Can Lyme Disease Cause Shoulder and Arm Pain?
Lyme disease can present with shoulder pain, arm weakness, and meningitis
Brachial plexopathy is an uncommon but important manifestation of early Lyme neuroborreliosis
Early recognition and treatment can lead to excellent recovery
Shoulder pain is a common complaint, but in rare cases it may signal an underlying neurologic infection rather than a musculoskeletal injury.
Although Lyme arthritis is well recognized, Lyme disease can also inflame nerve roots and peripheral nerves, producing shoulder pain, arm weakness, and sensory symptoms before joint swelling develops.
In their article, Early Lyme neuroborreliosis manifesting as brachial plexopathy and meningitis in Northwestern Ontario, Canada, Gu and colleagues describe an unusual case of early Lyme disease presenting with brachial plexopathy, meningitis, and progressive arm weakness.1
The case highlights an important clinical lesson: patients with Lyme disease may not recall a tick bite or develop the classic erythema migrans rash. Instead, they may present with painful neurologic symptoms that resemble orthopedic or spinal disorders.
These manifestations fall within the broader spectrum of neurologic Lyme disease, which can affect the brain, spinal cord, cranial nerves, and peripheral nerves.
A Case of Lyme Brachial Plexopathy and Meningitis
A 76-year-old man was admitted to the hospital with left arm weakness, neck pain, headaches, and a three-day history of body aches.
Several weeks earlier, he had noticed what he believed was a mosquito bite that became increasingly red and swollen. He did not recall finding an attached tick.
Because the lesion appeared inflamed, he was diagnosed with purulent cellulitis and treated with a seven-day course of cephalexin. His skin symptoms resolved completely.
At that point, Lyme disease was not suspected.
What Is Brachial Plexopathy?
The brachial plexus is a network of nerves that travels from the neck into the shoulder and arm. Damage or inflammation of these nerves can produce:
- Shoulder and neck pain
- Arm weakness
- Numbness or tingling
- Reduced sensation
- Difficulty lifting or using the arm
This condition, known as brachial plexopathy, is one form of peripheral neuropathy and has many potential causes, including trauma, autoimmune disease, diabetes, and, less commonly, infections such as Lyme disease.2
Patients may initially be diagnosed with a pinched nerve, cervical radiculopathy, rotator cuff disease, or shoulder arthritis before the underlying neurologic cause becomes apparent.
Neurologic Symptoms Continued to Progress
Twenty-four days after completing antibiotics for cellulitis, the patient returned to the emergency department with several days of persistent headache and new neurologic pain.
He described bilateral, paroxysmal “shock-like” pains radiating from his shoulders into both arms and across his chest.
Although additional testing was initiated, he was discharged while awaiting results.
Over the following several days, his condition worsened. Weakness developed in his left arm and hand, prompting another emergency department visit.
Five days later he returned once again with increasing left arm weakness, persistent neck pain, and intermittent night sweats.
The progressive neurologic symptoms suggested a process extending beyond a localized musculoskeletal injury.
MRI and Lyme Testing Revealed Early Neuroborreliosis
MRI findings demonstrated increased signal uptake along the ventral aspect of the spinal cord at T3 and along the left brachial plexus, findings that the authors considered consistent with polyradiculitis.
Given the patient’s progressive neurologic symptoms, Lyme disease testing was performed. Both the enzyme-linked immunosorbent assay (ELISA) and confirmatory Western blot were positive.
The combination of painful radiculitis, meningitis, and brachial plexus involvement led to the diagnosis of early Lyme neuroborreliosis presenting as meningoradiculitis.
Lyme neuroborreliosis can involve the meninges, cranial nerves, spinal nerve roots, peripheral nerves, and, less commonly, the brachial plexus. Although facial nerve palsy remains the most recognized neurologic manifestation, painful radiculitis and peripheral neuropathies are also well-described presentations.
Comprehensive reviews by Koedel and colleagues emphasize that Lyme neuroborreliosis may present with meningitis, cranial neuropathies, radiculoneuritis, and peripheral nervous system involvement, particularly during early disseminated infection.3
Treatment Led to Complete Recovery
The patient was treated with intravenous ceftriaxone after the diagnosis of Lyme neuroborreliosis was established.
According to the authors:
“The patient was diagnosed with meningoradiculitis as a manifestation of early Lyme neuroborreliosis.”
This pattern is one of the classic manifestations of early Lyme neuroborreliosis described in European and North American literature.
Over the following year, he experienced gradual improvement.
Muscle strength and sensation returned completely, while his neck pain and left arm pain improved more slowly before eventually resolving.
This favorable outcome illustrates the importance of recognizing neurologic Lyme disease early enough to initiate appropriate antimicrobial therapy before permanent nerve injury develops.
