<s>[INST] I have pain in my right shoulder that radiates down to the elbow. Each time I clench my fist, to reach or grab for something, I have this pain. It hurts mostly at night and when I wake up. There s a bone by my elbow where I get stabbing pains like sharp pin pricks. I m almost never without this pain or sharp stabbing pains. [/INST] Hi.thank-you for providing the brief history of you.A thoroguh neuromuscular assessment is advised.As by reading your history I feel you need a thorough neuromuscular assessment by which it will be possible to determine the muscles strength and also the nerve functions.As your pain radiates from shoulder to the arms and below, you may be having a spinal pathology or a muscle tightness as which need a thorough neuromuscular assessment and post which an MRI of cervical spine is recommended. Based on the MRI scan reposts the extent of the soft tissue Injury will be determined.Post which - Rest, medication and physical therapy will be advised. As physical will focus on your muscles strengthening of the neck and upper limbs. Also, the use of the therapeutic ultrasound therapy and TENS therapy will help you with the reduction in the pain.in my clinical practice i have seen patients with similar issues and post undergoing a proper neuromuscular assessment and physical therapy we have 99% success. I will expect the same results from you.RegardsJay Indravadan Patel </s>