes time for the clot to form and cause heart attack. Symptoms of heart attack begin to appear only when complete blockage of heart vessels occurs. Sign and symptoms of heart attacks are often very subtle and misleading. Therefore, chances of misdiagnosis are high. Sometimes, people become unable to recognize the early symptoms of heart attack and keep neglecting them until they get a full blown heart attack. The earlier you recognize the symptoms of heart attack; the better is your chance to prevent the worse outcome.

Most of the people have a sort of confusion or misconception about the symptoms of heart attack. Often it is presumed that chest pain or discomfort is the only warning sign of heart attack and heart attack cannot occur until or unless there is associated chest pain. This happens only when heart attack presents with classical symptoms of chest pain, chest tightening or squeezing. But atypical presentation of heart attack is very common now. Pain or ache in left arm is one of the atypical symptoms of heart attack. It can be warning sign that you are going to get a heart attack heart sooner or later. So, never do the mistake of ignoring pain in left arm.

If you are having a dull pain in your left arm that has just begun now, then it’s time to get alert. Pain in left arm due to heart attack usually begins suddenly and persists for a few minutes. Usually the pain persists for few minutes and then goes away and comes back. Pain due to heart attack radiates to left shoulder, left arm and toward jaw and neck. Left arm pain may occur alone as a warning sign or in combination with other symptoms of heart attack.

Other symptoms of heart attack are as follows:

  • Feeling of heaviness, pressure or fullness on chest or breastbone
  • Crushing or squeezing chest pain that is not localized and radiates to neck jaw, left shoulder and left arm
  • Feeling of chest tightness
  • Sometimes heart pain radiates to upper abdomen or gastric area that may be confused with indigestion
  • Difficulty in breathing or shortness of breath even on rest
  • Feeling of lightheadedness and dizziness
  • Nausea, vomiting or feeling of indigestion
  • Increased sweating
  • Irregular heart beat or palpitations
  • Feet and arms getting cold
  • Extreme fatigue or unexplained weakness

If left arm pain is associated with any of the above symptoms, then its right time to seek immediate medical help because heart attack is more likely to occur in this scenario. However, if left arm pain occurs alone without any other symptom and is of sudden onset persisting for more than 15-30 minutes, it is likely to be heart related pain. And if you are already having a previous history of ischemic heart disease and you get a dull ache in your left shoulder or left arm, it may indicate towards aggravation of your heart problem.

Why does left arm pain occur in heart attack?

The reason behind pain in left arm due to heart attack is very simple. The nerves that supply heart and left arm arise from the same nerve root in the spinal cord. Whenever heart attack occurs, the nerves that supply heart region take signals to common nerve root. Now from this common nerve root in the spinal cord, the pain signals are referred towards left shoulder and left arm. That is why an ache is felt in left arm in heart attack.

How to differentiate cardiac pain from non cardiac pain?

Before we start we just want to emphasize that you should always call a doctor or an ambulance if you do not feel well. Never attempt to treat anything on your own. The information below is just for information but the first thing you should do is call a doctor!

Heart attack is not the only cause of ache in left arm (3). There are a lot more other causes of pain left arm. It’s hard to differentiate the pain of cardiac origin from pain of musculoskeletal origin. But, there is some minor difference in the onset, character and duration of pain in all the cases. Here are some points that will help you recognize whether the ache in left arm and shoulder in due to heart related issue or not:

  • Heart attack ache is a dull ache with sudden onset that persists for 15-30 minutes. This dull ache in left arm sometimes radiates towards neck and jaw too. Other symptoms of heart attack like nausea, chest heaviness and shortness of breath may accompany the pain in left arm.
  • Left arm ache due to musculoskeletal problems like tendinitis and bursitis develops gradually and is sharp and tearing in nature. This type of pain is usually associated with swelling and inflammation of arm and shoulder. On the other hand, pain due to nerve entrapment will be more like a tingling sensation along with numbness and limb weakness.
  • Heart related left arm ache remains consistent and does not change with movement of the arm. But, pain due to musculoskeletal problem gets worse on moving the limb and relieves on avoiding arm movements. If you get left arm ache while doing some heavy work like pushing the objects, then it’s least likely to be the heart pain because heart related pain starts on its own and limb movement or activity has no role in initiating the pain. However, a sudden dull ache starting while taking rest or reading a newspaper will strongly point towards heart attack.
  • If left arm pain remains stubborn for days and months, it’s more likely be due to some chronic conditions like arthritis.

