Development Of Neck And Shoulder Pain
The neck and shoulder are interconnected by many nerves, blood vessels, muscles, and other tissues. A problem in the neck can send pain to the shoulder, and vice versa. Some of the underlying biomechanics that can contribute to both neck and shoulder pain include:
- Muscle dysfunction. An injury or inflammation to a muscle in the neck or shoulder may lead to pain and stiffness. Sometimes when one muscle becomes tight or dysfunctional, nearby muscles may need to work more and become painful. The muscles connective tissues , tendons, or ligaments may also become injured or inflamed, possibly sending referred pain to nearby areas.
Chronic Shoulder Pain Treatment Or Arm Pain Treatment
Through years of experience, weve figured out that good and long-lasting chronic shoulder pain and arm pain relief doesnt work unless all bases are covered.
The best pain management combines pain-reducing treatments with selected therapies like physical and psychological rehabilitation treatment.
TYPES OF TREATMENT
Medications to reduce the pain
These may be simple over the counter medications or can be medications prescribed by your pain specialist. Medications might include muscle relaxants or nerve pain medications . Sometimes analgesic compound creams are used to ease pain.
Injection therapies can be used to target, diagnose and manage chronic pain caused by muscle, joint and nerve pain.
It includes interventional therapies like nerve blocks radiofrequency ablation , pulsed radiofrequency and epidural and nerve root steroid injections. Sympathetic nerve blocks can also be performed.
Some of these therapies can be focused on various structures that might be causing or making the pain worse like the glenohumoral joint, the acromio-clavicular joint, the subacromial bursae, muscle trigger points, the brachial plexus, the spinal nerve roots and other nerves around the shoulder. Platelet-rich plasma can also be used in some locations around this area.
Nerve stimulation or neuromodulation techniques
How Does The Shoulder Work
Your shoulders each have two joints, making them the most flexible parts of your body.
The main shoulder joint the glenohumeral is a ball-and-socket joint. Its called this because the top of the upper arm bone the humerus is shaped like a ball. This ball fits into the shoulder blade bone, which acts as the socket, giving your shoulder a wide range of movement.
But, the shoulder socket is very small, compared to other ball-and-socket joints, such as the hip. Its held together and controlled by a covering of muscles, which are secured to the bones by strong cords called tendons.
These muscles and tendons form a capsule around the joint and support its movements, but can make it more likely to dislocate than other joints.
Inside the capsule is the synovium, which produces fluid that lubricates the joint and keeps the cartilage healthy. The cartilage helps protect your bones from any impact and sits between the bones of your shoulder joints to stop them rubbing together.
Above the main shoulder joint theres a smaller joint where the top of the shoulder blade the acromion meets the collar bone.
This is known as the acromioclavicular joint. It helps the larger joint below to move through its full range, particularly when youre raising your arm, lifting or throwing.
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Why The Pain Radiates Down The Arms
When neck and shoulder pain radiate down the arms it may be most likely due to their proximity to one another. When structures in the neck that suffer any type of damage, it can easily extend to any nearby body parts, and in this case can cause arm pain.
This phenomenon is most common when a nerve root in the neck has been pinched, especially when that nerve has a direct connection with the arm that it affects.
Pain that occurs specifically in the arms and/or hands may be due to local issues with the arm itself. On the other hand, when the pain originates in the neck, but extends down to the arm or even to the hand, it is likely that the source of the pain is within the neck region.
That being said, if the pain that affects the arm originates in the neck/cervical spine, by addressing the problem from its source , the pain and other symptoms should then go away.
How Is Cervical Radiculopathy Diagnosed
Determining the cause of the cervical radiculopathy begins with a complete history of physical examination. Details of previous traumas including motor vehicle accidents is important. At the Centeno-Schultz Clinic you will spend quality time with a board certified, fellowship trained physician who is committed to your care and success. Specific physical examination tests will be performed to document weakness, numbness and neck function. This may include:
- How well you can bend your neck and roll your head in all directions
- If there is tenderness around the neck
- If there are muscle spasms around the neck and shoulders
- Areas of tenderness that create shooting pain down shoulder or arm
Radiograhic studies are necessary and include:
X-ray: Useful to document narrowing of disc spaces, Neural Foramen narrowing and curvature of the spine
CT AKA CAT Scan: Helpful to access bone spurs, narrowing of the Neural Foramen, facet overgrowth and calcifications of the spinal ligaments. Diagnostic accuracy is between 72-81% .
MRI: The most common imaging for Cervical Radiculopathy with a diagnostic accuracy of 88% . MRI captures muscles, ligaments, tendons, nerve and all boney structures along with any narrowing of the neural foramen.
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Medical History And Physical Examination
After discussing your symptoms and medical history, your doctor will examine your shoulder. They will check to see whether it is tender in any area or whether there is a deformity. To measure the range of motion of your shoulder, your doctor will have you move your arm in several different directions. They will also test your arm strength.
Your doctor will check for other problems with your shoulder joint. They may also examine your neck to make sure that the pain is not coming from a pinched nerve, and to rule out other conditions, such as arthritis.
