Bicep and Armpit Pain

This is a very specific and complex issue that I have been dealing with for over a year now. After searching the internet, talking to several doctors, and trying several different types of treatment, I am still no closer to understanding what is happening and how to get over it.

In May 2012, I had been climbing hard for several days. After starting on a fairly hard climb in the morning, without warming up or stretching, I got down from the climb and noticed that my left bicep had a deep throbbing pain that extended from upper forearm (tennis elbow), along the inside of my arm between the bicep and tricep, into my armpit, and then up into my deltoid. The pulling motion of belaying aggravated it. After a couple hours of rest and stretching, it was gone, and I continued to climb for several days, although cautiously, with only minor pain. The pain came back on days that I would climb really hard, but would go away just as quickly, and not appear at all if I was climbing easier stuff between long periods of rest.

In September, after returning to Taiwan, my arm would almost instantly start hurting whenever I climbed hard. If I took a few months off, it would take a day or two of climbing to start hurting again, but inevitably it would start hurting. Climbing in a gym would always hurt instantly. I tried forearm stretches for tennis elbow and rotator cuff exercises for my shoulder. I saw several doctors, none of whom took my condition seriously or thought it was much of a problem.

In February, I finally found a doctor who actually took it seriously. He took several X-Rays, which were totally negative of any bone problem. Then he did an ultrasound and diagnosed calcified tendinitis in my left forearm and shoulder. I then began a series of "extracorporeal shockwave therapy" treatments to break up the deposits. Whenever I climbed after this treatment began, I had no pain. But I never climbed for several days straight, although I was able to climb in a gym without pain.

In April, after two days of climbing, I was playing baseball and when I swung the bat my left shoulder subluxated. It does this in a strange way - it comes out the bottom of the socket, where I feel the pain in my armpit. It didn't hurt at all afterwards. But as soon as I jumped on a short, bouldery 5.11, it began to hurt again.

We continued the treatments for a few more sessions. Shortly thereafter I fell off my motorcycle and tore a tendon in my rotator cuff. Obviously, I stopped climbing. I rested, iced, and eventually began rotator cuff exercises and stretches again. Within a month, my strength was back to normal, although I do feel a little impingement pain if I reach for something high (like that far-off jug). I took another month off because I was busy.

In July, just a week ago, I spent three days climbing hard. By the third day, I was starting to get the old pain again. This did not seem to be in any way related to the rotator cuff tear. The pain was very minor, so after a day off I decided to climb at the gym. I did a little warm-up, stretched out well, then continued to climb. By the end of a long session, the pain had come and gone, but never stuck around. The next day, I went out to the crag again, did one physical climb, and the pain started to come back. We rapped, ropes got stuck, and I had to prussik back up to get them. After this, my arm was in agony.

This puts me at the present. The same pain, the same location. It only happens after several days of climbing hard. I am not a particularly flexible person, and I definitely have very tight lats and scapula, which feel very good but sore to massage. It also feels good but sore to dig deep into my bicep and armpit to massage the tight cords (tendons?) that feel like they are at the root of the problem. When I do this, it almost feels like I am hitting a nerve, as I can feel a sensation running all the way to my fingertips.

What is causing the pain?
What can I do make it go away?
Should I stretch more often?
Should I get massages more often?
Should I start a back exercise routine?
Should I stop the shockwave therapy?

It has been a year of injury, and I'm just ready to figure out what I can do to heal myself.

Thanks for reading this epic long post.

Don't mind the purple bruising. That's just from my masseuse. I'm trying everything.

Area of pain

Depicting the area of pain on the inside of my arm: in the armpit, where the bicep joins the lat; the small band of muscle (Coracobrachialis?) between the bicep and tricep, all the way to the elbow.

Area of pain 2
Depicting the area of pain on the outside of my arm: mostly only at the top of the forearm (lateral epicondyle); the area in blue is where the rotator cuff tear is (supraspinatus), which seems unrelated to this problem

Which specific tendons show Ca deposits on x-ray? I think this may be the key to your problems. If you're not sure have the Dr. send you a copy of the x-ray report. It's all very interesting. Edit: sorry, I meant ultrasound. report.

