Neck-Related Arm Pain
Chiropractic FOR NECK-RELATED ARM PAIN RELIEF
No other spine problem gives more clinical challenge than neck, shoulder and arm pain (radiculopathy). The cause of arm pain (aka cervical spine radiculopathy) is most commonly a herniated cervical disc, degenerative disc disease resulting in spinal stenosis, or a combination of the two problems. Arm pain radiculopathy follows the course of a spinal nerve in the cervical spine / neck that is compressed or chemically inflamed. Knowing the where the arm pain is in the arm and/or hand/fingers directs the doctor to the identity of the level of the spine where the problem starts.
Let's start by viewing spine conditions that are common causes of neck, shoulder and arm pain. We will compare the problem areas to normal spine levels to aid your understanding of the spine condition causing the arm pain.
First is a case of a 35 year old female with bilateral arm pain, much worse in the left arm, and severe headaches. The x-ray study and MRI of this patient's spine are here.
|Figure 1 shows the cervical spine, or neck, from a side view. At the arrow notice how the vertebra is moved backward on the vertebra below it. This is called retrolisthesis subluxation and occurs because the intervertebral disc between the vertebrae has been torn and sprained to the point that it can no longer hold the vertebrae in normal alignment. Such malpositioning of the vertebra is a clue to the possibility of a disc herniation and disruption inside of the disc to allow the excessive movement of one vertebra on its adjacent segment. Such movement is termed instability.|
|Figure 2 shows the neck in a forward flexed position with the chin on the chest. Note at the arrow that the vertebra that was positioned back on the vertebra below in Figure 1 is now moved forward to a normal position. This again shows the instability of the spine due to tearing and sprain of the disc between the vertebrae. This is an example of marked instability. |
|Figure 3 is an xray taken with the patient looking up to the ceiling, or placing the neck into extension motion. Note that the vertebra at the arrow has moved backward on the vertebra below, again demonstrating instability of the intervertebral disc. Compare this vertebra position at the arrow to the same position shown in Figure 2 in which the vertebrae are in normal alignment.|
|Figure 4 is called an oblique x-ray of the neck and this view allows the reader to look into the nerve openings and note any diminished size of one opening to other openings in the cervical spine. In this case, at the arrow, note the narrow front to back size of that opening compared to adjacent levels. This noted level is the level of backward position of one vertebra on the one below. This narrowing compressed the nerve passing through it and sometimes this narrowing is termed minor stenosis.|
|Figure 5 is a lateral MRI view of the spine shown on x-ray in Figures 1-4. At the arrow is the disc herniation, in this case at the C5-C6 level, where we see the instability and backward movement of the C5 vertebra on C6 below it. This disc herniation is also shown in Figure 6 below in an axial or cross cut view through the disc space at C5-C6 showing the disc herniation compressing the nerve to cause the arm pain that this patient complains of. (See the large arrow.) |
Note in Figure 6, at the small arrow, the white dense material within the disc herniation; this signifies active inflammation within the disc and such inflammation is considered a source of pain. Also note that this disc herniation also contacts the spinal cord as shown at the yellow arrow.
HOW DOES THE COX TECHNIC SYSTEM OF SPINAL MANIPULATION BENEFIT PATIENTS WITH NECK, SHOULDER AND ARM PAIN?
Please consider some basic facts and findings.
Cervical radiculopathy is relieved in 91% of cases by manual physical therapy, traction, and exercises. (1)
Cervical disc removal relieves cervical spine discogenic headache due to soft disc herniation because discogenic cervical headache is a subtype of cervicogenic headache that arises from a degenerative cervical disc abnormality. (2)
Serious cord compression is termed myelopathy and can cause serious nerve damage. Yet some interesting facts are presented in the following paper. (3)
Myelopathy is due to post and lat column compression, ischemia and neuron loss in gray matter.
Surgery is not proven better than conservative care.
Spondylosis causes paresthesias, numb clumsy hands, fasciculations, sensory and vibratory loss, muscle wasting, spasticity. (3)
Another study on myelopathy shows:
Cervical spondylotic myelopathy is not greatly relieved surgically.
Surgery does not consistently alter the natural history of cervical spine myelopathy.
It is reported that follow-up of 7 years post surgery shows only 1/3 of the patients were improved. (4)
King (5) showed that at a 6 month follow up of 62 myelopathy patients, surgery yielded no benefit over non-surgical care for these myelopathy patients. Surgery is no better than non-surgical care for myelopathy patients.