Your doctor will test your range of motion by having you move your arm in different directions.
Reproduced with permission from JF Sarwark, ed: Essentials of Musculoskeletal Care, ed 4. Rosemont, IL, American Academy of Orthopaedic Surgeons, 2010.
What Causes A Pinched Nerve
A pinched nerve refers to a nerve in your neck that has become irritated due to an increase of pressure on it. Muscle tension, herniated discs and bone spurs are just a few examples of conditions that can pinch the nerve in your neck.
When this affects a nerve ending that extends into your shoulder, you may feel pain, tingling and weakness that radiates through the shoulder and down into your arm.
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What We Might Do Next
One way to treat unexplained pains like these is with a local anaesthetic injection in the shoulder. If the arm pain disappears temporarily , its a good indication that the shoulder is indeed the culprit. We can then focus our treatment there and get to the root of your pain. On the other hand if the injection works for a little while and seems to be improving the arm pain, we could look to continue progress with some targeted physiotherapy.
Sometimes the best course of action is to monitor and manage the discomfort over the medium term, either with physical therapy or perhaps with a steroid injection every six to 12 months. But of course its also possible that the problem is beyond the reach of either physio or injections. When that happens, we can look at surgery options to stop the pain for good.
Have you been ignoring a long-running pain in your arm or shoulder? Dont feel as though you should put up with it forever! Book in to see your GP, or make an appointment with us direct. Well be very happy to help you find out whats happening, and how we can help you get back to normal.
When To See A Doctor
A person who suspects they are having a heart attack should seek emergency medical attention.
People with angina may have difficulty differentiating a heart attack from an episode of angina. If symptoms persist after treatment with aspirin or nitroglycerin sublingual spray, emergency treatment is necessary.
Sports injuries, such as swimmers shoulder and RCT, may require medical attention if rest and ice do not alleviate symptoms. A doctor may prescribe pain relief and may refer the person to a physiotherapist for further treatment.
People with brachial neuritis may consult their doctor for a diagnosis and pain relief. However, there are few other treatment options available. The condition generally resolves on its own.
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Causes Of Shoulder Pain Radiating Down Arm To Fingers
Shoulder bursitis When a fluid-filled bursa is aimed at reducing joint joint movements, you may experience severe pain when raising your hands over your shoulders, numbness and tingling, stiffness and increased tenderness of the affected shoulder. Shoulder bursitis is usually caused by injury, repetitive motion, hemorrhage or tear rotator cuff tears.
Carpal tunnel syndrome The symptom of a Carpal tunnel may be due to a variety of factors but the repetitive activity is a common known cause that I see in the office. Often, however, there is no specific underlying cause. Patients experience numbness and tingling in the thumb, index, middle, and middle finger area.
Nerve pinching Common symptoms of nervous compression include pain and neck stiffness, usually electric pain under the arm, numbness, and muscle weakness. Depending on the nerve involved, these symptoms usually begin in the neck and may involve the shoulder, upper arm, forearm, arm, or even both.
Cubital tunnel syndrome The most common cause of this is due to holding the elbow in a very long shifted position, which puts nerves, or directly puts pressure on the humorous bone. Patients experience numbness and tingling that starts at the elbow and passes to the pinky finger and ring.
Consider these conditions of shoulder pain radiating down arm to fingers
Who have the risk factors for getting shoulder pain radiating down arm to fingers?
- Old age
- Lack of exercise and low level of body balance
- Being overweight
Typical Symptoms Of Pinched Nerve
The common symptoms of a pinched nerve include shoulder pain or electrical shooting sensations down the arm. They can consist of muscle weakness or a numb feeling, aches, or a tingling sensation . The severity of the pain varies based on the location and cause of the trapped nerve. A common complaint from some patients is waking up with a sore or frozen neck.
A pinched nerve usually only causes pain in one shoulder. Often, its a sharp pain instead of a dull ache or discomfort similar to that you may experience when youve overworked your muscles.
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Common Risk Factors For Cervical Radiculopathy
There are many factors that can increase your risk of cervical radiculopathy. Having one or more of these risk factors may mean youre more likely to develop pain in the neck and shoulder that radiates down your arm:
- Age The risk of pinched neck nerves increases as a person ages. Generally, the risk is highest when youre between the ages of 40 and 59.
- Doing repetitive neck movements Years of repetitive neck movements can wear out structures in the neck. In turn, this makes cervical radiculopathy more likely.
- Working with vibrating equipment The vibrations caused by certain work equipment, such as jackhammers, can lead to a greater pinched nerve risk.
- Repeatedly overstressing your neck muscles Activities like weightlifting can put a lot of stress on your neck muscles. Over time, this can increase your risk of pinched neck nerves. Forward head posture can also cause neck muscles to be overstressed and increase your risk of this condition.
Treatment Of Shoulder Pain Radiating Down Arm To Fingers
Effective pain management combines pain relief treatment with selected therapies such as physical and psychological rehabilitation treatment.