Angina

Angina is defined as the chest pain on exertion and is typically the symptom of heart disease. Angina is often termed as mini heart attack but this condition is milder than myocardial infarction. In angina, the complete occlusion of coronary vessel does not occur. There is partial obstruction of vessels due plaque formation. Due to this, the symptoms of angina do not appear on rest because the coronary vessels are not completely blocked and blood flow remains maintained to heart muscles.

Until the heart is receiving sufficient amount of blood and oxygen, it will keep working normally. But, when a person starts doing exercise or some strenuous activity, the oxygen demand of heart tissues increases many folds. The only way to meet up this high oxygen demand of the heart muscles is by increasing blood flow. But, this cannot happen in patients of angina pectoris because these people have a fixed blood flow due to partial occlusion of coronary vessel.  The blood flow in these people cannot increase enough to meet up the oxygen demand. Thus, heart muscles become deprived of oxygen and ischemia starts that lead to onset of chest pain. That is why angina pain starts only when angina patients do some exertion because their heart becomes deprived of oxygen. Angina pain is relieved on rest because during rest, the oxygen demand comes back to normal and blood flow is enough to cope up with it.

Angina pain typically starts in chest on doing exertion. The pain is usually felt as burning, pressure or squeezing of chest that radiates towards left arm, jaw and neck. But, this pain typically starts on doing any exertion or activity and is relieved on taking rest. The duration of pain lasts for 5-10 minutes and unlike the pain of heart attack, this pain is not persistent and is not associated with other symptoms like nausea, dizziness or lightheadedness.

Whenever you get a dull boring ache in your left arm that comes with exertion and goes with rest, consider it as the pain of angina and get a complete medical checkup immediately because negligence in the treatment of angina may increase your chances of getting a heart attack in future.

Flu shot pain

Flu shots are given as the vaccination to prevent influenza spread. This flu shot is given as an injection in the upper arm on either left side or right side. Some people who receive injection in left arm often complain of pain in left arm after the flu shot. The sharp pain develops after flu shot due the muscle soreness at the site of injection. Flu shot vaccination contains dead flu viruses and when this vaccine is injected, antibodies are produced by the body’s immune system against the dead virus in vaccine. These antibodies once formed provide long term protection against flu virus. Some of these antibodies reach the side of injection and cause inflammation at the site causing, muscle soreness and pain that spreads to whole arm.

This pain may be accompanied by flu like symptoms like fever or runny nose. However, the pain only persists for 2-3 days and then vanishes on its own. This means there is nothing to worry about arm pain after flu shot. One important thing is that flu shot pain should not be confused with heart pain because both occur in different scenario. Flu shot pain starts after injection while heart pain starts all of a sudden without any physical cause.

Musculoskeletal causes of left arm pain

As the name in indicating, musculoskeletal pain is defined as the pain that originates from muscles, bones, tendons and ligaments. The main causes of musculoskeletal are muscle sprain, tendon inflammation, ligament tears, bone fractures and nerve compression or injury. Here are some of the musculoskeletal disorders that may cause pain in left arm:

Muscle sprains and strains

One of the most common causes of left arm pain is muscle sprain or strain (4). Muscle sprain occurs while pushing or pulling heavy things, which causes overstretching of muscles, causing injury or tearing or muscle fibers. Injury of muscles initiates inflammation that leads to onset of pain, swelling and muscle soreness. Pain of muscle sprain typically occurs after physical injury or misuse of muscle and cannot be confused with heart pain because heart pain can start even when you are taking rest and has no relation to physical injury or stress. Risk of muscle sprain is high is athletes, sportsmen and old peoples.

Here are some of the symptoms of muscle sprain that help differentiate it from heart pain:

  • Sharp sudden pain after strenuous physical activity or muscle overstretching
  • Aggravation of pain on moving arm. Heart related pain, on the other hand, does not aggravate with limb movement
  • Difficulty in moving shoulder. Heart attack pain does not affect joint mobility
  • Swelling and redness of affected area. There is no swelling or redness of arm in heart related pain
  • Muscle stiffness. This is typically a sign of muscle injury and has no role in heart related pain.
  • Skin bruise indicating muscle tear

Mild muscle sprain won’t give you trouble as it heals own its own within 2-3 weeks and pain can be relieved by taking pain killers. If the pain persists longer than this, then seek medical help as it may be a sign of serious muscle injury that may need surgical repair as well.

