Arm Pain vs. Neck Pain 
Recently, I had a very nice elderly man referred to me with tennis elbow. This is pain on the outside part of the elbow, usually caused by over doing it with gripping, lifting, and pinching. Sometimes I think it should be renamed workers elbow, as few people who get it play tennis. However, after 1 1/2 weeks of typical treatment for tennis elbow he was not better. In fact, he was worse. He said the pain was spreading up his arm to his shoulder. Strange! How would tennis elbow spread up the arm, unless it was not tennis elbow! I did nerve testing and determined a loss of sensation in the thumb and the outside part of the forearm. We tried cervical traction that very same day. The patient was surprised, his arm pain was greatly relieved. His "tennis elbow” had disappeared. How could this be? You know I used to see this all the time in the poultry plants? So often people were misdiagnosed with tennis elbow only to get relief of their symptoms from cervical traction. That was before I started doing nerve testing myself. So what gives? How can pain in the elbow be coming from the neck? It is a matter of pain being referred down the arm via certain nerves which can be tricky to diagnose. Particular attention must be paid to the neck during the clinical examination regardless of where in the arm, shoulder or hand the patient complains of pain. Getting back to our current tennis elbow patient how did it begin and how did it turn out? During the history it was unusual for a tennis elbow patient to have no memory whatsoever of overdoing it at all. No wood chopping, house projects, work or even washing the car. This raises bells and whistles that say “whoa, what’s wrong with this picture,” because tennis elbow is a problem of overuse. Interestingly, he had a history of several bad falls and a bad lower back. This is another suggestion to look at the neck because often if one end of the spine is bothersome so is the other. In other words, if the back is bad so the neck may be a problem. If you look at the illustration called Cervical Radiculopathy, you can see there are seven neck (cervical) vertebrae. Each has an area that its nerve roots supply. The second cervical root (C2) supplies the area of the ear and above it as well. C3 supplies the lower part of the ear plus the neck and upper shoulder. C4 and C5 supply the shoulders and upper chest. C6 supplies the outside part of the elbow and forearm and the thumb and index finger. C7 and C8 supply the inside part of the elbow and forearm including the small, ring and long fingers.  The key is to remember these nerve roots, while doing the examination of the neck during the initial clinical examination. The history also may suggest a spinal injury either recent or in the past which should be considered. Also lifting, driving, smoking and diving are associated with neck problems. The nerve testing we do is very sensitive and can pick up a problem before nerve damage becomes serious. This can help us tell where the problem is coming from. If you have pain in the arms, hands or neck give your doctor a call and request a visit to us at TriState Hand and Occupational Therapy, Inc. We also offer a free screening as a community service. Stop suffering from pain or numbness and tingling in the hands and feet. Call 301-759-4263 and give therapy a try with us. You will get individual care and treatment and we will share the information with you. Get your problem handled today. Give us a call at 301-759-4263. You will be glad you did. Tips --Cervical Radiculopathy is the medical name for pinched nerve with nerve root irritation. --Arm pain may come from or be worsened by nerve problems in the neck. --Neck problems are most frequently found at C7 (inside elbow and small ring and middle finger) in 60% of neck problems. The second most common are found in C6 (outside elbow plus thumb and index finger) and represent 25% of the cases. --In younger patients pinched nerves usually result from an injury or disc herniation causing an impingement on the nerve exiting the spine. See herniated disc illustration. --In the older patient pinched nerves are often a result of narrowing of the opening of the hole in the vertebrae where the nerve comes out of the spine due to arthritis and oseophyte formation. --Heavy manual labor of lifting beyond 25lbs. regularly, smoking, driving and operating vibrating equipment are factors which increase risk of symptoms of neck problems. This is called foraminal stenosis. |
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