Differential Diagnosis for Bilateral Intermittent Hand and Arm Pain
Single Most Likely Diagnosis
- Thoracic Outlet Syndrome: This condition involves compression of the nerves and/or blood vessels that pass into the thoracic outlet (the space between your collarbone and first rib). It can cause pain in the shoulders, arms, and hands, which may be intermittent and can be exacerbated by certain movements or activities.
Other Likely Diagnoses
- Repetitive Strain Injury (RSI): Also known as work-related upper limb disorder, RSI can cause pain in the muscles, tendons, and nerves of the neck, shoulder, and arm due to repetitive movements or overuse.
- Cervical Spondylosis: This condition involves wear and tear on the discs in the neck (cervical spine), which can lead to pain and stiffness in the neck, shoulders, and arms.
- Fibromyalgia: A chronic condition characterized by widespread muscle pain, fatigue, and tender points, which can include the arms and hands.
Do Not Miss Diagnoses
- Acute Coronary Syndrome: Although less common, pain in the arms can be a symptom of a heart attack, especially if accompanied by chest pain or other cardiac symptoms. It's crucial to rule out cardiac causes, especially in patients with risk factors.
- Multiple Myeloma: A type of bone cancer that can cause bone pain, including in the arms, due to the proliferation of malignant plasma cells in the bone marrow.
- Hypothyroidism: Severe, untreated hypothyroidism can lead to musculoskeletal pain, including in the arms and hands, among other systemic symptoms.
Rare Diagnoses
- Complex Regional Pain Syndrome (CRPS): A chronic pain condition that most often affects one of the arms, legs, hands, or feet after an injury or trauma. It's characterized by intense burning or aching pain in the affected limb.
- Ehlers-Danlos Syndrome: A group of disorders that affect connective tissues supporting the skin, bones, blood vessels, and many other organs and tissues, which can lead to joint hypermobility and musculoskeletal pain.
- Sarcoidosis: A disease in which abnormal immune cells, called granulomas, form in various organs, including the bones, which can cause pain and other symptoms in the affected areas.