(Keywords: slipped disc in neck, tingling in arms and hands, arm pain, shoulder abduction relief)
SLIPPED DISC IN NECK is one of the most painful and difficult conditions seen at the Chiropractic Coalface.
The nerve roots in the cervical spine find themselves precariously placed between three types of joints:
Mr G, a fifty year old body builder consulted me with bad neck pain and headache radiating vaguely, but severely in the right shoulder and lower arm. The arm felt weak and there was frequent pain and tingling in the arms and hands. Bench press in particular was difficult.
The pain had begun some five weeks previously, with no known cause. He recalled no injuries to the neck.
He had consulted a physical therapist and another chiropractor, neither of whom could find the cause of the pain or the weakness in his arm. Nevertheless there had been some improvement in the slipped disc symptoms in his neck with their treatment, but not his arm.
Mr G was an extremely well built man, with enormous muscles associated with body building. He wasn't carrying an ounce of fat.
Right rotation of his head and neck, right lateral flexion, and extension, all produced pain in his neck and upper right arm.
On observation, it was obvious that there was severe wasting of the right pectoralis major muscle and the right triceps. Both were very weak for such a strong man. I could overpower both, difficult even in a normal person.
Kemp's test and the Upper Limb Tension Test were extremely positive, with pain in the lower cervical spine (C7 in particular) radiating radiating tingling in the arm and hand.
The triceps reflex was absent and there were sensory changes in the middle finger (numbness).
In short, so-called "hard" neurological findings, both affecting the sensory and motor nerves. Slipped disc symptoms in the neck can be very severe, and unresponsive to medication.
Depending on the severity of the bulge, and whether it affects just
the sensory nerve (pain and tingling, numbness in the arm), or also the
motor nerve (loss of reflex and weakness and wasting of muscles) you would be likely to experience several of these symptoms...
The deep ache in the arm is often worst at night.
Chiropractic treatment of slipped disc in neck
A slipped disc in neck is certainly one of the most difficult conditions to manage in any practice. It frequently leads to surgery, which in itself is complex and not without danger. Approximately one in a thousand patients die in surgery.
A letter received at Chiropractic Help (January 2012):
My right neck, arm, leg and foot are experiencing tingling, burning sensations. Sometimes my foot will feel like it has fallen asleep as well. Also, occasionally, the right side of my face feels numb. I have previously had L2-L4 interbody fusions Jan 2009), Disk repair (somewhere around L2 ... 2010) and C4-C6 (Dec 2010) interbody fusions. The pain is unbearable at times. Sitting, standing and walking are the worst. Please help!!
Chiropractic treatment of slipped disc in neck would probably include some or all of the following:
More about Mr G
I was insistent that he ceased with body building for a period, certainly his upper body, something he was only partly compliant with, to his detriment. Eventually he learned: "Those who will not hear, must feel."
20-6-2011: T6 adjustment, cervical spine mobilisation and axial traction.
23-6-2011: Some improvement, but a very weak feeling remains in the right arm. Tingling in the shoulder region with Kemp's Test. ULTT test R ++ still very positive. Tric R weak. Chiropractic rotatory adjustment C7R (no release), L (release), Half nelson adjustment of upper thoracic spine.
Advice: Cervical spine X-rays. (Better and safer would be an MRI, but very expensive).
28-6-2011: Definitely some improvement, but Upper Limb Tension Test (ULTT) and Kemp's test still positive. Same treatment.
30-6-2011: Further improvement. Same treatment. Oblique X-rays show mild foraminal encroachment at C5-C6 and C6-C7.
5-7-2011: Continuing improvement. ULTT is negative for the first time, and strength appears to be returning to the triceps and pec major muscles. Kemp's test does not radiate to the arm today.
Add first exercises: Neaderthal.
7-7-2011: Continuing improvement. Same treatment.
14-7-2011: Set back after trying to do some light weights, and pull downs. Forbidden to do any upper extremity gym.
21-7-2011: Again pain in arm after forbidden training! C7 Left with release. Half Nelson. Deep soft tissue in right trapezius muscles, and rotator cuff muscles, triceps.
23-7-2011: Still very sore, especially at T3. Kemp's test pain bilaterally, but only in neck.
26-7-2011: Improving again. Same treatment.
23-8-2011: After a month's holiday, almost no neck or arm pain. Range of motion is good, Kemp's test is negative and ULTT is negative. Strength has returned to the triceps but wasting of triceps and Pec Major is still evident. Occasional tingling, now in thumb and forefinger (C6 dermatome).
No manipulation today. Axial traction, cervical mobililisation and soft tissue work.
Whether Mr G can return to body building or not remains uncertain. Certainly a month away from his weights has done him a power of good.
He's happy. I'm optimistic, but clearly it's the weak link in his chain... and another slipped disc in neck is quite possible.
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Interesting challenges of the day
1. Mr D has very severe midback back. He bent and twisted, feeding his son, and then laughed. Every breath is a nightmare. A sprung rib is every chiropractor's delight. He or she has golden hands. 30 percent better after one treatment.
2. Mrs C has a long history of severe, disabling migraine headaches since having her wisdom teeth removed. She clenches her teeth at night. After six treatments she has no migraines but some jaw joint discomfort remains; a bite plate is in the offing.
3. Mrs U has the trophy for the worst back this year. After major surgery with plates and screws two years later she still had paresis in the lower leg and severe disabling back pain. She's doing far better than expected, in no little part due to a lift in her shoe for a very short leg.
4. Mr V is 86 years old and hurt his back helping his wife into the car. Just one treatment of the sacroiliac joint and he's eighty percent better. It's not always like that.
5. Mr W lay on his back knocking down a pillar. Turning his head causes severe vertigo. He needs the Epley exercises, not pills, research shows. Update, he's fine.
6. I myself had an acute exacerbation of a femoral nerve lesion last year. One immediate treatment 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. 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 75 percent improved. No longer vomiting all falling. She's not enjoying the Brandt Daroff home exercises.
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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"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.
Letter from reader looking for advice.
How bad is your arm shoulder hand pain?