ARM PAIN Case Histories(Keywords: ARM PAIN Case Histories, frozen shoulder, tennis elbow, arm pain, carpal tunnel syndrome ) Neck and arm pain is a frequently reported complaint which can be disabling and costly to society. Certainly they are inter-connected and a daily issue at the Chiropractic Coalface. Two cases from the Chiropractic Coalface:
Searching for something specific? Say, " Chiropractic Alternative Medicine ". Just type it in here...  Custom Search
INITIAL CONSULTATIONMrs H is a 64-year old woman, in excellent health, but with a long history of low-key left lower neck/ upper thoracic pain. There was never radiation to the arm, but it obviously created a weakness in her left arm.Nine months prior to the first consultation, she had to take her grandchild out of the car, and then carry the child in the Snug 'n Safe baby car chair for about half an hour. The next day she developed acute left elbow pain which never went away. Physiotherapy brought only very temporary relief. EXAMINATIONOrthopaedic tests (Cozen's and Lateral Epicondylitis test) and resisted isometric wrist extension were severely painful in the left elbow. Shaking her hand hurt, and she reported that lifting the kettle, pots... was very painful. Radial head fixation. Left neck rotation was restricted and Kemp's test for a facet syndrome was mildly positive in the left lower neck. Brachial nerve tension test for a frankly pinched nerve in the neck, and Adson's test for a subluxated first rib causing a Thoracic Outlet Syndrome were negative. DIAGNOSISWhilst the case had the appearance of a routine "tennis elbow" or "lateral epidcondylosis" in the jargon (not "itis", there are no inflammatory changes), there were two little warning signs: Consult 2: REPORT OF FINDINGSAt the ROF I always like to Oddly, this is the most important consultation, more important than the treatment itself. Chiropractic treatment of musculo-skeletal conditions like Tennis Elbow is superior to anything medicine can do, the research confirms it, but the Chiropractor often fails at this first hurdle, if s/he fails to 'sell' the programme to the patient. I did it thoroughly, and Mrs H is still with us six weeks later. I then proceeded with a gentle first consultation. The treatment of tennis elbow can be painful, and it makes no sense to bully the patient in the beginning, though it may well be the case later. Consult 3:Her neck felt looser, but her elbow rather "burny". No real improvement. I added an adjustment of Th 5 vertebra in her midback. Consult 4:The Lateral Epicondylosis orthopaedic test was slightly less painful. Consult 5:As before. Perhaps 5-10% improvement.Consult 6:Mrs H confided that she also had chronic right groin pain. She had to dot-and-carry-one up a staircase. Medical treatment hadn't helped.A short examination confirmed mildly reduced range of motion, particularly adduction and internal rotation with sharp pain at the end of the range. Early osteoarthritis was on the list of DDs. I suspect a FEMERO ACETABULAR IMPINGEMENT SYNDROME and recommended a trial of 4 treatments before asking for X-rays. FAIS untreated leads inexorably on to arthritis as the replenishment of synovial fluid becomes progressively less, leading to degeneration of the hyaline cartilage one of the few tissues to have no blood supply of its own.Consult 7:Elbow continuing to improve. Slightly.Quite a lot of "napijn" after the treatment of the hip. Aside: Pain after a chiropractic is not uncommon. Mostly, it's a discomfort, a sense of having been battered about, which you have been. And it passes within a day, or sometimes 2-3. Very occasionally patients have really quite severe "after-pain". Don't be alarmed, afterall you also have after-pain after your wisdoms out... but do phone your chiropractor and let him/her know. Consult 8-12:Most encouraging was that the chronic pain in the groin improved greatly after the chiropractic treatment of the sacro-iliac joint, hip capsule and groin muscles, particularly the pectineus and adductor magnus. Less encouraging was that the progress with the elbow pain was SLOW! IN CAPITALS! But the important "lateral epicondylosis test" was nearly negative. Consult 13-15:A personal family friend, Mrs H continued to come for treatment of her elbow despite my misgivings. I like to the progress to be much faster. But where to refer her after medicine and physiotherapy hasn't helped. She reports that it is now 50% better and rarely wakes her at night.I add acupuncture treatment to all the other therapy. Rome wasn't built in a day, and sometimes one must