Arm / hand / elbow pain (approach)

The regional approach hub for arm, elbow, wrist and hand pain. See the individual pages for carpal tunnel syndrome, De Quervain’s, Dupuytren’s, trigger finger, ganglion, hand OA, tennis/golfer’s elbow, olecranon bursitis and paronychia — this hub stays at differential level rather than duplicating their detail. For shoulder pain see the Shoulder pages. For acute injury see Finger & Thumb Joint Injuries and Wrist & Hand Injuries.

In the elderly, referred pain, tumours, polymyalgia rheumatica and entrapment neuropathies are more likely.

Cervical-spine referred pain — the commonest “arm pain” mimic

Cervical radiculopathy occurs when a nerve root is compressed as it passes through the neural foramen, causing pain that radiates beyond the neck into the arm along a dermatomal pattern rather than staying local to a joint. The C7 root is affected in over half of cases, C6 in roughly a quarter; symptoms worsen with neck extension or rotation toward the symptomatic side. Motor testing by myotome (C5 deltoid/biceps, C6 wrist extensors, C7 triceps, C8 finger flexors, T1 interossei) plus the biceps/brachioradialis/triceps reflexes localises the level; the Spurling test (axial compression with neck extended and rotated toward the symptomatic side) is specific but only moderately sensitive. Bilateral symptoms, hand clumsiness, gait change or urinary urgency without much neck pain suggest myelopathy rather than simple radiculopathy and warrant urgent imaging/referral.

Thoracic outlet syndrome and axillary vein thrombosis

Neurogenic thoracic outlet syndrome (nTOS) — chronic brachial plexus compression at the scalene triangle — is ~97% of thoracic outlet syndrome, typically age 20-40 (70% female), with arm pain/paraesthesia not confined to one nerve distribution, worse with overhead activity or sleeping with the arm overhead; preceding whiplash or repetitive overhead strain is common. There is no single rule-in test, so diagnosis is often delayed — degenerative disc disease, cervical arthritis, rotator cuff tendinitis and carpal tunnel syndrome all sit in the differential.

Paget-Schroetter syndrome (effort-induced axillary/subclavian vein thrombosis) is the venous form of TOS — ~3% of cases versus nTOS’s 97% — and is the specific “not to miss” behind the “axillary vein thrombosis” bullet above. It typically affects healthy people in their 20s-30s doing repetitive overhead sport, presenting acutely (within 24 hours in 60-85% of cases) with sudden unilateral swelling, pain, heaviness and sometimes cyanosis; prominent collateral veins over the chest/shoulder (Urschel sign) support it. Duplex ultrasound is first-line; missed cases risk pulmonary embolism, so sudden unilateral swelling after exertion should prompt same-day imaging, not a “muscle strain” label.

Pulled elbow (radial head subluxation) — the paediatric pitfall

Nursemaid’s elbow occurs when the radial head slips under the annular ligament, most often in children aged 1-4 after axial traction (swung by the hands, pulled up by one arm, or a fall onto an outstretched arm) — caregivers may not recall the mechanism. The child holds the arm extended and pronated, refuses to move it, but isn’t distressed unless it’s examined, with no swelling, bruising or deformity; image only if the mechanism was atypical or swelling/deformity suggests fracture. Reduction (hyperpronation, or supination-flexion if that fails) is quick, needs no sedation, and symptoms resolve within minutes.

Complex regional pain syndrome (a rarity, but easy to miss early)

CRPS typically follows a limb injury (often minor) or surgery and spreads beyond a single dermatome — e.g. hand to forearm — as burning, shooting pain with allodynia (pain from a non-painful stimulus). An early “hot, red, sweaty” phase can progress to a “blue, cold” atrophic phase, with fluctuating swelling; diagnosis is clinical, one of exclusion, investigations used only to rule out infection or a missed fracture. High initial pain, distress and opioid use beyond the first week flag the need for early referral — earlier multimodal intervention appears to improve outcomes.

Thumb base (CMC) osteoarthritis

The thumb CMC joint is commonly affected by osteoarthritis, more so in post-menopausal women (~80% of cases); the dominant hand is involved in 60-65%. See the hand OA page for staging/management. Source: Basal thumb arthritis, AJGP 2020 (registry: ajgp-basal-thumb-arthritis-2020; verified 2026-08-21)