- Fibromyalgia Symptoms and Diagnosis
- Symptoms of Fibromyalgia
- Fibromyalgia Tender Points
- Fibromyalgia Diagnosis Challenges
- How Fibromyalgia Is Diagnosed
- Ruling Out Other Conditions
- Lupus and Fibromyalgia
- Upper Arm Pain
- Common Causes of Upper Arm Pain
- Broken Arm
- Shoulder Impingement
- Frozen Shoulder
- Biceps Injury
- Other Causes of Upper Arm Pain
- What Next?
- Learning About Fibro Sensitivity and Pain
- Burner (Stinger)
Fibromyalgia Symptoms and Diagnosis
This condition often causes tender “trigger points” in specific areas of the body.
Fibromyalgia causes widespread pain and tenderness. Chris Rout/Alamy
Fibromyalgia is a chronic disorder characterized by pain and tenderness throughout the body, as well as fatigue.
Although the condition is often grouped in the same category of disorders such as arthritis, it doesn’t cause damage to joints or other tissue.
Instead of being caused by inflammation, fibromyalgia is widely understood to be a disorder of the central nervous system — meaning that the brain is oversensitive to pain signals.
Symptoms of Fibromyalgia
Fibromyalgia symptoms may fluctuate in intensity, and may improve or worsen over time.
Factors such as stress, changes in weather, too much or too little exercise, and too much or too little rest can affect the severity of your symptoms.
Symptoms of fibromyalgia may include:
- Widespread pain, occurring on both sides of the body, above and below your waist
- Tenderness to touch
- Fatigue, despite getting enough rest
- Difficulty falling or staying sleep
- Morning stiffness, or worsened pain in the morning
- Difficulty with memory or concentration (known as “fibro fog”)
- Vision problems
- Problems with balance or coordination
- Numbness or tingling in your hands or feet
- Sensitivity to temperature (hot or cold)
- Sensitivity to bright lights or loud noises
- Painful menstrual periods in women
- Pain in your face or jaw
- Headaches, including migraines
- Digestive issues, including abdominal pain, bloating, or constipation
- Bladder difficulties
- Dry eyes or mouth
- Skin sensitivity or rash
Fibromyalgia Tender Points
Fibromyalgia tender points — also known as trigger points — are areas of the body where pain frequently occurs.
People with fibromyalgia often say that these areas hurt when you press on them with a finger.
There are 18 identified tender points (nine pairs) that tend to be painful when pressed.
These spots are commonly found on both sides of the body around the elbows, shoulders, knees, neck, hips, sides of the breastbone, and back of the head.
Fibromyalgia Diagnosis Challenges
Fibromyalgia is sometimes difficult to diagnose because many of its symptoms are similar to those of other disorders.
A diagnosis often requires excluding other conditions, rather than finding definitive proof that fibromyalgia is what you have.
In someone with fibromyalgia, “There’s very little to see on a physical exam,” other than reported pain and tenderness, according to Don L. Goldenberg, MD, a rheumatologist and professor emeritus of medicine and nursing at Oregon Health and Science University in Portland.
In addition, “Laboratory tests are unremarkable,” and often give doctors little help, Dr. Goldenberg says.
You may end up seeing several doctors before getting an accurate diagnosis. This process may last longer than it should because of mistakes made by both doctors and patients, according to Goldenberg.
“Many patients with this condition will shop from doctor to doctor,” he says. “They’re sure that they’ve been injured or damaged, or there’s something in their environment. And they keep searching and searching.”
A diagnosis of fibromyalgia, says Goldenberg, requires accepting that your pain has no cause beyond the nervous system itself — and may, as a result, be more difficult to treat.
At the same time, doctors may prolong the diagnostic process by being either too deferential to — or too dismissive of — patients, Goldenberg says.
“A lot of doctors will order a lot of unnecessary tests,” he notes, due to patients’ desire to rule out improbable causes of their pain.
But more commonly, “Doctors will say, ‘It’s all in your head, toughen up,’” Goldenberg laments. “And of course that’s the last thing a person wants to hear.”
While Goldenberg doesn’t excuse this kind of behavior in doctors, he understands why some of them react so badly to fibromyalgia.
“For a certain type of physician who likes things black and white, this is a real gray area,” he says. “There’s no cause and effect. The symptoms can be murky. The treatment is very murky.”
