Physio Hub:
Evidence-Based Article
Strange Arm Pain? It Might Be Coming From Your Shoulder (Referred Pain)
Understanding Referred Pain From the Rotator Cuff
Many people experience a strange, vague pain running down the arm and assume it’s coming from a pinched nerve in the neck. They stretch their neck, ice their shoulder, or even get imaging—yet the pain doesn’t change.
Surprisingly, arm pain isn’t always a nerve problem. In many cases, it’s a form of referred pain originating from the rotator cuff muscles inside the shoulder—key stabilizers that control every overhead or reaching motion.
What Is Referred Pain—and Why Can the Shoulder Cause Arm Pain?
Referred pain happens when the brain misinterprets the origin of pain signals. Instead of feeling discomfort where the issue actually is, the pain appears somewhere else along the same neural pathway.
Research shows several mechanisms behind muscle-related referred pain:
✔ Central Sensitization
Persistent irritation in muscle tissue can activate broader neural networks, making pain spread beyond the original site.
✔ Trigger Points Reproduce Distant Pain
Myofascial trigger points in the rotator cuff can send pain into the arm—similar to how trigger points in the neck can reproduce headache patterns.
✔ Longer Irritation = Larger Pain Zone
Prolonged inflammation or past trauma increases the size and intensity of referred pain.
When specifically looking at the rotator cuff, studies describe classic symptoms such as:
-
Pain in the front or side of the upper arm (deltoid region)
-
Pain with overhead motions
-
Weakness or loss of control
-
Night pain, especially lying on the affected side
👉 Translation: That odd “deep arm ache” may not be an arm problem at all—your shoulder may be the true source.
How to Address Referred Pain From the Rotator Cuff
Because referred pain involves both the muscle and the nervous system, effective treatment usually combines multiple strategies.
✔ 1. Exercise Therapy: The Most Evidence-Based Approach
Strengthening and mobility exercises targeting the rotator cuff and scapular muscles are consistently shown to reduce pain and improve function.
✔ 2. Trigger Point Interventions
Evidence supports several techniques that reduce pain by addressing myofascial trigger points, including:
-
Dry needling
-
Manual pressure release
-
Trigger point injections
These treatments help interrupt pain signals and improve local muscle function.
✔ 3. Adjunctive Therapies When Needed
Some individuals benefit from additional treatments such as:
-
Low-level laser therapy
-
Botulinum toxin injections
-
Medications for neuropathic pain (e.g., gabapentin, tricyclic antidepressants)
✔ 4. Combination Approaches Show Promise
For example, certain studies suggest acupuncture plus trigger point injection may enhance outcomes more than either intervention alone.
The specific strategy should always be individualized—where the pain refers depends on which rotator cuff muscle is involved.
Conclusion
If your arm pain hasn’t improved despite treating the neck or shoulder joint, consider the possibility of referred pain from the rotator cuff.
This type of pain can mimic nerve symptoms, yet the solution is often different—focusing on evidence-based exercises, targeted trigger point therapy, and supportive modalities.
A qualified clinician can evaluate which rotator cuff structures are involved, identify referral patterns, and create a personalized treatment plan to restore comfort and function.
< Recommendation by Our Experts>
✔ Don’t Assume Arm Pain Is a Nerve Issue
Rotator cuff–related referred pain is extremely common and often overlooked.
✔ Prioritize Evidence-Based Exercise Therapy
Strengthening and mobility work remain the foundation for long-term relief.
✔ Consider Trigger Point–Focused Treatments
Techniques like dry needling or manual trigger point therapy can reduce pain quickly and improve function.
< Reference >
- Hansen, Ann E., and Norman J Marcus. “Is It Time to Consider Soft Tissue as a Pain Generator in Nonspecific Low Back Pain?” Pain Medicine 17, no. 11 (2016): 1969–70. https://doi.org/10.1093/pm/pnw204.
- Fernández-de-las-Peñas, César. “Myofascial Head Pain.” Current Pain and Headache Reports 19, no. 7 (2015): 28. https://doi.org/10.1007/s11916-015-0503-2.
- Doménech-García, V., T.S. Palsson, P. Herrero, and T. Graven-Nielsen. “Pressure-Induced Referred Pain Is Expanded by Persistent Soreness.” Pain 157, no. 5 (2016): 1164–72. https://doi.org/10.1097/j.pain.0000000000000497.
- Masuda, Manabu, Hidetoshi Hayakawa, Shellie Ann Boudreau, Takashi Iida, Peter Svensson, and Osamu Komiyama. “Standardized Palpation of the Temporalis Muscle Evoke Referred Pain and Sensations in Individuals without TMD.” Clinical Oral Investigations 26, no. 2 (2022): 1241–49. https://doi.org/10.1007/s00784-021-04096-z.
- Lo, Chi Ngai, Hubert Van Griensven, and Jeremy Lewis. “Rotator Cuff Related Shoulder Pain: An Update of Potential Pathoaetiological Factors.” New Zealand Journal of Physiotherapy 50, no. 2 (2023). https://doi.org/10.15619/NZJP/50.2.05.
- Manoso-Hernando, Daniel, Ignacio Elizagaray-García, Javier Bailón-Cerezo, Filip Struyf, and Alfonso Gil-Martínez. “Pain Localization and Associations with Strength and Range of Motion Deficits in Rotator Cuff-Related Shoulder Pain vs Asymptomatic: A Cross Sectional Case Control Study.” Musculoskeletal Science and Practice 78 (August 2025): 103354. https://doi.org/10.1016/j.msksp.2025.103354.
- Kulkarni, Rohit, Joanna Gibson, Peter Brownson, et al. “Subacromial Shoulder Pain.” Shoulder & Elbow 7, no. 2 (2015): 135–43. https://doi.org/10.1177/1758573215576456.
- Lam, Christopher, Vinicius Tieppo Francio, Kelsey Gustafson, Michael Carroll, Abigail York, and Andrea L. Chadwick. “Myofascial Pain – A Major Player in Musculoskeletal Pain.” Best Practice & Research Clinical Rheumatology 38, no. 1 (2024): 101944. https://doi.org/10.1016/j.berh.2024.101944.
- Fukuda, Ken-ichi. “Diagnosis and Treatment of Abnormal Dental Pain.” Journal of Dental Anesthesia and Pain Medicine 16, no. 1 (2016): 1. https://doi.org/10.17245/jdapm.2016.16.1.1.
- Handa, Toshiyuki, and Tatsuya Ichinohe. “Acupuncture Combined with Trigger Point Injection in Patient with Chronic Myofascial and Referred Pain.” The Bulletin of Tokyo Dental College 61, no. 2 (2020): 121–26. https://doi.org/10.2209/tdcpublication.2019-0017.
Stay Informed with Physio Hub
Unlock a world of knowledge with our expertly curated articles on fitness, rehabilitation, and health & diet. Stay ahead with the latest evidence-based insights and practical advice. Subscribe now to receive updates and never miss out on new content!
