Slipped Disc Arm Pain

Keywords; slipped disc arm pain.



Discomfort radiating from the neck into the limb is common at the chiropractic clinic; but the true prolapse in the spine producing a severe ache and tingling in the upper extremity is fortunately relatively rare.

It's an extremely nasty condition, and a deep ache spreading from the trapezius down the limb is one of the noteworthy features; it's often worse at night. If it affects the fifth cervical nerve root, then the symptoms radiate to the mid back between the shoulder blades; to the rhomboid and levator scapular muscles.

There are other conditions that can mimic the injury; there are orthopaedic tests that help us distinguish between them. The aim is to reproduce the ache in the limb, so they need to be done gently; they can aggravate the disease process.

Folk are often afraid of that word; it simply means a lack of ease and could relate just as easily to an ingrowing toenail as cancer of the spine.

Some tests are complex but others, like Spurlings and the Upper Limb Tension stretch, you can do for yourself.

More usually turning towards the side of the ache increases the symptoms; but if the nerve is tethered by a degenerate joint of Luschka then turning in the opposite direction increases the stretch on the root.

It's often provoked by working above your head as in painting the ceiling or replacing a light fitting for example.


ANATOMY OF A DISC

The Intervertebral Disc (= between the vertebrae) is made of two parts.

  1. ANNULUS FIBROSIS ... a very thick tough ligament-like ring of fibres which contains the
  2. NUCLEUS PULPOSIS ... a gel-like material that keeps the vertebrae apart, whilst giving them mobility.


The gel is essentially a liquid, and liquids are incompressible. When the neck is moved the bubble of gel bulges into the surrounding ring-like annulus which distorts to accommodate the nucleus. That's all quite normal anatomy.

The annulus fibrosis consists of about six layers, criss-crossed to make a very tough ring to support the nucleus pulposis.

However, in the slipped disc in neck the gel ruptures through one or more layers of the annulus fibrosis. Initially there is just pain in the neck, but the disc will swell and then may cause arm pain.



Slipped Disc Arm Pain


Shoulder Abduction Relief sign.

If the slipped disc has a large bulge then you will often get relief by placing your hand on, or above, your head; or sleeping with it under your pillow. Raising the limb takes the stretch off the nerve, reducing the ache. Conversely, carrying anything heavy increases the pull.

If raising the arm increases the pain and tingling in the hand then we are probably talking about a thoracic outlet syndrome, rather than a slipped disc in the neck.


Another sign of a slipped disc is that rotating your head to the side of the aching arm, and then looking up increases the symptoms; it immediately produces pain and tingling, not just in the neck, but in the shoulder and down towards the hand too.

When this happens you must take it seriously. It's a very painful condition and, if you neglect it, the chances of spinal surgery are relatively high.

The arm becomes numb, and may develop weakness. The triceps is the most commonly affected muscle. Press ups will be difficult; the limb becomes lame.

Periodically a patient walks into the clinic with his hand on the head; the diagnosis is already made.


UPPER LIMB TENSION TEST (ULTT)

Your chiropractor will stretch out first your good arm, and then the naughty arm. In the true slipped disc arm pain, the naughty arm will feel very tight and painful in the lower arm. This is a test you could do at home... but be careful, when it's strongly positive it can be very painful and, injudiciously done, could aggravate the condition:



Cervical compression tests

There are various procedures, placing axial compression on the head and neck in different positions, looking to provoke the pain in the arm. 

A variation is Spurling's test. Does turning to the side of pain, and then looking up produce lower neck stabs, and more significantly, an ache or tingling in the arm?



Your chiropractor will test the reflexes, look for sensory changes and search for weakness in the arm. This is a very painful condition and needs to be taken seriously, both by you, and by those treating you.

Controversial, this may make me a few enemies, if your chiropractor doesn't do a proper examination, and just wants to click your neck then go elsewhere; or, for that matter, your medical doctor just wants to give you anti inflammatory drugs without examining you, then I recommend you decline treatment, and look for someone who is thorough. This is not a condition to be treated by those who are out of their depth, or want to take short cuts.

The most common muscle affected by slipped disc arm pain is the triceps which straightens the elbow. Try doing some pressups. Does the affected arm tire much more quickly?


TRACTION

Research does not confirm that traction ON ITS OWN will relieve a slipped disc in neck, or help reduce the pain and tingling in arms and hands, but my experience is that as an adjunct to chiropractic care it is very helpful. But that is just an opinion, based on my experience, and not confirmed by research. HOME TRACTION UNIT


PAIN AND TINGLING IN ARMS AND HANDS

One of the first nasty signs of slipped disc in neck is various nerve-like symptoms that radiate down your arm. Not that this necessarily implies a slipped disc neck pain.

A Cervical Facet syndrome for example, can easily mimic a slipped disc in neck. So too can worn joints of Luschka in the neck, usually caused by an injury to the neck, such as an old whiplash that wasn't properly attended too. CHIROPRACTIC HELP Whiplash and the joints of Luschka ...



Cervical rib

So too a large cervical rib can cause pain and tingling in arms and hands, mimicing a slipped disc arm pain condition. See in the graphic below how the cervical rib passes through the interscalene triangle, along with the brachial plexus and the Subclavian artery?