accept that some conditions takes time and commitment. We both have that. Consult 16-20:She reports that the acupuncture is definitely helped. Her grandchildren have been to visit from England, the cause of the original problem, and despite a three week stay, the pain is gradually lessening. She says about 75% better. She can lift the kettle with her left hand. Her groin pain is over. We add some rehab exercises for the hip. A trying case! Normally patients respond faster than this!I don't adjust her neck at every consultation. I believe that too much manipulation, like to many drugs, is not good. But how much is "too-much"? We don't know. She's happy. I should be too! Under construction INITIAL CONSULTATIONMrs M is a 51 years old woman, in good health, apart from severe "the top of my head is going to explode off" headaches of many years duration, significantly worse over the last 6-7 years when she relocated, and had a bad experience with a Chiropractor. Previously chiropractic kept her headaches under control, though they never totally abated. She is on heavy medication for migraine.One year ago insidious left shoulder started with no known cause. Medicine would describe the case as "idiopathic" though subsequent chiropractic examination was interesting... She routinely does her own housework, but no specific injury was recalled.
After a few weeks she consulted her medical doctor who diagnosed a muscle strain, and prescribed anti-inflammatory drugs. Aside: Interestingly, NSAIDS are the most commonly used medical treatment for frozen shoulders but there are no RCTs (the gold standard of research) confirming that antiinflammatories help. It's unscientific treatment. Subsequent corticosteroid injections did not help either and after a month there was zero improvement. X-rays showed an acromial spur and calcium deposits in the tendon and subacromial bursa. A burning pain would radiate into her lower arm and hand periodically. She was not sure which fingers but was fairly sure it did not include the thumb. She was referred to an orthopaedic surgeon who removed the spur and "cleaned out the calcium deposits" and infiltrated the joint with a combination of NSAIDs and cortisone. For 6 weeks the condition was much improved. She was then referred for physiotherapy to build up the muscles. Despite faily gentle and conservative exercise regimen the pain returned and the range of motion became progressively worse. She could not sleep on that shoulder, undressing became very difficult and she couldn't lift her arm above 90 degrees, and reaching her bra strap was quite impossible. A return to the orthopaedic surgeon proved fruitless. "Stop everything and take antiinflammatroy drugs." Despite the medication the arm pain became progressively worse, and stiffer: frozen shoulder. In desperation she decided to try another chiropractor. Bernard Preston!
X-raysX-rays of her left shoulder reveal an old injury - a subluxated AcromioClavicular joint - and at least three calcium deposits in the shoulder.AcromioClavicular Joint ...
EXAMINATION: ARM PAIN Case HistoriesMrs M is a slim woman in apparent good health. Both active and passive flexion and abduction (whether she or I lifted her arm) was severely limited and painful. Internal and especially external rotation were limited, as was extension. Apley's scratch test (reaching for the bra strap) was painfully impossible.Active resisted isometric contractions of the shoulder (without movement) caused severe pain on internal, external rotation. In particular contractions of the Supraspinatus muscle that lifts the arm were very painful. There was a severe active trigger point in the Subscapularis muscle (under the shoulder blade) that caused pain to radiate deep into the shoulder and chest. The Subclavius muscle that rotates the collar-bone was painful. Neurological exam was normal. The Upper Limb Tension Test for a pinched nerve root was negative. Right rotation of the neck caused pain in the Scalene muscles on the left side. The test of Adson was markedly positive with an immediate sessation of the pulse in her left arm when she turned her head and breathed in, a sure sign of the so-called
THORACIC OUTLET SYNDROME ... 
CHIROPRACTIC EXAMINATION: ARM PAIN Case HistoriesThere was a profound fixation of the first rib on the left, the probable underlying cause of the whole syndrome.In addition the fifth rib head was fixated, and the whole rib was tender on palpation, and the attachment at the breastbone was very painful, but only on palpation. An incipient Tietze's syndrome was in the making.
