[30F] Experiencing upper back pain and arm symptoms

Patient Description

A 30-year-old female presents with a 2-week history of bilateral forearm pain, difficulty moving arms, shocking pain just below the neck in the upper back, and soreness around the outside of the breasts. The upper back pain is described as a constant shocking sensation that worsens with twisting, turning, and bending, without any relief noted. The pain radiates down to the side breast. The patient also reports her breasts feeling heavy with a soreness severity of 8 out of 10. Additionally, there is tingling in the forearms and mild difficulty breathing. The patient has a past medical history of asthma, migraines, anxiety, and hypothyroidism, diagnosed in her teenage years. Current medications include Levothyroxine, Breo, Effexor, and Topamax. There are no known drug allergies.

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Arora's Assessment

What might be happening

Based on the information you've provided, the following conditions may be causing your symptoms:

  • Musculoskeletal strain or injury: This could be due to overuse, poor posture, or a physical activity that put strain on your upper back and arms. This would explain the pain in your upper back and forearms, as well as the difficulty moving your arms.

    • Treatment typically involves rest, pain relief medication, and physical therapy.
  • Thoracic outlet syndrome: This is a group of disorders that occur when blood vessels or nerves in the space between your collarbone and your first rib (thoracic outlet) are compressed. This can cause pain in your shoulders and neck and numbness in your fingers.

    • Treatment may involve physical therapy and pain relief medication. Surgery may be necessary in some cases.
  • Breast pain (mastalgia): This is often related to the menstrual cycle, but it can also be caused by injury or trauma to the breast, a side effect of certain medications (such as some antidepressants), or an infection in the breast.

    • Treatment depends on the underlying cause and may involve medication or surgery.
  • Anxiety: Anxiety can cause a variety of physical symptoms, including chest pain and difficulty breathing. Given your history of anxiety, it's possible that some of your symptoms could be related to this.

    • Treatment typically involves psychotherapy (counseling), medication, or both.

What you can do

  1. Rest and avoid activities that worsen your pain.
  2. Over-the-counter pain relievers, such as ibuprofen, can help reduce pain and inflammation.
  3. Apply a warm compress to your upper back to help reduce pain and stiffness.
  4. Practice good posture, especially when sitting for long periods.
  5. Regular exercise can help strengthen your back and improve your posture.
  6. If your symptoms persist or worsen, seek medical attention.

What you should look out for

Seek immediate medical attention if you experience:

  • Severe chest pain
  • Difficulty breathing
  • Sudden arm weakness or numbness
  • Changes in your breast, such as a lump or skin changes
  • Any other symptoms that concern you

Please note that this advice is intended to be general in nature, and specific causes may not apply to your situation. Always consult with a healthcare provider for appropriate examination, testing, and care recommendations.

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11 mo ago

People Also Ask


What are the common causes of bilateral forearm pain and tingling?

Bilateral forearm pain and tingling can be caused by repetitive strain injuries, nerve compression (such as carpal tunnel syndrome), or systemic conditions like thoracic outlet syndrome. Diagnosis typically involves a physical examination, imaging studies, and sometimes nerve conduction tests.


How can thoracic outlet syndrome be diagnosed and treated?

Thoracic outlet syndrome is diagnosed through a combination of physical exams, imaging tests like X-rays or MRIs, and sometimes nerve conduction studies. Treatment often includes physical therapy to improve posture and strengthen muscles, pain relief medications, and in severe cases, surgery to relieve compression.


What are the potential side effects of medications like Effexor and Topamax on breast pain?

Effexor (an antidepressant) and Topamax (used for migraines and seizures) can have side effects that include breast pain or tenderness. These medications can affect hormone levels or cause fluid retention, which might contribute to breast discomfort.


How can anxiety contribute to physical symptoms like difficulty breathing and chest pain?

Anxiety can lead to physical symptoms such as difficulty breathing and chest pain due to the body's stress response, which includes increased heart rate and muscle tension. Managing anxiety through therapy, relaxation techniques, and medication can help alleviate these symptoms.


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