Rotator cuff overuse

Shoulder joint is supported by the help of muscles and ligaments that are commonly termed as rotator cuff (6). This rotator cuff keeps the shoulder joint stabilized and helps improve its mobility. Any injury or overuse of this rotator cuff may cause severe pain in arm and shoulder. Common causes of rotator cuff injury are sudden overhead movement of arm, lifting of heavy objects, falling on outstretched hand, sports injury and age related wearing and tearing of muscle tendons. Here are described the typical features of rotator cuff injury;

  • Sudden onset of sharp shooting pain in the shoulder region. The pain of rotator cuff injury radiates from shoulder towards arm and elbow
  • Painful movements of shoulder joint
  • Difficulty in causing overhead movement of arm such as brushing hair or changing clothes
  • Painful abduction (moving arm away from body) and rotational movement of arm
  • Swelling and redness around shoulder
  • Worsening of pain at night
  • Joint stiffness and weakness

Avoiding strenuous physical activity or limb movement will help heal rotator cuff injury. Pain can be managed by taking over the counter pain killer medicines.

Tendinitis

Tendinitis is defined as the inflammation of tendons. Tendons are white fibrous cord that attach muscles to bones and help stabilize their movement. Tendinitis can be one of the causes in left arm. Tendinitis can occur in tendons of shoulder joint or of elbow joint. It can be acute or chronic depending upon its cause. Acute tendinitis occurs in case of repetitive movement of joints, sudden movements and physical injury due to heavy object lifting and falling. Chronic tendinitis is more likely to occur in old people or those having autoimmune joint disorders.

Whatever the cause of tendinitis, it can lead to severe pain in whole arm. Symptoms of tendinitis are:

  • Dull, burning or sharp pain in the affected area that may radiate to whole arm
  • Usually the pain is more on the site of affected tendon and you may be able to localize the point of pain
  • The affected area seems to be tender on touching. Contrary to this, in heart attack the left arm in non tender and pain does not increase on touching
  • Painful movement of affected joint
  • Swelling, warmth and redness in the area of affected tendon
  • Muscle and joint stiffness
  • Movement of the limb may produce a crackling sound, named as crepitus.

Tendinitis pain can be simply relieved by taking pain killers and rest. It takes 2-3 weeks for tendon injury to heal depending on the severity of injury. Medical help should be sought when pain does not away within a month.

Brachial plexus injury

Brachial plexus is a group or network of nerves located in the neck from where nerves are supplied to shoulder, arm and hand. Injury due to overstretching of arm, inflammation and compression of this nerve plexus can cause pain in arm (5).

Brachial plexus injury is accompanied by following symptoms:

  • Onset of tingling pain in arm, more in the area supplied by affected nerves
  • Pain is accompanied by numbness or abnormal or absent sensations
  • Limb weakness may be present

Minor injuries due to physical activity can be healed by taking pain killer and avoiding limb movements. Injuries due to nerve compression may need to be treated by surgery.

Carpal tunnel syndrome

Carpal tunnel syndrome is caused by compression of median nerve. Median nerve supplies forearm muscles, thumb, index finger, middle finger and half of ring finger. Median nerve passes through tunnel like structure from forearm to hand. When nerve gets pinched it causes tingling pain in first three finger, wrist and forearm. This pain may radiate to arm and shoulder as well. There is also associated numbness and hand and forearm weakness.

Broken bone or fracture

Broken fracture pain is extremely severe and sharp with inability to move the limb. It is an emergency condition that must be treated promptly.

Conclusion

The whole purpose of this article was to discuss common causes of left arm pain with more emphasis on heart related pain because heart related pain is the most lethal one and is the warning sign of heart attack. If left arm pain occurs suddenly without any evidence of physical injury, then it must be taken as heart attack pain. All other causes of left arm pain due to physical injuries are less serious and usually heal within a short time until or unless there is any complication. 

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Written by: Michal Vilímovský (EN)
Education: Medical student, 3rd Faculty of Medicine, Charles University, Prague, Czech Republic
Article resources: See numbered references within the article.
Image resources: Dollarphotoclub.com
Published: September 7, 2015 8:37 AM
Next scheduled update: September 7, 2017 8:37 AM
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