Pain Can Be Referred To Other Parts of the Body Recently we had a patient named Karen who had an interesting problem. She had numbness and tingling, also described as “pins and needles” that appeared in her hands and also soon into her forearms as well. She was convinced, as many people are, that she had carpal tunnel in her hands. However, pressure nerve sensitivity testing revealed a sensory loss that did not match with carpal tunnel. The sensory loss appeared more related to nerve compression in the shoulder and neck. After treatment consisting of stretching her shoulder, traction to the neck and a muscular stabilization program, her symptoms went away. It is nice to have a story with such a happy ending but how can one feel pain, numbness and tingling in the hands and forearms and have it caused by the neck and shoulder without having a complaint of pain in the neck or shoulders? This is the concept of referred pain. Referred pain is pain can be felt elsewhere than its true site. The brain “feels” pain in the sensory cortex. This is a memory storage system and it is fed by a constant input from the skin. The areas of greatest sensitivity are first the lips and secondly the hands, especially the thumb. Some general concepts of referred pain are: * Felt deeply and vaguely *Referred from closer in the body to farther out in each dermatome segment of the body *Pain felt anywhere within the dermatome *Pain is not necessarily at the site of the cause of the pain (lesion) A dermatome is defined as a specific segment of the body that is fed by a specific nerve level from the spine. If the pain causing area is centrally located very near the spine, the pain is usually stronger and a larger area is affected. For example, a disc pinching a nerve may make the whole arm and shoulder ache with numbness and tingling. The further away from the spine the pain causing lesion is located, the smaller the area affected. However, not all pain comes from nerve pressure. Other tissues can also refer pain. Bone can refer pain but it is usually fairly localized. Muscles which are injured such as the rotator cuff in the shoulder refer pain down the arm but only moderately so and rarely below the elbow. Interestingly, structures such as the joint capsule, ligaments, bursa and the sleeve around the nerve as it leave the spinal cord refer pain the most. Remember that pain referred does not necessarily mean a nerve is involved. However, lesions of the nerves are characterized by pins and needles and numbness and tingling when it is early on in the problem. Unfortunately, people often wait too long when they first have this problem; hoping that it will go away on its own. However, that is a mistake for it is a clear sign of pressure on a nerve or the blood supply to the nerve. If you fail to get treatment, you may end up with permanent nerve damage. If the tingling and numbness are constant, next comes permanent loss of strength, sensation and function. Most of these problems are due to soft tissue lesions of joint capsules, ligaments, bursa, the sleeve of the nerve root at the spine, the nerve root itself or the nerves in the arms and leg itself. Diagnosis and treatment: Initially, we do a very close clinical examination. The patient’s history of the problem often reveals if the problem is from the spine, in the neck or in the shoulder. We look at range of motion, strength of specific muscles and mostly, can we reproduce “the” pain or symptom that the patient complains of specifically. We also consult with your doctor and possibly refer to painless nerve testing or other tests to get to the cause of your problem. At Tri State Hand & Occupational Therapy, we take the time to listen to your problem. You get a very careful examination of the problem in your body. We communicate with your doctors and keep them informed. We pride ourselves on no waiting for treatment & offer 8:30am-6:30pm office hours to cater to your busy schedule. It’s important to take care of yourself . We look forward to meeting you and helping you with your problem. Try therapy first at Tri State Hand & Occupational Therapy. You will be glad you did. SOME TIPS ABOUT DEALING WITH PAIN, NUMBNESS OR TINGLING IN THE ARMS AND HANDS *Don’t ignore the pain or numbness and tingling. It can lead to permanent nerve damage. *Early recognition of the problem and getting treatment early means greater success with treatment. *Problems in the shoulder can refer pain to the upper arm but rarely below the elbow. *Problems in the neck can refer pain or numbness & tingling into the hands and arms. This can be confused with carpal tunnel. *Testing can be done in the clinic to help identify your problem. Painless nerve testing may also be helpful. |
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