How Fibromyalgia Is Diagnosed
While there’s no definitive test to diagnose fibromyalgia, the American College of Rheumatology (ACR) has established criteria for identifying the disorder.
In the past, doctors would check the 18 tender points on the body to determine a person’s level of pain. Current guidelines don’t call for this kind of exam.
Instead, the ACR instructs doctors to consider the following factors:
- How many areas of the body (out of 18) are painful
- Whether symptoms like fatigue, waking up unrefreshed, or difficulty thinking are present
- Whether these symptoms have lasted at least three months
- Whether any other condition might be the cause of these symptoms
It’s important to find a doctor who is familiar with fibromyalgia. Many rheumatologists, internists, and family doctors can properly diagnose and treat the disorder.
Before seeing your doctor, you may want to write a list that includes:
- All past and present medical conditions
- A detailed description of your symptoms
- Medical conditions that run in your family
- All medicines and supplements you take
- Any questions you’d like to ask your doctor
Ruling Out Other Conditions
Even if your doctor suspects you have fibromyalgia, it may be desirable to rule out other, more serious conditions.
For example, “Widespread arthritis can cause pain in multiple areas,” Goldenberg notes. But, he adds, “Most doctors, although not all, should clearly be able to see that.”
If your doctor isn’t ready to diagnose fibromyalgia based on your symptoms and a physical exam alone, the following tests may be helpful:
Complete Blood Count This test can help rule out a number of disorders, including anemia (inadequate red blood cells), infection, and leukemia.
Erythrocyte Sedimentation Rate (ESR, or Sed Rate) This test can help reveal inflammatory processes throughout your body.
Cyclic Citrullinated Peptide and Rheumatoid Factor These tests can help detect rheumatoid arthritis.
Thyroid Function In some cases, it may be helpful to rule out a thyroid problem as the cause of your symptoms.
Additional reporting by Quinn Phillips.
Lupus and Fibromyalgia
How can fibromyalgia be differentiated from renewed lupus activity? That can be difficult.
- Generally, in patients with fibromyalgia and no other underlying disease, the sedimentation rate is normal and there is no positive ANA. So if a patient with lupus is very symptomatic and in the past has had a lot of changes in labs to go along with such symptoms – but this time the lab work does not show any changes, that can be a hint the symptoms may not be due to lupus.
- If the patient is placed on corticosteroids and it doesn’t help the symptoms, that suggests the symptoms are not due to an inflammatory cause such as lupus – and fibromyalgia might be considered.
- If you are having a major lupus flare, then you will hurt all over and other signs and symptoms occur that usually make it obvious to you and your physician. But when patients come in looking pretty good and the only complaint is “I hurt all over,” and then the doctor touches them and they jump, that’s suggestive of fibromyalgia coming into the picture.
The bottom line is that you need to keep track of all of your symptoms to help your doctor discern any new patterns that might merit a different diagnosis – and different treatment.
Learn more about the SLE Workshop, a free support and education group held monthly as HSS.
Summary of a presentation given at The SLE Workshop, a free support and education group held monthly for people with lupus and their families/friends. Adapted from Dr. Sammaritano’s presentation by Diana Benzaia.
Lisa R. Sammaritano, MD
Associate Attending Physician, Hospital for Special Surgery
Associate Professor of Clinical Medicine, Weill Cornell Medical College
Upper Arm Pain
Author: Chloe Wilson BSc (Hons) Physiotherapy
Upper arm pain refers to pain that is felt anywhere from just below the shoulder joint to just above the elbow.
It may be a problem in the muscles, tendons or bones, or even referred pain from elsewhere such as the neck or heart.
Upper arm pain may be a sign of wear and tear, postural problems, an injury or even an underlying medical condition.
Here we will look at the most common causes of upper arm pain and how they present, how to tell the difference between them and how to know if it is something serious. We will then go on to look at the best treatment options.
