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. Mrs B has had one of the nastiest of conditions; vertigo caused by a disturbance in the inner ear. Falling repeatedly and vomiting she consulted her doctor but medication didn't help. After two sessions of the Epley manoeuvres she was 50 percent better. After two weeks she was 75 percent improved; no longer vomiting or falling. She's not enjoying the Brandt Daroff home exercises.

2. Mr S, a 48 year old man, has right low back pain, groin pain and a numb feeling in his lower leg when he sports. For six months he's been off football. He too has two problems; a very treatable lumbar facet syndrome and a very serious blocked artery in the groin; it's called intermittent claudication. Smokers beware.  

3. Mr S looks like the leaning tower of Pisa; he has a slipped disc at L5 making him lean towards the opposite side. It's called the postero lateral disc hernia; we'll fix it, but he has to stop for a week or two. Antalgias are serious so take them seriously. 

4. Mrs V too has  two conditions; a chronic low grade sciatica giving her an ache in the right leg, and a threatening Morton's neuroma. She's glad I'm back in Holland; chiropractic fixed it before, and we'll fix it again. 

5. Mrs W is one of the lucky ones, says her doctor. I agree. He says only 40% of patients with lumbar stenosis have a successful operation. We fixed a nasty slipped disc three years ago, but it came back two years later; the surgeon did a fine job but she has a weak ankle now giving her subtalar joint pain; it's routine stuff. 

6. I myself had an acute exacerbation of a femoral nerve lesion last year. One immediate treatment of the new strain by my colleague has fixed the pain in the lower back, but there's some residual numbness in the lower leg; no soaring tomorrow alas.

7. This lady is a 86 year old woman with a 63 scoliosis. Chronic lower back has been her lot in life but she's well pleased with chiropractic and comes for chiropractic help once a month; some conditions you can never cure.

8. She is an 78 year old woman, is doing remarkably well with a bad sciatica. But over 200 pounds she is not losing weight; in fact, gaining despite my suggestions. She's high risk for a stroke. I have referred her to a dietician to crack the whip.

9. A 61 year old man with upper cervical pain yesterday; it's not severe but also not getting better of its own accord. He's afraid it may turn very acute as when I treated him three years ago. Since then it's been fine. 

10. A 64 year old woman has had scheuermanns disease; it's left her with a spinal kyphosis and chronic middorsal pain. She responds well to chiropractic treatment provides she come every six weeks or so for maintenance treatment.

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. Mrs D, a middle aged woman with hip pain of one year duration, despite other treatment. Xrays reveal an impingement syndrome and early hip arthritis. There's much to be done.

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.



Have a problem that's not getting better? Looking for a different slant on your pain? Want to pose a question?


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You helped me quite some time back with a soothing and professional response which turned out to be exactly correct. I now consult a local chiropractor. You write a superb newsletter, too.

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Knowing that up to 70% of the time the correct diagnosis is made with no examination, no special tests, no xrays, but just from the history, there's a fair chance I can add some insight to your unresolved problem. But at least 30% of the time, I may be quite wrong! Give plenty of detail if you want a sensible reply.


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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?