SUCCESS OF THE COX SYSTEM OF SPINAL MANIPULATION
Kruse (6) presents a 51 y/o woman with 2 years of left arm pain. Her MRI shows a C5-C6 herniated disc. She had tried P.T., home traction, exercise, and medication no help. Cox Technic Flexion-Distraction produced relief for her after the first treatment. She was treated for 3 visits a week for 2 weeks, then every 2 weeks for total of 24 visits over 6 months. At one year follow up, she was symptom free with normal neurological status.
Gudavalli et al (7) reported the relief of the Cox Technic system of spinal manipulation for spinal stenosis of the cervical spine. Cox Technic Flexion Distraction and Decompression manipulation with physiotherapy modalities showed good subjective and objective clinical outcomes for a C6-C7 disc herniation causing severe neck and upper back pain and radiating left arm pain to the fingers in a 33 year old man. The C6-C7 herniated disc was MRI confirmed. It caused severe foraminal stenosis. The patient was treated 15 times over a 10 week period for relief of his symptoms. At 2 year follow-up, he was stable.
Kruse (8) reported on cervical spinal stenosis with arm pain and the relief following administration of the Cox Technic system of spinal manipulation:
60 year old male with cervical stenosis and radiculopathy
Weakness and pain in left shoulder and arm
Previous Treatments: medication, PT, MRI
Diagnosis: C4-C5, C5-C6, C6-C7 central and lateral recess stenosis
Examination Findings: Hyper-reflexia, hypesthesia C6 dermatome, Positive Hoffman reflex
Treatment: Cox Technic Decompression Distraction Manipulation – Protocol I
Time of Care: 5 weeks, 3 treatments a week, total of 19 visits over 5 months
Outcome at 8 weeks:
- Normal reflexes and sensation
- negative Hoffman reflex
- VAS improved from 7 to 2
- no arm or neck pain
Kruse (9) again reported on a severe case of neck, shoulder and arm pain relieved with the Cox Technic System spinal manipulation in a 34 year old female with severe neck, shoulder, arm pain of several months’ duration. Her diagnosis was a C2-C3 blocked vertebrae with occipitalization of atlas and degenerated discs. Flexion- Distraction manipulation gave complete resolution of symptoms after 8 treatments over 2 months.
A 39 case study of upper extremity radiculopathy (cervical radiculopathy / arm pain) treated with Cox Technic flexion-distraction and decompression (10) reported that
Patients were treated with Flexion Distraction and Decompression Manipulation.
Visual Analog Scale scores dropped from mean of 50.1 to 8.7 for a 41.4 drop in pain score which was statistically significant.
The pain scores dropped dramatically in treating upper arm radiculopathy with Cox Technic flexion distraction spinal manipulation.
Morris (11) reported a case of lower extremity pain with muscle weakness:
31 y/o man with severe low back pain
Cox Technic decompression was part of the treatment resulting in return to work in 27 days.
Repeat MRI showed no change
Outcome: 20 visits over 50 days with total remission of pain.
Lingering Symptom: Absent Achilles’ reflex
Other individual studies showing relief of pain caused by disc herniation:
Guadagnino (12) reported on Cox Technic's spinal manipulation successfully relieving pain due to a proven disc herniation.
Haldeman (13) published a description of Cox Technic as a chiropractic technique in a textbook on the principles of chiropractic.
Snow (14) published on the successful Cox Technic system management of a patient with lumbar spinal stenosis.
SPINAL STENOSIS SUCCESS WITH NON-SURGICAL CARE SUCH AS THE COX TECHNIC SYSTEM OF SPINAL MANIPULATION
Another study of 30 patients with C6-C7 herniated disc showed immediate increase of grip strength following electrotherapy and exercise. (16)
Conservatively treated cervical spine disc herniation patients without myelopathy responded better than surgically treated patients. (17) This study emphasizes the importance of non-surgical treatment for cervical disc herniation patients: complications.
Interestingly, females with bilateral chronic neck pain had a generalized smaller cross sectional area of the cervical multifidus muscles compared to healthy females, contributing to spinal stenosis. (18)
- Cervical radicular arm pain often results from a herniated cervical disc or degenerative disc disease with spinal stenosis or a combination of the two. (19, 20)
- Upper-extremity pain, paresthesia or numbness, weakness, scapular pain, or a combination of these signs and symptoms (21), headaches (22), and neck pain may point to arm pain radiculopathy.
Let's end this section on the management of neck, shoulder and neck-related arm pain patients with the Cox Technic system of examination, diagnosis and spinal manipulation treatment with a classic example of a cervical disc herniation in Figures 7 and 8 below.
Figure 7 shows a large C5-C6 disc herniation (see arrow) that was successfully managed with Cox Technic Flexion Distraction and Decompression spinal manipulation.