Common Causes of Upper Arm Pain
What Is It: A rotator cuff tear is a very common cause of pain in the upper arm caused by damage to one of the tendons of the rotator cuff – a group of muscles that surround the shoulder joint and control the movement and stability of the shoulder
Onset: May be gradual due to wear and tear over time from repetitive friction, or sudden with an injury such as falling on to an outstretched arm or picking up something heavy
Symptoms: Upper arm pain across the shoulder and down the upper arm, usually a dull ache, weakness and cracking/popping noises when you move your arm
Aggravating Factors: Lying on the affected arm, lifting or twisting the arm
Treatment: Rest from aggravating activities, rotator cuff exercises to strengthen and stretch the shoulder and steroid injections. In severe cases, surgery may be required
Recovery: Rotator cuff tears are often slow to heal and it can take a few months to fully recover. If symptoms persist for more than 6 months, surgery may be recommended
Find Out More: Visit the Rotator Cuff Tear section
What Is It: A break or crack in the upper arm bone known as a fractured shaft of humerus. It may be anything from a small hairline fracture to a complex fracture where the bone has completely broken into two or more pieces
Onset: Sudden onset from a direct blow to the upper arm, e.g. a fall or RTA, sudden severe twisting of the arm or occasionally from an extreme contraction of one of the arm muscles e.g. when throwing. In most cases there is an obvious event that caused the fracture. If this is not the case, there may be an underlying pathology that has weakened the bone making it more likely to break e.g. osteoporosis or cancer
Symptoms: Severe upper arm pain – often described as a sharp pain, deformity (if the fracture has displaced there may be a bulge where the bone is out of place), shortening of the arm, bruising, swelling, minimal arm movement
Aggravating Factors: Any arm movement, pressure over the fracture site
Treatment: Minor fractures may be treated by immobilising the arm in a cast for 4-6 weeks. Major fractures will require surgery to realign the bones and fix them back together using either a metal rod or a metal plate and screws
Recovery: It usually takes around 3-6 weeks for the bone to knit back together and then the same length of time again for it to strengthen. However, in elderly patients healing is often slower. You will need physical therapy to regain strength and movement in the arm as stiffness and weakness is a common problem. It can take up to a year to fully recover from an arm fracture
Find Out More: Visit the shoulder fractures section to find out all about the different types of fractures that cause upper arm pain
What Is It: Shoulder impingement is a collective term for anything that reduces the amount of space in part of the shoulder, known as the subacromial space, which places pressure and friction on the rotator cuff. Shoulder impingement is a common cause of shoulder and upper arm pain affecting approximately 20% of people at some point usually caused by repetitive overhead activities such as throwing or swimming, aging, posture or genetics.
Onset: Gradual onset that gets progressively worse over time. Most frequently develops in middle age (45-65)
Symptoms: Shoulder and upper arm pain, usually on the outside of the arm which may extend down to the elbow, often described as feeling like toothache. Painful arc with shoulder movement (as shown in picture) and weakness. Shoulder movement is not usually restricted initially, but over time, stiffness may develop due to lack of use
Aggravating Factors: Reaching and lifting above your head, lying on your side, reaching behind your back, getting dressed
Treatment: Rest from aggravating activities, ice, rotator cuff exercises to strengthen and stretch the muscles and steroid injections. If the impingement is caused by small bone spurs in the subacromial space, surgery will be required to remove them, known as a subacromial decompression
Recovery: It can take 3-6 months for upper arm pain to settle with shoulder impingement syndrome, with or without surgery
Find Out More: Visit the shoulder impingement syndrome section
What is it: Thickening and tightening of the joint capsule, a fluid filled sac that surrounds the glenohumeral (shoulder) joint
Onset: Gradual onset over weeks/months, most common between the ages of 40-70 and in females. Often no obvious cause but it can develop after a shoulder injury or surgery
Symptoms: There are three phases to a frozen shoulder, each with different symptoms – shoulder and upper arm pain that gets gradually worse (phase 1) then increasing restriction of shoulder movement (phase 2) in what is known as a capsular pattern – lateral rotation most limited, then flexion and medial rotation least affected. The pain gradually subsides but stiffness remains for a number of months (phase 3). Upper arm pain from a frozen shoulder is often worse at night
Aggravating Factors: Arm movement, particularly above head height or twisting movements
Treatment: Initially focuses on pain management e.g. medication and steroid injections. Once the pain has settled, an exercise programme is followed to strengthen and stretch the shoulder to regain full movement. If symptoms fail to improve after six months, surgery may be recommended