Thoracic outlet syndrome

A cervical rib is a complication of TOS. Through this triangular space pass the five nerve trunks to the arm, and the subclavian artery.



CHIROPRACTIC MANAGEMENT OF Slipped Disc Arm pain

Your chiropractor will have to work out what works best for your slipped disc in neck. Usually a gentle cervical adjustment is in my book the treatment of choice, but it has to be done very skillfully and carefully.

And sometimes manipulation just doesn't seem to help, and may even increase the pain. Then your chiropractor will have to try this and that. Axial traction often helps, working on the scalene muscles, ice, acupuncture, electrical modalities... this is a difficult condition and you may well have to be patient. It will take at least six weeks to heal.


SLIPPED DISC ARM PAIN CaseFile

Mr G is a 42 year old weight lifter. He had an old lifting injury to his shoulder and neck. Suddenly, two months previously, whilst doing a pull down, he developed severe neck and arm pain... a separate page will be built with this case history. SLIPPED DISC IN NECK ...


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Interesting challenges of the day

1. Mr S is a 76 year old man with neck pain of some 9 months duration. Luckily, most of the discomfort is upper cervical which is only rarely arthritic; his lower cervical spine is a degenerative mess that I've left alone. After seven treatments his pain and stiffness is 50 percent better, and he's happy in the circumstances. He can sleep through the night now and that makes a huge difference.

2. Mr P is 32 year old man with very severe lower back pain radiating to the big toe which is 30 percent numb. He had an episode three weeks ago, took anti inflammatories and was soon better as is typical of the medial disc herniation. But before it healed, after a trivia it came roaring back, much worse. The characteristic crossed sign was evident; sitting in a chair, straightening the right leg provoked severe left back pain and tingling in the leg. He's doing well.

3. Mrs T looked like the leaning tower of Pisa; she had a slipped disc at L5 making her lean towards the opposite side. It's called the postero lateral disc hernia; she's much better after two weeks of treatment and will go back to work next week, part time. Lateral discs are more difficult; both take a minimum of six weeks to heal. In my opinion, antalgic patients need what I call exercising bed rest. Sit and it won't get better.

4. Mr S has had lower back, groin and back of thigh and calf pain for fourth months. He has a pincer deformity in the hip causing the groin pain, and a degenerative facet causing the sciatica. Both are responding well to chiropractic and he's well pleased; sixty five percent better after three treatments.

5. Mr T is a wise man; he's taken a warning TIA seriously and has lost 15 pounds, and has at least as much again to lose. A change to a low starch diet and half hour daily walk has made the difference; but the walking is making his foot and back miserable. The expensive orthotic is hopeless; luckily his hips and back are fine, but he needs a simple heel lift.

6. I too have had serious lower back issues, luckily fixed by my own chiropractor; so I too have to do my exercises, take care when lifting supers full of honey, gardening and using the chainsaw. Regaining the function of your lower back is just as important as the pain.

7. My own granddaughter, only 7 is hypermobile giving her hip, knee and ankle issues. Xrays show a mildly dysplastic hip. Years ago we would have called it growing pains. She too regularly needs chiropractic care and luckily responds well. Hypermobility is more difficult that too stiff in my opinion. Chiropractic is for kids too.

8. This 65 year old lady is a serious gardener; every day she is bending, lifting and digging for 2 to 3 hours a day. It regularly catches her in the sacroiliac joint, so she has a treatment once a month that sorts it out. She does her lower back exercises faithfully.

9. This 88 year old lady is an inspiration; every day she is busy in the community. With a nasty scoliosis she manages very well with a chiropractic adjustment every six weeks and exercises faithfully done.  

10. Mr X is a 71 year old retired man who wants to continue with maintenance care every six to eight weeks; he had suffered from two years of lower back pain when he first came a year ago. He has no discomfort now after 8 chiropractic treatments, but is aware that danger lurks.

11. Mrs C has been having severe headaches, and taking a lot of analgesics. It's a non complicated upper cervical facet syndrome, and she's doing well.

12. Mr D is a 38 old year man with chronic shoulder pain after a rotator cuff tear playing cricket. It responded well to treatment, but he knows he must do his exercises every day; for two years he couldn't sleep on that shoulder.

13. Mr D, a 71 year old man, has a severe ache in the shoulder and midback since working above his head. Trapped nerve tests are negative but he has advanced degenerative joints of Luschka; after just two treatments he is 50 percent better. Can we reach 90?

And so the day goes; chiropractors shouldn't be treating the elderly most medical sites state but that's so much bunkum.



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Brachial plexus


Arm pain

1. Shoulder

Frozen Shoulder

Rotator cuff

"My thumb, forefinger and middle finger went weak after cuff surgery."

"Hello John, I take it you've been back to the surgeon.

It's probably temporary inflammation of the median nerve, but of course could be worse... I'm afraid I don't think chiropractic has anything to offer at this stage.

Once everything has healed up, if you don't get the strength back, or your fingers remain numb and tingly, then I'd consult a local chiro to see if there is also a problem in your neck or the first rib.

Dr B"

Letter from reader looking for advice.

2. Elbow

Elbow pain

3. Wrist

How bad is your arm shoulder hand pain?