Yes, I think the supraspinatus tear was likely an unrelated incident. A few questions, can you describe the pain a bit more? I saw throbbing pain. You also describe a shooting sensation down to your fingertips. Can you tell me what fingers? Or where on the hand or arm? This is very important. If you are indeed pinching a nerve it could be sensory only, in which case you need to map where you feel numbness/tingling/burning to figure out which nerve you are affecting. It could also be mixed motor and sensory nerve, in which case you'd have some sensory symptoms and likely some weakness in muscles during these episodes. Unfortunately there are a lot of nerves running in the area you are describing, and the pain is high enough that it could be a brachial plexus problem. Starting with figuring out those symptoms will probably be best. Based on your symptoms and how quickly the pain disappears after climbing (tendonitis, torn muscle etc, I would expect to be very painful with movements of daily life), I am guessing you have a nerve problem. Of course, its pretty hard to tell from internet posts. If you make it to the States some time I suggest seeing a sports medicine doc, they will take it seriously and figure it out.

Calcification was initially found in my shoulder (deltoid) and upper forearm (lateral epicondyle), as that was where I was complaining of pain. But it always hurt in between, in a line from my elbow to my shoulder through the Coracobrachialis. Now, on the most recent ultrasound, they also found calcification in the Coracobrachialis and the rotator cuff. This is where the pain is now localized, for the most part.

When I massage the Coracobrachialis head in my armpit, I am definitely hitting some nerves, and that's the sensation I'm feeling. I do not have this sensation when it starts to hurt. As I massage it now, I can't reproduce the sensation of the tingle down my arm. It mostly happens after it's started to hurt or when the doc is doing the ECSWT (shockwave treatment).

Hopefully this information clarifies some things. Thank you very much for your posts.

I agree it sounds like a peripheral nerve injury. Brachial plexus traction injury (stinger) perhaps involving the lateral cord (musculocutaneus nerve). Is your brachialis involved? If I were in your shoes my next course of action would be an EMG test, especially of the coricobrachialis.

Don't know what to make of the Ca deposits in so many muscles. Also don't know anything about your shockwave therapy. Have you tried acupuncture? There is some evidence that it is helpful for partially denervated muscle. Might need to find an experienced acupuncturist to hit the coricobrachialis though. Also, the various nerve glides exercises are often helpful. Can you visit a physical therapist where you live? If not then perhaps YouTube median/radial/ulnar nerve glides and start slow. Good luck & keep us up to date with your progress.

Nate Ball wrote:Don't mind the purple bruising. That's just from my masseuse.

I work in the massage industry (in social media, not as a practitioner). You shouldn't be getting bruising like that from any normal massage, so that picture is a little concerning. Also, "masseuse" is often a euphemism for a sex worker; legit therapists usually prefer the gender-neutral term "massage therapist".

My first suggestion though was going to be to talk to a massage therapist, as I've had a lot of success with my various aches, pains and injuries from climbing through massage work. Maybe look for someone with a focus on Neuromuscular Therapy—I've found that technique to be a particularly effective treatment for the weird referring pains you get from soft tissue problems.

The I have exactly the same issue as you and I've been struggling with it now for over a year:-/. Did you find any effective treatment? (I ve already tried shockwave therapy, dry needling and acupuncture)

I'm confronted with the same problem. How's your shoulder today?

Please look at some YouTube videos regarding Thoracic Outlet Syndrome. With symptoms coming and going I would suspect an impingement issue especially if your posture is the typical forward flexed/hunched shoulder climber posture. This would also explain why none of the other modalities have seemed to address the root issue. Good luck!

Thank you for taking the time to post Marco. It is indeed a complex and difficult issue. It has to be mentioned that on one shoulder surgical intervention was made approximately half a year ago specifically for impingement syndrome. It should have resolved! Instead it appears that after surgery symptoms were only getting worse slowly and surely despite initial impingement syndrome being somewhat resolved.   

So many years later, and I'm still dealing with the same general issues. I don't have the throbbing pain as I once did (at least there's that), but I regularly experience discomfort in my shoulder (specifically the rotator cuff) through my inner bicep to my elbow. My gym workouts are usually less climbing and more warming up, doing push-ups, stretching, and antagonistic muscle training: internal/external shoulder rotations, dips, scaptions, shrugs, various back-strengthening exercises, always light-weight high-rep. I also take regular multi-week-long breaks when it gets especially bad to do yoga or drink beer at home. I have never been able to train hard and have never been able to push myself grade-wise because of this.