Recovery: It can take up to 2 years to fully recover from a frozen shoulder. Each phase can last for a number of months
Find Out More: Visit the Frozen Shoulder section
What is it: Inflammation and thickening (tendonitis), or a tear, of the long head of biceps tendon. It is often associated with other shoulder problems such as impingement and arthritis. People who do lots of heavy lifting overhead are at increased risk of biceps injuries
Onset: May develop gradually over time from overuse, or suddenly with an injury such as a fall or lifting heavy weights
Symptoms: Tendonitis – achy upper arm muscle pain, mostly at the front, especially when the arm is overhead. Tendon tear – sudden, sharp upper arm pain, sometimes accompanied by an audible pop, and bruising from the mid upper arm to the elbow. There may be a bulge in the upper arm, known as a “Popeye Muscle”. The upper arm pain may in both cases extend down to the elbow
Aggravating Factors: Heavy lifting, raising your arm above your head
Treatment: Rest, ice, injections and exercises. In persistent cases of tendonitis, or severe tendon tears, surgery may be required, after which you will need to wear a sling initially and then work on a rehab programme of strengthening and stretching exercises
Recovery: It usually take 3-6 months to fully recover from a biceps injury
Other Causes of Upper Arm Pain
In some instances, upper arm pain may actually be a symptom of a problem elsewhere:
Angina: A condition where the blood supply to the heart is restricted which can cause upper arm pain. The pain usually gets worse with activity and eases with rest
Heart Attack: Where a blood clot blocks the blood supply to the heart. This is a medical emergency. If your upper arm pain, usually in the left arm, is accompanied by chest pain (may feel like a squeezing sensation or pressure), shortness of breath, nausea, light-headedness or sweating call for an ambulance immediately
Pressure on the nerves that run from the neck across the shoulder and down the arm can cause pain in the upper arm. The nerve may get pinched where it exits the spine or anywhere along its path which leads to pain.
Nerve pain is often accompanied by pins and needles and/or numbness in the arm or burning shoulder pain.
You can find out more about the causes of upper arm pain by clicking on the link above.
If the pain is more across the front of the shoulder and chest, it may indicate a problem with your collarbone – visit the collar bone pain section for help working out what is going on.
If your upper arm pain is radiating to the shoulder blades or across your upper back, visit the shoulder blade pain section.
Most cases of upper arm pain benefit from strengthening and stretching exercises – visit the shoulder exercises section for a whole range of exercises that might help.
If none of these is sounding quite like your pain, it may be that there is something else going on such as bursitis or a problem in the shoulder joint itself.
- Shoulder Guide
- Upper Arm Pain
Page Last Updated: 10/10/19
Next Review Due: 10/10/21
Share your shoulder pain experiences with others, whether it be ideas, top tips, things that worked well for you, problems you’ve had etc…….
Learning About Fibro Sensitivity and Pain
Talk to Friends and Family
It would also be helpful to have an open and honest discussion with your family and close friends. Explain to them what hurts and why it hurts.
If you only have allodynia pain at certain times, request they inquire before hugging you so you have the opportunity to let them know if it’s a good day for you or not. At the very least, ask that they be sure to give very gentle hugs.
Do your best to be kind and considerate in the way you explain these things to them. Ensure they know you understand they do not have bad intentions — this can go a long way in preserving the closeness of the relationship and hopefully avoid any hurt feelings.
You May Also Like:When Fibromyalgia Is a Pain in the Neck
When dealing with acquaintances, kindness and graciousness is generally the best course. Different cultures have different customs; if the custom is to shake hands when greeting someone, try offering your left hand, this may throw the other person off enough to where they don’t squeeze your hand as much as they normally would. If the custom is to give hugs in greeting, you can stand a distance apart from the person to keep from being squeezed too hard.
Perhaps standing away from others and receiving them with a friendly smile, a wave and a warm greeting might be enough to get you out of these common rituals. If it’s not, and even gentle handshakes and hugs are still too painful for you, have something ready to say that conveys to the other person you are unable to be touched, but it is not personal.
Maybe try something like: “I would love to shake your hand, but mine are very sore right now.”
I think it is important for those of us with chronic illnesses to accept that there will always be people who do not understand our limitations — and may even blame us for them. This is not a pleasant thought, I know it is something I struggle with.
