Shoulder, Arm & Hand Pain Caused by the Neck – Lina Englund, Physiotherapist
Many clients who come in for shoulder, arm or hand pain end up getting their neck treated, and of course, many wonder why.
Referred pain from the neck is very common. A bundle of nerves track from the neck out to the very tips of the fingers, and compression anywhere along the nerve path can cause pain in the full distribution of the nerve. The neck joints themselves can also refer pain to the back and shoulders.
There is often a history of neck pain, but it is usually not the primary area of complaint. If you come to the clinic with hand, arm or shoulder pain, your physiotherapist will always do a thorough neck assessment to rule in, or out, referred pain from the neck.
Nerve compression at the C6 level in the neck can show the following symptoms:
- Pain in the back and shoulder area around the shoulder blade
- Pain along the front of the arm
- Pain in the thumb and index finger
- Weakness when bending the arm
- Difficulty turning the forearm to get the palm facing up
- Numbness or tingling in the thumb and index finger
Peripheral Nerve Entrapment
It is possible for a nerve to get compressed anywhere along its distribution and it does not have to involve the neck. An example of that would be carpal tunnel syndrome, where the median nerve is compressed in the carpal tunnel of the wrist.
Double, Triple… Multiple Crush
It is possible for the nerve to be compressed in multiple places, such as; the neck, shoulder, elbow, wrist. A nerve that is compressed at both neck and wrist level is referred to as a double crush syndrome because of its two compression sites.
Due to the complexity of referred pain, it is important that health professionals take their time to do a thorough assessment in order to tailor the most comprehensive treatment plan for each individual.
A treatment plan for the example above may include;
- Manual treatment of the affected neck joints to restore mobility
- Myafascial release of tight muscles that may contribute to compression
- Active and passive neural mobilization to restore length and elasticity and decrease irritability of the neural tissue
- Postural realignment to reduce nerve compression
- Specific strengthening of weak muscles
Take home message: The neck can cause referred pain to many areas of the body and it is important to figure out the root of the problem.
Written by Lina Englund