Burning Pain in the Upper Left Arm: Causes, Red Flags, and Treatment

Burning pain in the upper left arm can arise from musculoskeletal, neurological, vascular, or referred cardiac sources. Differential diagnosis guides urgency.

Common Musculoskeletal/Neurological Causes

• Cervical radiculopathy (C5–C6): Nerve root compression → radiating burning pain, numbness, weakness in lateral arm/thumb.
• Thoracic outlet syndrome: Neurovascular compression at scalene/pectoralis minor → medial arm/ulnar distribution symptoms.
• Rotator cuff tendinopathy/tear: Deep shoulder/arm ache, worse overhead.
• Bicipital tendinitis: Anterior shoulder pain radiating to biceps.
• Myofascial pain syndrome: Trigger points in infraspinatus, scalenes, pectoralis refer to arm.
• Median/ulnar/radial neuropathy: Compression at elbow, wrist, spiral groove.

Vascular Causes

• Subclavian/axillary artery thrombosis or aneurysm
• Vasculitis (Takayasu, temporal arteritis)
• Raynaud's phenomenon (cold-induced colour changes)

Cardiac Referral (Critical)

• Angina/myocardial infarction: Left arm pain/heaviness/burning ± chest discomfort, diaphoresis, dyspnoea, nausea.
• More common in women, diabetics, elderly.

Red Flags → Immediate Evaluation

• Chest pain/pressure, dyspnoea, diaphoresis
• Sudden onset weakness, numbness, cold arm
• Pulsatile mass, absent pulses
• History of cancer, IV drug use, anticoagulation

Conservative Management (Non-Cardiac)

• Activity modification, NSAIDs, neuropathic agents (gabapentin, duloxetine)
• Physical therapy: nerve glides, postural correction, strengthening
• Ergonomic optimization (workstation, sleep position)
• Image-guided injections (epidural, perineural, trigger point)
• Surgical decompression for refractory radiculopathy/TOS

Always rule out cardiac etiology first in new-onset left arm pain, especially with cardiovascular risk factors.