But the constant reminder that you can in no way control the way fibromyalgia affects you, in addition to the knowledge that you are doing your best to preserve the relationships you have, can certainly help ease the guilt we may at times feel.
I wish there were more suggestions I could offer to help with dealing with the sensitivity to touch many of us experience, but as usual this terrible illness doesn’t offer a lot of options. However, by being mindful of our limitations and doing everything we can to work within them, we can hopefully reduce how much tactile allodynia affects our lives.
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What Are Burners & Stingers?
Burners (also called stingers) are injuries to the nerve network that provides feeling and muscle control in the shoulder, arm, forearm, hand, and fingers. The medical name for burners is brachial plexus injuries. They are common sports injuries. Most go away pretty quickly.
What Happens in a Burner?
The brachial plexus nerve network begins with nerve roots at the spinal cord in the neck and reaches to the armpit. Nerves branch out from there and continue down the arm to the forearm, hand, and fingers.
When a strong force increases the angle between the neck and shoulders, the brachial plexus nerves might stretch or tear. The injury may also pull the nerve roots of the brachial plexus from the spinal cord. Damaged nerves conduct sensation poorly and weaken muscle movements.
What Are the Signs & Symptoms of a Burner?
Someone with a burner may complain of:
- pain or an electric shock shooting down the arm
- numbness in the arm or fingers
- clumsiness or weakness in the hand or arm
- a warm sensation in the affected area
A severe injury may cause paralysis (loss of movement) of the arm and a loss of sensation.
Who Gets Burners?
Football players are most at risk for burners. But they also can happen in teens who participate in:
Burners can also happen in a motor vehicle crash when the head is pushed to one side or something hits the neck and shoulder.
How Are Burners Diagnosed?
A doctor will usually recognize a burner from your symptoms and a physical exam. The doctor may check arm strength, reflexes, and range of motion in the arm.
The doctor may order imaging tests — like X-rays or magnetic resonance imaging (MRI) — if you have:
- a history of burners
- neck pain or decreased range of motion in the neck
- symptoms in both arms
- weakness lasting more than a few days
- problems with thinking, speech, or memory
The tests can help doctors see the extent of the injury and rule out a more serious condition, such as a spine fracture.
How Are Burners Treated?
Treatment depends on how severe a burner is. Many mild injuries need no treatment because feeling and muscle control return within a few minutes.
Someone with a lasting burner might need:
- Ice applied to the affected area. Use an ice bag or a cold compress for 20 minutes every 2 to 3 hours for the first couple of days to ease any swelling.
- Anti-inflammatory medicines. Pain relievers (such as ibuprofen or acetaminophen) can help ease pain and in the neck and shoulder.
- Range of motion exercises. Your doctor may recommend exercises to keep the neck, shoulder, arm, and hand limber and flexible while the nerves heal. These can also help ease muscle spasms.
What Else Should I Know?
Most burners go away on their own. Someone with a more serious injury might work with a physical therapist or trainer to keep the muscles strong during healing.
A burner should heal completely before you return to sports. To make burners less likely if you play contact sports, be sure to:
- Keep your neck and shoulder muscles as strong and flexible as possible.
- Gently stretch the neck muscles before any athletic activity.
- Use protective gear (like a football neck collar or specially designed shoulder pads).
- Use proper sports technique (never lead with your head during a football game, etc.).
Reviewed by: Christopher A. Gegg, MD Date reviewed: June 2018
Massage. A massage therapist who has experience working with people with cancer can do a gentle therapeutic massage that may help ease muscle pain. You or your caregiver can also do simple massage techniques at home.
Physical therapy. A physical therapist can treat muscle problems and teach you how to relieve pain using simple exercises or devices.
Exercise. Gentle exercise, along with stretching and strengthening, may help loosen muscles and increase blood flow to them.
Heat and cold. Hot or cold compresses, heating pads, or ice packs may help decrease discomfort from muscle aches.
Relaxation techniques. Gentle breathing or meditation exercises may enhance relaxation and reduce muscle tension, which may help decrease muscle aches.
Track the results of the techniques you use to find out which ones manage your muscle aches best. You can use a chart like the one in the ASCO Answers Managing Cancer-Related Pain booklet (PDF) to track your pain.
Pain: Causes and Diagnosis
Types of Complementary Therapies
Medline Plus: Muscle Aches