TIETZES SYNDROME ...
Consult 2: REPORT OF FINDINGSI explained in some detail the nature of her condition, what the treatment would be and what she could expect. In particular that the pain would first increase quite likely for a week or two as we stretched the capsule, then would begin to subside within 3-6 weeks. I expect a big improvement with two months, but the range of motion of the shoulder could take a year or more to return.Under medical care, research confirms the following: DIAGNOSIS Early Phase II Frozen Shoulder. In particular, when a new patient is consulting a Chiropractor for the first time, or has obviously had a very different experience of Chiropractic we always give a short outline on the nature of Chiropractic, the importance of the neurological system, and how nerve irritation or impingement can have a profound affect on health.
CONSULTING A CHIROPRACTOR ... CONSULT 3:Mrs M experienced as expected increased pain the next day, but she arrived this morning smiling. The arm pain is 20% less she reported, and the range of motion definitely improved.We followed the same treatment protocol. CONSULT 4:After the last treatment she experienced a disquieting numbness in her whole lower arm and all fingers. No pain. Range of motion continued to improve.COMMENT: As a doctor one is very aware that one is stomping where angels fear to tread. This is a serious condition, severe irritation of both a nerve and an artery, and continous weighing of the treatment options is vital. Happily Adson's test was negative - there was no change in the pulse in her wrist when she turned her head, looked up and breathed in, challenging the structures in the scalene triangle. On this occasion no manipulation of the first rib was done, but the rest of the treatment was as before. CONSULT 5:For the first time, BEFORE THE TREATMENT, external rotation exceeded 90 degrees. Flexion was vastly improved and happily the numb feeling in the lower arm was much improved.However, left lower neck pain had increased, pain she had had for years. Chiropractic adjustment of the C7 facet joint on the right proved difficult, and I chose not to use "brute force and ignorance". Instead we adjusted C7 on the left, using a "spinous-push-manoeuvre" with the usual audible release.
CONSULT 6:Mrs M is extatic - for the first time in over a year she was able to sleep on her left shoulder. She says the pain and disability is at least 50% improved.We added an isometric exercise protocol to be done with "every cup of tea or coffee." Progress!
CONSULT 7: A setback...Mrs M bumped her arm on the mirror of the car giving her shoulder a sharp jolt yesterday. It's very sore again, but the range of motion is still improving. Worryingly her lower arm is aching again. There was no spinal fixation, but the scalene muscles in the neck were in spasm, affecting the nerves and artery in the Scalene Triangle.An aside: Do you know about the 50 percent less pain principle. The pain of many conditions abates faster than the tissue heals.
50 percent less pain is the dangerous time. CONSULT 8: ProgressHave you been to read 50 percent less pain? Go on, it's important, I'll wait for you to return...!The ache in Mrs M's shoulder lasted about three days, and then continued to improve. She says the pain and disability is about 80% less. That's fine for a condition that she's had for over a year... flexion and external rotation are almost normal now, but abduction is still limited to about 100 degrees. We added in a new exercise in which she holds a 500 ml water bottle (half full) in her hand and moves it in and out. As the water reaches the end of the bottle, having to stop suddenly, it gives the shoulder a little jolt. Rehab, that's what it's taking now... CONSULT 9-10Most gratifying progress. Mrs M can raise her arm with pain, though the last bit of abduction is slightly limited. But she has almost no pain. She can sleep through the night without pain, and do most of the chores that every housewife is called upon to do.I give her an exercise device that I make with pulleys and ropes. It's a simple gadget, and yes it's time to do a page so you can make one for yourself. Just a high quality pulley, 2m of rope and couple bits of wood for handle. Time to build another page... and take the photos. Watch this space, it'll happen. Some time! Update: Mrs M brought her daughter in today for another complaint. It's now about three to four months since her initial consultation. She has almost no pain in her shoulder. Passive flexion is very slightly limited, but not painful. Apley's scratch is negative, and she can reach her bra-strap with ease. Internal and external rotation are quite normal. Adson's test is negative, and she has no rib pain. We have a lot of fun in our clinic: she is a firm Baptist by Christian tradition, and waving your arms in the air is definitely Non-U in Baptist circles. She range of motion is virtually normal: I told her she can shout alleluias, and be very charismatic! I'm firmly convinced the rapid resolution of this nasty condition, is adjusting the first rib. Untreated, she could have expected another two years of pain, and 5% don't resolve. Interestingly, her headaches are also very much better. She will now come for a treatment every 6-8 weeks for maintenance. UPDATE: It's now six months, and M has little problems with her shoulder. The neurologist has greatly reduced her headache medication, and is considering dropping them altogether. Mrs M continues to come for a six weeks maintenance treatment. Vital in her case.
