ARM PAIN

BRACHIAL NEURALGIA

Arm pain is a very general term, but underlying many of the conditions of the arm is an irritated, or frankly pinched nerve in the neck.

Brachial neuralgia ("arm-nerve-pain") is the medical name for a pinched nerve in the neck. In its acute phase it is probably one of the most painful conditions faced in the chiropractic clinic. The pain is relentless and it is difficult to find a position which relieves the pain. It is often especially bad at night.

A characteristic sign is the so-called "Shoulder abduction relief sign". Raising your arm above your head brings a measure of relief, as it takes the stretch off the nerve. Conversely, carrying a bag of groceries will increase the stretch on the tethered or irritated nerve, aggravating the pain.

SOME ANATOMY WILL HELP YOU UNDERSTAND THINGS

Neck pain is a common reason people visit their chiropractor. Typically it doesn't start from a single injury, though it may � a car accident, a fall from a horse etc. Instead, the problem usually develops over time from the stress and strain of daily activities, which includes the traumas that almost everyone experiences. Sports injuries, blows to the head and neck (as in boxing and rugby), whiplashes and so on.

The cervical spine is formed by seven vertebrae, to which we should add the upper two or three thoracic vertebrae, as they are often involved in neck pain.

Each vertebra is formed by a round block of bone, called the vertebral body, and a bony ring which surrounds and protects the spinal cord.

As the spinal cord travels from the brain down through the spine, it sends out nerve branches between the bones. They are called nerve roots. The nerve roots form the nerves that go to the arms and hands, via a small bony tunnel called a foramen.

As the nerve emerges via the foramen it may become irritated and/or pinched by a slipped disc, swelling from the facet joints or arthritic changes within the foramen. More commonly, it has now been proved that fixated joints release noxious chemicals that stimulate so-called nociceptors, causing tingling and pain in the arm.

For more information about how subluxations cause arthritis in joints, click here.

An intervertebral disc is made up of two parts. The centre, called the nucleus pulposis, is like egg white. It provides most of the ability to absorb shock. The nucleus is held in place by the annulus, a series of strong rings of cartilage. If the gel in the nucleus tears through the annular fibres, then you have a slipped disc which may pinch the nerve and cause arm pain.

There are two facet joints between each pair of vertebrae, one on each side of the spine. The alignment of the facet joints of the cervical spine allows freedom of movement as you bend and turn your neck. They are the most common cause of neck pain. Should a piece of the capsule become entrapped, then you have the classical stiff neck that we in chiropractic help on a daily basis. Bread and butter. If allowed to become chronic, then irritating chemicals may be released which inflame the nerve causing tingling or pain in the arm.

What is a brachial neuralgia?

The arm is innervated by nerves that emerge from the lower neck. Their function is two-fold: To bring information to the brain from the arm (such as pain, should your fingers be burnt by hot oil for example), and secondly to send information to the muscles of the arm, enabling you to rapidly move your hand away from the source of pain (the boiling oil!)

These nerves emerge from the neck via the tiny neural foramen seen in the picture above, travelling through the armpit, via the elbow and to the forearm and fingers.

Irritation of these nerves is what causes most of the painful conditions of the shoulder, elbow, wrist and fingers.

A frank pinching of the nerve root in the neck is what we call a brachial neuralgia. It may cause extreme arm pain, tingling, numbness and even weakness of the muscles, most usually the triceps. Less severe arm pain, and especially tingling may be caused by noxious chemicals released by a fixated joint.

If you enjoy reading, and you want to find out more about chiropractic, then you will love chiropractor Bernard Preston's books. Anecdotes and yarns from his own Coalface, and out of his life, will keep you alternately happily chortling and scratching your head as he stretches you. "Don't you want to see those grandchildren grow up, and sit under the trees you once planted?" asks he.

Crazy about hobbies, Preston will tell you about his gliding, motor cycling, carpentry - but all related to better health and chiropractic.

Described by his editor as the James Herriot of Chiropractic, you will love these light and witty stories.

More about Bernard Preston's books.

FROZEN SHOULDER AND ROTATOR CUFF SYNDROME

Because the shoulder muscles, the capsule, the ligaments and fascia are supplied by nerves from the neck, a chronic irritation of the nerve is usually the underlying causes of many shoulder syndromes, such as Frozen Shoulder Syndrome (a capsular condition) and a Rotator Cuff Syndrome which is a muscular condition. For more information about how chiropractic helps the muscles, joints and nerves of the shoulder click here.

For more information about Rotator Cuff strengthening exercises click here.

TENNIS ELBOW

Moving down the arm, should the nerve supplying the extensor muscles of the wrist (they are found around the elbow), then you become prone to tennis elbow, and golfer's elbow too. For more information about chirorpractic helps these conditions click here.

CARPAL TUNNEL SYNDROME

There is much anecdotal evidence that carpal tunnel syndrome, but it remains to be scientifically proved. Because it usually falls into the so-called "double crush syndrom" we find CTS responds well to chiropractic. The nerve may be irritated in the neck, and in the forearm and the wrist. Charasterically you have tingling in the thumb, fore and middle fingers.

THORACIC OUTLET SYNDROME

A fairly common condition is the irritation of the nerves causing arm pain by a subluxated first rib in the neck. If it also affects the artery supplying the arm, then it is called a Thoracic Outlet Syndrome. Medicine likes to remove the offending rib surgically. A patient this week had the procedure, and it made absolutely no difference to his arm pain, but I have seen no research showing how effective the surgery is. We adjust the subluxated rib, I think very successfully, though once again I have no stats for you. Certainly it is much simpler than the grisly operation, done through the armpit. For more information about Alzheimer's disease after anaesthetics click here.

CHIROPRACTIC TREATMENT.

Chiropractors use a variety of techniques to free up the tethered nerve root causing the arm pain. Most of them involve manipulations.

Treatment may also include stretching of the neck, treatment of the muscles of the neck and an array of physiotherapy devices.

What is surprising is that even in the most degenerative neck, with huge arthritic spurs surrounding the nerve root, adjustment of the vertebrae above and below the arthritis relieves the arm pain.

Rotating the arm like a windmill sometimes helps a brachial neuralgia, but will aggravate a rotator cuff syndrome. Sleeping with the hand under the head may relieve the pain of a pinched nerve.

Simple traction devices can be very useful in the treatment of a brachial neuralgia. Follow this link for an

inexpensive and effective traction device.

SURGERY

Occasionally, this arm pain will not respond to conservative treatment. If the arm becomes weakened, and the nerve pain in the arm remains relentless, surgery may have to be considered.

It can be very successful, though it is a dangerous procedure with a relatively high rate of morbidity and complications. Sometimes there is no other option.

LINKS

Complications from the anaesthetic should also be considered.

For more interesting cases from the Chiropractic Coalface, click here.

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