Figure 8 shows the disc herniation seen in Figure 7 in a view looking down upon the disc. See the herniation at the arrow.
The chiropractic management system of Cox Technic Flexion Distraction and Decompression protocols for the examination, diagnosis and treatment of neck pain and arm pain (radiculopathy) patients may be a solution for your neck-related arm pain.
Contact Chiropractic Care for an evaluation and treatment plan for the relief of your arm pain today.
- Cleland, JA; Whitman, JM; Fritz, JM; Palmer, JA. Manual physical therapy, cervical traction, and strengthening exercises in patients with cervical radiculopathy: A case series. JOURNAL OF ORTHOPAEDIC & SPORTS PHYSICAL THERAPY 35 (12). DEC 2005. p.802-811
- Ahn,Y; Lee, SH; Chung, SE; Park, HS; Shin, SW. Percutaneous endoscopic cervical discectomy for discogenic cervical headache due to soft disc herniation. NEURORADIOLOGY 2005; 47 (12):924-930
- Rowland LP: Surgical treatment of cervical spondylotic myelopathy: time for a controlled trial. Neurology 1992; 42(1):5-13
- Henderson FC, et al: Stretch associated injury in cervical spondylotic myelopathy: new concept and review. Neurosurgery 56 No 5, May 2005
- King, JT: Multimodal assessment after surgery for cervical spondylotic myelopathy. J of Neurosurgery – Spine 2005;2(5):526-34
- Kruse RA, Imbarlina F, DeBono VF: Treatment of cervical radiculopathy with flexion distraction. J Manipulative Physiological Therapeutics 2001;24(3):206-209
- Gudavalli, S, Kruse, RA. Foraminal stenosis with radiculopathy from a cervical disc herniation in a 33 year old man treated with flexion distraction decompression manipulation. J Manipulative Physiological Therapeutics 2008;31(5):376-80
- Kruse RA, Gregerson D: Cervical Spinal stenosis resulting in radiculopathy treated with flexion-distraction manipulation: A case study. J of the Neuromusculoskeletal System 2002;10(4):141-7
- Kruse RA, Schliesser J, DeBono VF: Klippel-Feil syndrome with radiculopathy. Chiropractic management utilizing flexion-distraction technique: a case report. J of Neuromuscular System 8(4):124
- Schliesser JS, Kruse RA, Fleming Fallon L: Cervical radiculopathy treated with chiropractic flexion distraction manipulation: a retrospective study in a private practice setting. J Manipulative Physiological Therapeutics 26(9)
- Morris CED: Chiropractic rehabilitation of a patient with S1 radiculopathy associated with a large lumbar disc herniation. J Manipulative Physiological Therapeutics 22(1)
- Guadagnino MR: Flexion Distraction manipulation of a patient with a proven disc herniation. J of Neuromusculoskeletal System 5(2)
- Haldeman S: Traction and distraction techniques. Principles and Practices of Chiropractic 3rd edition, 2005
- Snow G: Chiropractic management of a patient with lumbar spinal stenosis. JMPT 2001; 24(4): 300-304
- Simotas AC: Non operative treatment for lumbar spinal stenosis: clinical and outcome results and a 3 year survivorship analysis. Spine 2000;25(2)
- Joghataei, MT, et al: The effect of cervical traction combined with conventional therapy on grip strength on patients with cervical radiculopathy. Clin Rehabilitation 2004; 18(8):879-87
- Heckmann JG: Herniated cervical intervertebral discs with radiculopathy: an outcome study of conservatively or surgically treated patients. J Spinal Disorders 1999; 12(5)
- Fernandez-De-Las-Penas, C; Albert-Sanchis, JC; Buil, M; Benitez, JC; Alburquerque-Sendin, F. Cross-sectional area of cervical multifidus muscle in females with chronic bilateral neck pain compared to controls. Journal Of Orthopaedic & Sports Physical Therapy 38 (4). Apr 2008. P.175-180
- Radhakrishnan K, Litchy WJ, O'Fallon WM, Kurland LT. Epidemiology of cervical radiculopathy: a population-based study from Rochester, Minnesota, 1976 through 1990. Brain. 1994;117(pt 2):325–335
- Tanaka N, Fujimoto Y, An HS, et al. The anatomic relation among the nerve roots, intervertebral foramina, and intervertebral discs of the cervical spine. Spine. 2000;25:286–291.
- Cloward RB. Cervical diskography: a contribution to the etiology and mechanism of neck, shoulder and arm pain. Ann Surg. 1959;150:1052–1064.
- Persson LC, Carlsson JY. Headache in patients with neck-shoulder-arm pain of cervical radicular origin. Headache. 1999;39:218–224