An important note: the most climbing I've ever been able to do is crack climbing, especially low-angle to vertical. I can do weeks of this without any symptoms. I would guess that this has something to do with not making any significant over-the-head reaches; most of my pulling is down at eye-to-chest level.

In retrospect, I believe that the calcification of these muscle groups was the primary cause of the severe pain, and although it was partially alleviated by the treatment I received in 2013, it did not completely remove the calcification, and it has not been "reabsorbed" as it normally would be. Thus, regardless of how much warming-up, stretching, or antagonistic muscle training I do, the calcification is not going away and is not allowing the tendons/muscles to regain their normal elasticity.

Another theory of mine is that I simply haven't taken enough time off to let it heal properly. I never use ice or NSAIDs. The pain/soreness is just too long-term for me to believe that these would be helpful, as they are for short-term inflammation. Perhaps I'm just now noticing it again after primarily climbing indoors (where I tend to climb harder and do more routes) for the last several months. Perhaps this is just a part of my annual routine: climbing less outdoors without significant issues then moving indoors where it flares up again.

Others have suggested getting regular massage treatments, but that shit is expensive, and I have my doubts about its efficacy in my case. I can tell you that the ECSWT was a miracle treatment and that when my wife beats on my shoulder, bicep, forearm in the same way (like, giving me a massage, not abuse) that this feels awesome.

Does anybody else have any other treatment ideas?

I just came across this post after countless searches for exercises to take away this exact pain. I’ve had ton of injuries and have always been able to find a way to overcome them through some form of stretch or exercise but I cannot beat this one. As soon as I climb (usually boulder) hard on consecutive days, it’s game over for me. My bicep flares up and then the pain radiates into my armpit and behind my shoulder. I carry a back buddy with me to massage my shoulder and a small roller to massage my bicep. This at least makes my climbing trips managable. I’ve just now started doing this exercise which seems to help some with my bicep pain.
https://theclimbingdoctor.com/portfolio-items/biceps-tendinopathy/

Regardless, I am super frustrated with this because I’ve necer been able to fully appreciate an extended climbing trip unless I’m climbing well below my max grade. I would love some help as well. 

Did you get your neck wrist and fingers checked?
Also would consider muscle imbalance in the hip area.
Hope you find the cure for your problem soon.

Nate, i'm dealing with the same issue, though very different circumstances.

Your first photo that shows bruising between your pit and elbow is EXACTY what I've been dealing with.  Several variables in my story may be causing this; its complex.

Sequence of events starting about 6 weeks ago:

I got a bursitis in my elbow. Got infected. Antibiotics.  Went away.

3 weeks later, broke right hand and ring finger first knuckle (self identified; didn't go to doctor. still don't have full flexion of ring finger

2.5 weeks after that.  Moved and put together an incredibly heavy ping pong table (instructions said job for 3).  I can't stress how difficult/awkward lifting was. Tremendous downward pull on arm at lift/construction.

3 days later.  Despite hand hurting, knock out 50 pushups before bed.

Next day.  Wake up with recurring infection running from inside of elbow up to armpit and armpit hurts.  believed it to be lymphnode; now not so sure.

Since then:  slowly improving corded (ligament??) exactly on a line from pit to elbow right where your bruise is (do you have tension in ligament there??)

My thought is that my hand injury caused a ligament issue when doing the pushups and caused a pull of the muscle that you mention

Going to orthopedist today.  very strange.

Thanks for sending pictures. Very helpful!  I hope you are recovering by now. I began having the same pain shown in the first picture yesterday. Minor Bruising  in area and on inside forearm. Swelling and warm inside elbow. Can feel a tight cord running up inside of upper arm in the area shown on first picture. Pain when press on the cord. Sharper pain when stretching arm overhead. Nodule enlarged on inside of upper arm on the cord. Burning nerve pain when pressed on the nodule. Sprained ring finger about six months ago. Still swollen and healing. Any updates?

Same issue here.  Tightness and pain on both upper inner arms near the coracobrachialis, inner bicep area/armpit just like in the first pic, but more focused towards the armpit area.  I've been searching everywhere for answers but all I find is people who have a similar problem and can't solve it.  Has anyone been able to shake this?  

I'm trying a collagen Rich diet, and guessing maybe the short head of the biceps has tendonosis.  Been trying everything.  If someone has made progress with treatment please let us know.

