Arm Pain

Arm pain is a very general term but, underlying many of the conditions of the upper extremity, is an irritated or frankly pinched nerve root in the neck; it's called a brachial neuralgia.

In its acute phase this is probably one of the most painful conditions faced in the chiropractic clinic. The deep, penetrating ache is relentless and it is difficult to find a position which lessens it. It's often especially bad at night.

A characteristic finding is the so called shoulder abduction relief sign. Raising the limb 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 traction on the tethered or irritated fibres, exacerbating the pain.

The definitive examination for a pinched nerve is called the upper limb tension test; see the video lower down showing you how to discover if you have a irritated root that is causing causing the ache.

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 or a fall from a horse, for example. Instead, the problem usually develops over time from the stress and strain of daily activities, which includes the traumas that almost everyone experiences.

Plus, there is much confusion and disagreement even amongst experts.

This week we have a letter from a person with three months of severe arm pain whose neurologist told her that she had a thoracic outlet syndrome because raising her arm relieved the ache. Normally, that would increase the tingling and discomfort, but would relieve things in a tethered nerve; the so called shoulder abduction relief sign, is associated with a root impingement, and TOS patients get increased paresthesias, not relief, when raising their arms.

Arm pain

Sports injuries such as blows to the head in boxing and diving into shallow water are a frequent cause of injuries to the cervical spine; and neck and shoulder trauma as in rugby and falls from horses are often the cause of an acromioclavicular joint syndrome. These whiplashes are often the underlying cause of arm pain.

Let's face it, getting up in the morning is dangerous. If we want to avoid all injuries, then it's better to stay snuggled up under the blankets; only, more people die in bed than those out enjoying a full life.

Grasping this neck anatomy is vital if you want to gain a real understanding of what's happening. The cervical spine is formed by seven vertebrae, to which we should add the upper two or three thoracic bones, as they are often involved. The whole structure is stabilized by the facet joints, ligaments and muscles. Through a small foramen the nerve root escapes on its way to the upper extremity.

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

As the cord travels from the skull down through the spine, it sends out branches between the bones; they are called nerve roots. This is where much arm pain begins as these fibres follow a hazardous journey beginning in the brain and ending in the finger tips.

These roots form the nerves that go to the arms and hands, passing via a small bony tunnel; it's called an inter vertebral foramen.

As the nerve emerges from between the vertebrae via the foramen it may become irritated and or pinched by a slipped disc, swelling from the facets or arthritic changes within the canal. 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.

At the entrance to the foramen stand the joints of Luschka like guards protecting the nerve root from a slipped disc. Only sometimes they are turncoats, becoming arthritic after whiplash, and then sending pincer like projections into the canal.

For more information about the chiropractic subluxation and how they cause arthritis in joints, see here;

  • Chiropractic Conditions is a central page at Chiropractic Help. It provides you simply and easily with the sorts of conditions that the average chiropractor would be treating.
  • Healthy Living Tips is another vital page at Chiropractic Help. Sparkling good health is not just about having your subluxations adjusted. Our healthy living tips page gives you some insights into different foods you could and perhaps should be eating.

Slipped Disk

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 disk 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 within a fixated joint as the cartilage starts to degenerate. Read more about immobilisation arthritis.

Joints of Luschka

Protecting the nerve root from a slipped disc is a small "uncinate process" that makes up the Joint of Luschka, aka an UncoVertebral Joint. After a whiplash type injury this joint becomes arthritic, particularly in people who click their own necks, and because it is immediately adjacent to the nerve root it may begin to irritate the nerve. This is major reason for cervical spine surgery. Prevention is the the key when it comes to the uncovertebral Joint Luschka.

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)  - at this page you'll find some vital frozen shoulder exercises on You Tube.

... and a Rotator Cuff Syndrome which is a muscular condition. The hinge joint between your collar bone and the shoulder blade, the AcromioClavicular Joint, is central to normal shoulder function. For more information about how chiropractic helps the muscles, joints and nerves, the shoulder anatomy, click here: SHOULDER ANATOMY. If you are a woman, take your spouse with you and everybody will be more at ease. Your chiropractor may have to address a muscle deep in the armpit, right adjacent to your breast, making you both uncomfortable; sexual advances chiropractor are not common, but just to be safe, take hubby.

For more information about Rotator Cuff strengthening exercises, click here: ROTATOR CUFF STRENGTHENING.

Pain running down the arm is a serious condition. It's often EXTREMELY PAINFUL and is one of the conditions that will likely make your chiropractor running late.


