What could be causing my upper and mid back pain with numbness in my right arm from the shoulder to the elbow?

Upper and Mid Back Pain with Right Arm Numbness (Shoulder to Elbow)

Most Likely Diagnosis: Cervical Radiculopathy

Your symptoms strongly suggest cervical radiculopathy—nerve root compression in the neck causing referred pain to the upper/mid back and numbness radiating down the right arm from shoulder to elbow. This distribution (C5-C6 nerve roots) is classic for cervical spine pathology rather than a primary shoulder or elbow problem 1.

Initial Diagnostic Approach

Key Clinical Features to Assess

• Numbness distribution: The shoulder-to-elbow pattern suggests C5-C6 nerve root involvement, distinct from peripheral nerve entrapments which have more specific finger distributions 1
• Pain characteristics: Radicular pain typically shoots down the arm, worsens with neck movements, and may be accompanied by weakness 1
• Red flags requiring immediate evaluation: Progressive weakness, bowel/bladder dysfunction, bilateral symptoms, or trauma history 2

Initial Imaging

Start with plain radiographs of the cervical spine to rule out structural abnormalities, fractures, or significant degenerative changes 3. Radiographs are the appropriate first-line imaging for acute neck/upper back pain with radicular symptoms 3.

If radiographs are normal or symptoms persist, MRI of the cervical spine without contrast is the definitive study to evaluate for disc herniation, spinal stenosis, or nerve root compression 2. MRI provides superior soft tissue detail for identifying the specific cause of radiculopathy 3.

Important Differential Considerations

Shoulder Pathology (Less Likely Given Your Pattern)

While shoulder problems can cause arm pain, they typically:

• Cause pain localized to the shoulder joint itself 3
• Produce numbness in specific peripheral nerve distributions (axillary nerve affects lateral shoulder sensation) 3
• Worsen with shoulder movement rather than neck positioning 3

Your mid-back pain component and shoulder-to-elbow numbness pattern makes isolated shoulder pathology unlikely 1.

Thoracic Outlet Syndrome

This can cause upper back pain with arm numbness, but typically affects the ulnar side of the hand and little finger rather than stopping at the elbow 1.

Management Algorithm

Conservative Treatment (First-Line)

1. Activity modification: Avoid positions that reproduce symptoms, particularly neck extension or rotation 2
2. NSAIDs: First-line pharmacologic treatment for pain control 2
3. Physical therapy: Cervical traction, strengthening exercises, and postural training 2
4. Short-term use of muscle relaxants may provide additional relief if muscle spasm is prominent 2

When to Escalate

• Persistent symptoms beyond 6-8 weeks despite conservative management warrant MRI evaluation 2
• Progressive neurologic deficits (increasing weakness, worsening numbness) require urgent imaging and possible neurosurgical consultation 2
• Severe, unremitting pain may benefit from epidural steroid injections for short-term relief, though evidence is mixed 2

Critical Pitfalls to Avoid

Do not assume this is a shoulder problem based on arm involvement—the mid-back pain and specific numbness distribution point to cervical spine pathology 1. Treating the shoulder alone will miss the underlying cause.

Do not delay imaging if red flags are present (progressive weakness, bilateral symptoms, trauma, fever, unexplained weight loss) as these may indicate serious spinal pathology requiring immediate intervention 2.

Avoid prolonged bed rest—this worsens outcomes in spine-related pain 2. Maintain activity within pain tolerance.