Nearly seven years to the day and two-and-a-half years after my update, I have another update...

I was living with continued shoulder pain from things as simple as reaching for objects high overhead. I went to an orthopedist to get it checked out and was recommended to get an MRI with contrast to see if there was any rupture in the capsule. The MRI showed no "leakage" but did show a 25% tear of my rotator cuff. I think this actually goes all the back to 8th grade when I dislocated that shoulder (I think it was that one?) in a severe bicycle crash. This was also the same shoulder I injured in the motorcycle incident in 2013. I think that partial tear is what is causing all kinds of wackiness on that left side: the left side of my neck from between the ear and the cervical spine and down to the trapezius muscle is super tight, as are most of the other muscles in that area. Rolling on a tennis or racket ball feels really good and often snaps, crackles, and pops stuff in there. My right side is similar, but much less tender and point-specific.

I also got acupuncture treatment for awhile, but this also corresponded with a 50' fall and spinal/hip/ankle injury (which I've mostly recovered from), so not super-specific to the shoulder. However, it did help me become more aware of the actual origins of sensation, like my neck and scapula. This has helped motivate me to spend more time with more movement-based mobility exercise instead of just isometric physical therapy.

In fact, I've completely ditched the bands. They just weren't doing it for me. I've moved on to Indian clubs which are working wonders! Just a few weeks in and I have had no sharp pain, no weakness or throbbing while climbing, my shoulder feels far more stable, and I am gaining mobility in my shoulder, wrist, and neck. To be honest, I'm not climbing very hard, but I'm climbing a lot more often than I had been for quite awhile. I feel stronger, more able to do those "shouldery" moves that I would actively avoid before. After my Indian club workouts, I stretch extensively, specifically into that muscle on the inside of the bicep/arm, the coracobrachialis, as well as the deltoid, scapula, pecs, traps, lats, and neck.

Maybe this means I can finally start pushing myself to climb harder? We'll see how the rest of this season goes, but I'm feeling hopeful.

Thanks for your update Nate and glad you have found something that seems to be helping.  I consulted a tendonitis specialist and he usually doesn't deal with patients with this kind of pain in that area, but thought it could be treated similarly to a shoulder tendonitis problem.  Been doing ice massages regularly on the area and specific stretches while taking VitD3,B6, B12,  magnesium supplements and watching my diet.  Been two weeks and haven't noticed a significant improvement but am going to keep at it for a month or two and see if it helps.  I will try indian clubs now that you mention it - if you have any specific exercises you found help with them, please let us know.

Brent M wrote: Thanks for your update Nate and glad you have found something that seems to be helping.  I consulted a tendonitis specialist and he usually doesn't deal with patients with this kind of pain in that area, but thought it could be treated similarly to a shoulder tendonitis problem.  Been doing ice massages regularly on the area and specific stretches while taking VitD3,B6.B12 an magnesium supplements and watching my diet.  Been two weeks and haven't noticed a significant improvement but am going to keep at it for a month or two and see if it helps.  I will try indian clubs now that you mention it - if you have any specific exercises you found help with them, please let us know.  

Here are some videos with various movements.

https://www.youtube.com/watch?v=fIEOWh87ahY
https://www.youtube.com/watch?v=SIsim9RLp1g&t
https://www.youtube.com/watch?v=bnQrX_NznSY
https://www.youtube.com/watch?v=lv8Mb8n0B6U

I usually do 20 reps of each set. My exercises are, in this order:

1.) Internal/external side rotation (or "basic rotation")
2.) Traditional swing, 1-handed (both sides, just not coordinated enough to do both at the same time effectively)
3.) Crescent swing
4.) Overhead circles
5.) Backstroke

Stretch break: chest, deltoids, scapula, forearm, lats, basically every muscle feeling worked. I can give more details on which stretches I do if you'd like. Usually hold for 30 seconds each, focusing on deep breathing and sinking deeper into the stretch with each exhale.

6.) High block
7.) Lock block
8.) Front outward circle
9.) Halo swings
10.) 2-hand overhead swing

And finish with another round of stretching.

I am also a vegetarian and have been taking Vitamin B12 supplements but highly doubt this has much if anything to do with my shoulder recovery.

Awesome, Thanks for the video links and details, Nate.  What weight do you use and can you recommend a pair to buy? I'm having trouble deciding what Indian clubs to get and not sure how heavy they should be.