Clinical Lessons From This Case
This case highlights several important teaching points for clinicians.
- Patients with Lyme disease often do not recall a tick bite.
- The erythema migrans rash may be mistaken for cellulitis, an insect bite, or another skin infection.
- Progressive shoulder pain, neck pain, radicular pain, or arm weakness following outdoor exposure should raise suspicion for neurologic Lyme disease in endemic regions.
- Painful radiculitis may precede obvious neurologic deficits.
- Neurologic Lyme disease should remain in the differential diagnosis when shoulder pain is accompanied by headache, neck stiffness, radicular pain, cranial neuropathy, or other neurologic findings.
- MRI abnormalities involving nerve roots or the brachial plexus can support the diagnosis when interpreted alongside clinical findings.
- Prompt diagnosis and treatment are associated with excellent neurologic recovery in many patients.
The authors conclude:
“A history of erythema migrans rash or black-legged tick bite may go unrecognized. Therefore, patients with new cranial (especially facial) neuropathy, painful radiculitis, or aseptic meningitis who present in a Lyme-endemic area during or shortly after tick season should be evaluated for early Lyme neuroborreliosis.”
Clinicians should remember that Lyme disease may present with painful shoulder syndromes, brachial plexopathy, cervical radiculopathy, or meningitis before the diagnosis becomes apparent. Recognizing these atypical neurologic presentations can shorten diagnostic delays and improve outcomes.
Frequently Asked Questions
Can Lyme disease cause shoulder pain?
Yes. Lyme disease can cause shoulder pain through arthritis, radiculopathy, meningitis, or inflammation involving the brachial plexus. Nerve-related pain is often accompanied by weakness, numbness, or shooting pain.
Can Lyme disease cause arm pain?
Yes. Lyme disease can cause arm pain when inflammation affects nerve roots, peripheral nerves, or the brachial plexus. Pain may feel sharp, shooting, burning, or shock-like.
Can Lyme disease cause neck pain?
Yes. Neck pain may result from meningitis, radiculitis, muscle inflammation, or cervical nerve involvement. Persistent neck pain accompanied by headache or neurologic symptoms should prompt medical evaluation.
What is brachial plexopathy?
Brachial plexopathy is damage or inflammation affecting the network of nerves that supplies the shoulder, arm, and hand. Symptoms may include pain, weakness, numbness, and reduced arm function.
Can Lyme disease cause arm weakness?
Yes. Lyme neuroborreliosis can affect nerve roots or peripheral nerves, resulting in weakness, sensory loss, or muscle wasting if left untreated.
Can you have Lyme meningitis without knowing you had a tick bite?
Yes. Many patients with Lyme neuroborreliosis never recall a tick bite, and some do not recognize an erythema migrans rash before neurologic symptoms develop.
Clinical Takeaway
Lyme disease should remain in the differential diagnosis for patients with unexplained shoulder pain, arm pain, arm weakness, painful radiculopathy, neck pain, or meningitis—particularly in endemic regions and during tick season.
Although brachial plexopathy is an uncommon manifestation, this case demonstrates that early Lyme neuroborreliosis may mimic orthopedic, spinal, or other neurologic disorders, and prompt recognition and treatment can lead to substantial or complete neurologic recovery.
Related Articles
Neurologic Lyme disease can affect the brain, spinal cord, nerve roots, and peripheral nerves in many different ways. These articles discuss additional neurologic manifestations and diagnostic challenges.
Neurologic Lyme Disease: Symptoms, Diagnosis and Treatment
What Does Lyme Disease Do to Your Brain?
One Year After Infection, Patient Shows Signs of Lyme Meningitis
Podcast: 43-Year-Old Man With Lyme Meningitis and Radiculitis
Neck Pain in a Child With Lyme Disease Due to Radiculoneuritis
References
- Gu K, Boodman C, Orr P, Wuerz T. Early Lyme neuroborreliosis manifesting as brachial plexopathy and meningitis in Northwestern Ontario, Canada: A case report. Medicine (Baltimore). 2022;101(45):e31576.
- Wendling D, Sevrin P, Bouchaud-Chabot A, et al. Parsonage-Turner syndrome revealing Lyme borreliosis. Joint Bone Spine. 2009;76(2):202-204.
- Koedel U, Fingerle V, Pfister HW. Lyme neuroborreliosis—epidemiology, diagnosis and management. Nat Rev Neurol. 2015;11(8):446-456.
- Steere AC. Musculoskeletal manifestations of Lyme disease. Am J Med. 1995;98(4A):44S-48S.
Dr. Daniel Cameron, MD, MPH
Lyme disease clinician with over 30 years of experience and past president of ILADS.
Symptoms • Testing • Coinfections • Recovery • Pediatric • Prevention
