Tri State Hand and Occupational Therapy

Newsletter - October, 2005

Compression of Nerves in the Cervical Area vs. the Shoulder, Forearm and Wrist.

Description

Clinically patients present with complaints of pain, numbness and tingling in the hand and arm. The difficulty is conclusively telling if the compression is coming from the neck, shoulder, forearm or wrist area. From my experience in the past seventeen years, certain characteristics present in the clinic with each. Let’s look at the symptoms that each presents.

Cervical Radiculopathy

Although the problem is in the spine, the symptoms may be felt in the shoulder, arm and hand. I have found if the whole nerve root is pinched off, the whole arm is affected. Symptoms include whole arm tingling, numbness and pain.

However, this is really quite rare. More typically, only the sleeve surrounding the nerve root is affected

by either inflammation, arthritis or a partial disc protrusion on the sleeve of the nerve root. In this case, only one aspect of the arm is affected not the whole arm. In other words, the thumb side of the arm and hand or the small fingers side of the arm and hand. Occasionally, there is pain or discomfort into the chest and shoulder area. This is often mistaken as a heart attack.

Thoracic Outlet or Inlet Syndrome

Very simply, this is compression of the nerves and blood vessels that go to the arm. It can come from tight muscles in the neck or shoulder area. It is worsened by placing the hand overhead. Typically, the patient complains of numbness or tingling in the hand or arm, usually on the little finger side of the arm. There can also be pain in the chest area and shoulder. Sometimes the hand may be puffy or swollen. The patient may also complain of heaviness in the hand and arm as well as an easily fatigued arm and hand. This too is occasionally mistaken as a heart attack.

Compression of any of the Three Nerves at the Elbow

I. Ulnar Nerve

The patient complains of numbness and tingling in the ring and small fingers. There also may be aching on the inside part of the elbow and forearm. This disorder is called Cubital Tunnel.

II. Radial Nerve

This causes pain in the forearm in the muscle group of the extensors. It is easily confused with Tennis Elbow. In fact, really bad Tennis Elbow can irritate this nerve. This nerve disorder is called Radial Tunnel.

III. Median Nerve

The muscles in the forearm that flex the fingers for fisting and the muscle which rotates the forearm may get tight and compress the nerve. The patient complains of numbness in the thumb and base of the thumb. Also into the thumb, index and long finger. This is usually referred to as Pronator Syndrome.

Compression of the nerves at the wrist

I. Median Nerve

This is true Carpal Tunnel. It is compression of the median nerve at the wrist. Numbness and tingling in the thumb, index and long fingers but not at the base of the thumb and not on the back of the hand.

II. Ulnar Nerve

This is compression at the wrist in a small tunnel called Guyons Canal of the ulnar nerve. It is characterized by numbness and tingling in the ring and small fingers but usually no pain or symptoms in the forearm.

Treatment

These are typical conservative treatments for these neurovascular compressive disorders:

Cervical Radiculopathy – Moist heat, cervical traction, gentle joint mobilization and e-stim, ultrasound as well as strengthening of the muscles that support the neck can help the patient control symptoms. Ice may also be used.

Thoracic Outlet – Moist heat, stretching of specific muscles, home stretching programs, posture corrections, work place job station design changes, strengthening particular muscle groups, e-stim and ultrasound are all helpful. It’s also important to avoid overhead activities.

Compression of nerves at the elbow - These require reducing muscle pressure on these nerves. Special stretching procedures and/or bracing may be required. Avoiding activities that worsen pain and numbness are also important. Ice, e-stim and ultrasound may also be used.

Compression of Nerves at the wrist— Splinting of the wrist, cold laser stretching of the ligaments of the wrist and e-stim or ultrasound can help reduce symptoms. Teaching to avoid bending of the wrist. Ergonomics at job stations.

Tips

If you develop numbness, tingling or pain in your shoulder, arm or hand that persists, see your doctor or give us a call.

Avoid static postures that cause you to lean forward and look down. Reverse this posture by periodically bending backward and looking up. If you can, pull your shoulders back as well.

Avoid prolonged carrying of heavy loads. Use a cart or assistive device.

For bike riding, consider handle bar padding and adjustable handle bars. Try to keep the wrists straight.

For typing, keep the spacer bar at the same height as your elbow from the floor.

For driving, keep your seat fairly close. Also avoid long reaches to the steering wheel. Vary your hand positions on the wheel during your trip.

Stretch the muscles in the neck, head and arms regularly.

Diabetes and thyroid disorders increase the risk of developing these types of problems.

If your symptoms persist, consult your doctor or give us a call. Waiting may cause unneeded permanent nerve damage.

ATTENTION

Effective October 21, 2005 our office in Petersburg, West Virginia will be closing. We would like to take this opportunity to thank each of you for your support and express how much we have enjoyed working with you. If you should need to contact us concerning a patient we have treated for you after this date, please feel free to call our Cumberland, Maryland office at 301-759-4263. Thank you.