Surgery is often recommended when conservative treatment with steroids fails to provide a lasting benefit or signal. The specific type of surgery will depend on the cause and severity of the injury. Discectomy is a common surgical procedure in which a dislocated disc is surgically removed in the hope of reducing pressure and irritation in the spinal cord. Unfortunately disc reduction can weaken the side wall of the disc that puts the disc on for future injury including discomfort and deterioration of the disc.
It is generally recommended when measurements show structural changes, which require corrective surgery. When other treatments fail, surgery may be considered an option to reduce the pain caused by severe musculoskeletal injuries or nerve compression. These are usually performed by an orthopedic surgeon. Types of surgery can include, arthroscopy, stabilization surgery, trauma surgery joint surgery.
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3. See a doctor
- Shoulder pain and fever, swelling, or redness
- Trouble moving the shoulder
- Pain for more than 2 to 4 weeks, even after treatment at home
- Swelling of the shoulder
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Cervical Radiculopathy Treatment Options
Treatment options will depend upon the severity of the injury and clinical symptoms. When appropriate conservative care should always be first line of therapy.
Options include rest, safe anti-inflammatory medications, chiropractic care and physical therapy. Gentle cervical traction, mobilization and strengthening is often times helpful. To treat the burning arm pain some patietns are starting on nerve medications like Neurontin, Lyrica or Cymbalta. The nerve pain is rarely responsive to oral narcotics.
Steroids are powerful anti-inflammatory medications. They can be taken orally, injected into the muscle or injected into the spine. Examples of commonly used steroids include Depo-Medrol, Betamethasone, dexamethason, triamcinolone, Celestone and Kenalog. The dangerous side-effects have been discussed in previous blogs. The major side effects include:
- Destroying cartilage
- Increasing the risk of infection
- Systematic Problems
Surgery is often recommended when conservative care and steroids fail to provide signficant or sustained benefit. The specific type of surgery will depend upon the cause and severity of the injury. Discectomy is a common surgical procedure where the protruding disc is surgically trimmed in a hope of reducing the pressure and irritation on the spinal nerve. Unfortunately trimming of the disc can further weaken the disc side wall predisposing the disc to future injury including herniation and disc degeneration.
Symptoms Of Shoulder Blade Pain
The symptoms you experience depend on the cause of your shoulder pain. Pain can be sudden, chronic, temporary, burning, radiating from one area to another, and appearing in different parts of the shoulder. Shoulder blade pain can also cause numbness or tingling, and pain can become worsened when lying on the shoulder or breathing.Another symptom of shoulder blade pain is crepitus, which is a grating sound when the shoulder moves or when it is pressed.
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All Over The Shoulder
The tendons, ligaments, and muscles in your shoulder keep it stable. If these tissues become loose or torn, shoulder instability or dislocation may occur.
As the name suggests, instability causes loosening of the joint. It can be caused by a traumatic injury or from overuse. Shoulders that feel unstable may feel as though they will pop out of the joint.
Multidirectional instability can result from chronically loose ligaments.
This condition usually affects young, athletic women, making them feel as if their shoulder is not staying tightly in position . The sensation is often described as a “dead arm” with excessive shoulder range of motion.
A dislocation is an injury that occurs when the top of the arm bone becomes disconnected from the scapula.
If someone has dislocated their shoulder, then the normal ligaments that hold the shoulder in position may be damaged, and the shoulder has a tendency to pop out of the joint again.
Pinched Nerve In Shoulder Blade Symptoms
A pinched nerve in the shoulder will cause pain, numbness or discomfort. Other symptoms include changes to feeling on same side as shoulders that hurts muscle weakness of arm and hand due to damage caused by trapped nerves near neck region along with other related issues such as trouble turning head from side-to -side without experiencing Neck Pain!
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How Do I Get Arm And Shoulder Pain Relief
Shoulder pain and arm pain is best initially assessed by a general practitioner . They will make an assessment and make sure there are no warning signs for something serious.
If they suspect something more serious is causing your pain, they may do some scans or blood tests and send you to see a pain specialist or an orthopaedic surgeon.
If the shoulder pain and arm pain is mild or improving, GPs may:
Reassure that there is no serious cause for concern and advise that the pain should improve with physical activity and simple pain medications.
If the shoulder pain and arm pain persists or returns GPs may:
Use stronger pain medications
Suggest management by an expert pain physiotherapist
Refer to a pain specialist physician to provide more comprehensive back pain management using options like joint and nerve blocks, sympathetic blocks and radiofrequency ablation , pulsed radiofrequency or nerve stimulation and neuromodulation using spinal cord stimulation
Refer to an orthopaedic surgeon for an opinion.
Contact us to book an appointment with a specialist.
Test : Turning Your Head
Turn your head to the side that is not painful and hold it there for a few seconds. You shouldnt notice any restricted movement or pain. Next, turn your head in the opposite direction and hold for a few seconds. If you experience restricted movement or an element of pain radiating down your arm, then you have a positive result for this test.
If you have gone through each test and reached the end, you are likely suffering from a trapped or pinched nerve. The next step is to gain a comprehensive diagnosis from a medical practitioner.
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