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 how chirorpractic helps these conditions, click here: TENNIS ELBOW ...

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 syndrome" we find CTS responds well to chiropractic. The nerve may be irritated in the neck, and in the forearm and the wrist. Typically you have tingling in the thumb, fore and middle fingers. CARPAL TUNNEL SYNDROME ... Read more …

Included in this Carpal Tunnel Syndrome page you will find a short questionaire that will enable you to measure just how bad your CTS is, and whether the Chiropractic treatment was effective or not in the treatment of your hand and often arm pain that accompanies CTS.

Note: CTS NEVER affects the pinkie.

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; the classic sign is increased pain and tingling in the lower arm as you raise your arm above your head, as in hanging the washing. Not to be confused with a slipped disc in which case raising the arm reduces the tingling in the arm.


The classic test for Thoracic Outlet Syndrome examines the effect that moving the head and first rib have on the artery running down the arm to the hand.

The "thoracic outlet" is made up of a space behind the clavicle (collarbone) and above the first rib which is shown but not labelled above. Through this space three important structures pass on their way to the arm.

  • BP or brachial plexus of nerves
  • SA or subclavian artery
  • SV or subclavian vein

Two of these structures, the brachial plexus and the subclavian artery, but not the vein, first escape from the chest cavity via a narrow triangle known as the "inter scalene triangle".

This triangle is bounded by the

  • AS or anterior scalene muscle
  • MS or medial scalene muscle
  • the collarbone.

Cervical rib 

Very occasionally an extra rib, CERVICAL RIBS may invade the so-called inter scalene triangle through which the artery and nerves to the arm must pass. Only about 1/ 1000 people have a cervical rib and in the vast majority they are too small to be clinically significant. But occasionally it may cause severe pain and tingling in arms and hands, especially when the arms are lifted as in holding the telephone to the ear, or hanging the washing.

See how a large cervical rib can cause pain and tingling in the arms and hands and even effect the artery. In this cervical rib casefile the patient had absolutely no palpable radial pulse in the forearm. Little wonder the arm ached with use.

Medicine likes to remove the offending rib surgically. A patient this week had the procedure some six months ago, and it made absolutely no difference to his arm pain, but I have seen no research showing how effective the surgery is.

Chiropractors 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 which is done through the armpit. The anaesthetic itself is not without dangers...

For more information about Anaesthethic Alzheimers disease (memory loss after an anaesthetic) click here. ANAESTHETIC ALZHEIMERS ...

Chiropractic neck pain treatment 

Your Chiropractor may use a variety of techniques to free up the tethered nerve root causing your arm pain. Most of them involve manipulations, what we call an adjustment. In the hands of an experienced practitioner it's a very safe procedure, only very, very occasionally causing serious problems. A lot safer than anti inflammatory drugs that kill thousands. Literally.

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 your hand under the head may relieve the pain of a pinched nerve in the neck.

Simple traction devices can be very useful in the treatment of a brachial neuralgia. Follow this link for an My mind's made up, so DON'T CONFUSE ME WITH THE FACTS!

A survey of a large number of studies concerning traction for arm pain came to the following conclusions:

BACKGROUND: Neck pain is a frequently reported complaint which can be disabling and costly to society. Mechanical traction is often used as an adjunct therapy in outpatient rehabilitation.

OBJECTIVES: To evaluate the effectiveness of traction for cervical spine conditions. 

RESULTS: Of the seven selected trials, six clearly set out to prove what they already "knew to be true", or in research lingo only one of the randomised controlled trials had a low risk of bias. It found no statistically significant difference between continuous traction and placebo traction in reducing pain or improving function for chronic neck disorders with radicular symptoms.


  • The current literature does not support or refute the effectiveness of traction, intermittent or continuous, as compared to placebo treatments for people suffering from chronic cervical spine conditions.
  • Large, better research based trials are needed to determine if traction is effective in the management of neck pain.

I have used this traction device for home use of arm pain with great effect, as an adjunct to chiropractic treatment. However, there is no hard evidence that it is effective when used on its own, or as an adjunct to physiotherapy. There simply is only one good trial concerning traction used and it neither proved it effective, nor refuted its effectiveness in the treatment of arm pain.

If you have two right hands (Dutch proverb) you might like to make this home traction unit.

From the chiropractic coalface

Mr S, is a 43 year old Dutchman after my own heart. He's a motor cycling fanatatic. Only he has a problem. Two years ago he set off on a trip across Europe and within two hours had to return home: severe pain in the neck, radiating down the left arm. For over a year he was unable to ride his motor cycle. Literally. Within ten minute he would have severe neck and arm pain.

