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Neck and arm pain may not be a disc after all.

Posted Feb 10 2010 3:55am

In my Chiropractic officeI will frequently have people come in with neck pain radiating into the arm and hand telling me they have a cervical disc herniation. This is a very uncomfortable problem and can be interfering in a person’s day to day activities as well as interrupt sleep. They may have been prescribed medication by their primary doctor to make the symptoms go away and then they end up in my office where my job is to determine the cause.

There are many things which can cause neck and arm pain. Cervical disc herniationsshoulder injuriestrigger points are a few. One frequently overlooked problem is called thoracic outlet syndrome. Disc herniations affect the nerves by pinching them and causing the shooting pain as well as tinglingweakness and difficulty with fine motor skills. Thoracic outlet syndrome affects the nerves as well as the circulation into the arm and causes not only the arm paintingling and weakness but a variety of other symptoms as well. Swelling or puffiness in the arm or handbluish discoloration of the handcoldnessthrobbing pain and arm/hand fatigue are common as well.

The thoracic outlet is a small space between the collar bone and the first rib. The cause of the compression  of the nerves and vessels in this area can be anatomical including an extra rib located above the firstpoor posture such as drooping shoulders or holding the head forwardtrauma to the area as in a car accident or even a repetitive activity such a typingworking on an assembly line or repeatedly lifting things as in stocking overhead shelves.

The way I tell the difference between a disc problem and a circulation problem is with a couple of simple tests. I check the patients pulse and then raise the arm up over the head. If the pulse slows down or can no longer be identifiedthat is a good indication of this syndrome. Another check is if the pulse diminishes when I extend the arm and rotated the head. I may even add having the patient hold their breath. Againif the pulse changesthat can indicate TOS (thoracic outlet syndrome). I also would take x-rays of the area to determine any anatomical abnormality. If the patient didn’t respond to my treatmentI would refer them for further studies such as an MRI or a nerve conduction test.

Most cases of TOS can be successfully treated conservatively especially if treated early. We would recommend chiropractic adjustments to the neckshoulder and upper backposture exercises and stretchessoft tissue work on the trigger points and various physiotherapeutic modalities. By visiting our web site at you can see how gently we treat this type of condition.  Even more important is addressing the work challenges and changing sleep positions. Weight loss is helpful and we have a great weight loss program in our office.

Thoracic Outlet Syndrome is uncomfortable but can be treated. Feel free to call our office to discuss if you have this problem and the type of treatment that might be right for you.

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