SLIPPED DISC IN NECKWithout a doubt a slipped disc in the neck is one of the most serious and difficult cases that cause radiating arm pain. The deep ache in the arm is severe, nights are disturbed, the surgeon can't wait to get his knife in, the doctor his pills, the chiropractor his manipulation skills.You be the judge...
NUTRITIONAL CORNERWhat causes those calcium deposits in the shoulder? Probably old injuries, but so often having started in one shoulder, in a few months the pain begins in the other shoulder. Diet almost certainly has a role to play, and analysis of Mrs M's diet confirms my suspicions.So we are talking about the anti-inflammatory foods like
FISH OIL HEALTH BENEFITS ..,
ARM PAIN Case HistoriesPlease note that Arm pain case histories do not constitute a scientific basis on which to make definite proven conclusions. However, they often do give an inkling...MUSICIANSMusicians have to stand or sit for long periods in unusual postures, placing great strain on the arms, shoulders and midback. This often requires innovative Chiropractic treatment...
USEFUL LINKSFROZEN SHOULDER TREATMENTS - a systematic review of the literature.Return from ARM PAIN CASE HISTORIES to NECK PAIN AND HEADACHE homepage Go from ARM PAIN Case Histories to BERNARD PRESTON home page … MONTHLY NEWSLETTER @ ARM PAIN Case HistoriesChiropractic-Help.com and Bernard-Preston.com send out a joint monthly newsletter. It covers an overview of a health topic (December 2010 issue #19: Retirement Sentiments), always a nutritional corner (such as Mussels, loaded with anti-oxidants), and a piece from Bernard Preston.Sign up at the bottom of any Chiropractic Help Page, for example this one on Pubic Bone Pain , The newsletter is free, and one click cancels it if you find it boring or irrelevant. MONTHLY NEWSLETTERBACK ISSUESIssue #21: Neck Arm pain / Planning the summer vegetable garden Issue #20: 50 percent less pain / Green beans Issue #19: Retirement sentiments / Growing Garbanzo beans Issue #18: Shoulder Pain / A Walk in the Sun Issue #17: Facial Pain / Mussel Facts Issue #16: Obesity in the Chiropractic Clinic / Flax seed Issue #15: Breastbone pain / Broccoli Issue #14: Hip and Groin pain / Statins for lowering cholesterol Issue #13: Can a DC help your Lumbar Facet Syndrome / Strawberries, a wonder food Issue #12: Help Baby Colic Cures 2 / Eggplant for high cholesterol Issue #11: Groin and Thigh Pain / Hummus Issue #10: Friday Fun Stones in my Clog. / Cucumber Issue #09: Friday Fun: Headache Issue #08: Spinal Stenosis/ Celery Issue #07: Root of all Healing / Garbanzo beans /Chickpeas Issue #06: Safety on the Stairs / Ginger Issue #05: Safety in the home / Red foods Issue #04: Whiplash and the Joints of Luschka / Parsley Issue #03: How to stop falling / Danger of a low fat diet Issue #01: Tingling in the arms and hands / Apples (PS. If you find them irrelevant to your needs or an exercise in tedium, one click will UNsubscribe you.) ARM PAIN Case HistoriesDid you find this page useful? Then perhaps forward ARM PAIN Case Histories to a suffering friend. |