I won't pretend his case has been easy. His neck was technically difficult to adjust, but within six months of chiropractic treatment, with the aid of his home traction unit he was motor cycling again. Last night he had dinner with us, and took me for a ride on his new BMW 100, ah sublime. Next week he leaves on 10 day ride through the former Soviet republics. Estonia, Latvia... Chiropractic PLUS his home traction unit pictured above have enabled him to return to his favourite pasttime. Motor cycling. Mine too. Traction may not help on its own, but as an add-on to chiropractic, I highly recommend for radiating arm pain from the neck.

Update: Mr S had a very successful trip with minimal neck or arm pain.


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.

As you can see, when removing bony arthritic fragments and disc material from the foramen, the surgeon is working perilously close to the nerve.

Four NO-NO'S

  1. If you have a problem neck, and perhaps even if you don't, never carry a child with legs straddling your neck.
  2. Don't sleep on your tum. It's during the night that the pressure in the disc joints drops, bringing in fresh nutrient and removing waste products of hyaline cartilage metabolism. Your neck will become arthritic long before its time, not to mention neck pain and arm pain. Tum sleeping ...
  3. Don't hold the telephone between your neck and shoulder. It's one cause of pinched nerve in neck ...
  4. Don't do pull downs at the gym.

Musicians' health 

Are you a musician and suffering from neck, shoulder and arm pain? From Learn Theory Music you can pick up some very useful tips about musicians health. Musicians' health ...

In the Quick Dash questionaire mentioned below there is a specfic questionaire for musicians.

Arm pain case histories 

Arm pain case histories do not constitute scientific evidence of the efficacy of any particular treatment, but they do give an inkling of what can be achieved ... ARM PAIN CASE HISTORIES ...

50 percent less pain

With all Chiropractic Conditions - what we treat on a daily basis …, medical conditions too, I presume, you want to be very careful when the pain is about half. That's the dangerous time, we often see setbacks, sometimes serious ones: 50 percent less pain ...

Another case history

Mr S, a physically fit and strong man, a builder by trade decided to go to the gym. After lifting weights he developed severe pain between the shoulderblades, and then his left arm started to tingle when he turned to the left or looked up.

Various treatments didn't help, finally after four months he decided to try chiropractic, after a personal friend, a medical trauma specialist surgeon said only surgery in the region of the first rib would relieve the pain. 

On examination, there were several serious findings.

  • Stirling's test immediately provoked pain and tingling radiating down to all fingers.
  • Adson's test for a thoracic outlet syndrome was positive, with complete obliteration of the pulse in the wrist.
  • There was severe weakness in the triceps muscle, loss of the reflex and some paresis in the fingers.
  • The upper limb tension test was positive.
  • Xrays show uncinate joint of Luschka degeneration and invasion of the intervertebral foramen at two levels.

There is no doubt about it; had he consulted a neurologist first, he would have been under the knife within the week.

I made no promises; this is probably the most difficult condition facing the chiropractor. Deep upper back pain due to a pinched dorsal scapular nerve is problematic; add weakness, an ache and tingling in the arm and you have a great challenge on your hands.

Nevertheless, to be totally pessimistic also means that one is likely to have lost the battle before the first shot was fired. I was guardedly optimistic. There was also doubt about the diagnosis; was it a problem in the inter scalene triangle causing nerve and arterial pressure, or arthritic spurs invading the foramena, or both?

He consulted me this evening for the seventh visit. He has minimal pain, the strength has returned completely to the triceps muscles, but there remains some weakness of opposition in the hand. Range of motion of the neck is normal, with no radiation to the arm, but some discomfort between the shoulder blades in the rhomboid muscles, supplied by the dorsal scapular nerve. Stirlings and upper limb tension test test were both negative.

He feels 90 percent cured, and wanted to return to the gym, the original cause of the problem. Alas, no, was my reaction. And to be very careful with looking up.

All in all, we are both very pleased. The future? Neither of us are sure.


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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?

Interesting questions from visitors

CLS writes:

Greetings, Dr B.
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.

Your own unresolved problem. Pose a question

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.

You visited this chiropractic help site no doubt because you have a problem that is not resolving and want to know more about what chiropractors do.

The quickest and most interesting way is to read one of my ebooks of anecdotes. Described by a reader as gems, both funny and healthful, from the life and work of a chiropractor, you'll love them. Priced right at $2.99, though Kindle fiddles the price without telling me.