(Keywords: arm pain, chiropractic help, acromioclavicular joint, rotator cuff syndrome, home traction unit, neck pain anatomy, chiropractic subluxation, frozen shoulder exercises)
It's 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.
The definitive test for a pinched nerve is called the Upper Limb Tension Test ... follow this link to a YouTube video showing you how to test if you may have a pinched nerve causing your arm pain.
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.
Plus, there is much confusion and disagreement even amongst experts.
This week 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 pain. Normally, raising your arm giving relief, the so-called Shoulder Abduction Relief sign, is associated with a nerve root impingement, and TOS patients get increased tingling and pain, not relief, when raising the arm.
Sports injuries, blows to the
head, diving into shallow water, neck and shoulder injuries (as in boxing and rugby often causing an
Acromioclavicular Joint syndrome), whiplashes and so on.
Whiplash Chiropractic ... Read more …
Searching for something specific? Say, " ARM PAIN Quick DASH" score: How bad is your pain? Just type it in the Search function near the top of the navigation bar on the left.
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 and arm pain. The joints are stabilised by the "facet joints". Through a small "foramen" the nerve root escapes, on its way to the arm. Neck pain anatomy ... …
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 CHIROPRACTIC SUBLUXATION AND how subluxations cause arthritis in joints, click here:
CHIROPRACTIC SUBLUXATION ...
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... Uncovertebral Joint Luschka ...
Frozen shoulder and rotator cuff syndrome
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. For
more information about how chiropractic helps the muscles, joints and nerves (the shoulder anatomy), click here:
SHOULDER ANATOMY ...
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 arms, 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.
ADSON'S TEST FOR TOS
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.
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 assess the effects of mechanical traction for neck disorders.
MAIN RESULTS: Of the seven selected trials (called RCTs), only one 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.
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. There simply is only one good trial concerning traction used on its own 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 ...
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.
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.
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, also weakness, pain and tingling in the arm is a great challenge.
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: 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 ULTT test were both negative.
He feels 90% "cured", and wanted to return to the gym, the original cause of the problem! No! And to be very careful with looking up.
All in all, we are both very pleased. The future...? Neither of us are sure.
I'm not looking here for funny stories. That we'll find a place for elsewhere, and you can find an abundance of them in my books at Bernard-Preston.com. James Herriott genre books.
Here I'm looking for things that you particularly love / hate about a visit to the chiropractor. Share it! If we get too many, and we probably will, we'll split them.
Are there things you hate about a Chiropractic consultation? Let's hear about it. Hopefully even more stories about things you love.
You see, we Chiropractors can learn from your feedback, both positive and negative.
Click below to see contributions from other visitors to this page...
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