By Adelaide Women's Physio | February 28, 2017
A common condition presenting to our physiotherapists is arm pain. This may include hand pain. We will discuss the reasons for why people experience referred arm pain.
Non-traumatic arm/hand pain.
If there is no specific injury to the arm or hand tissues to explain the arm pain, the neck is the area that needs to be examined by a physiotherapist. Non-traumatic arm/hand pain can be referred from the neck, even when no neck pain or headache is felt.
The cervical spine is that part of the neck comprising of 7 cervical vertebrae. The spinal cord travels through the vertebrae foramen. At each vertebral level a nerve root exits from either side of the spinal cord. The cervical nerve roots join to form various nerves, which supply muscles, joints, skin, blood vessels and other tissues in the neck, shoulder, arm, hand and fingers.
Uncompromised messages running in the nerves enable muscle action, joint movement and sensation to occur normally in the arm and hand.
Irritation of cervical nerve roots from inflammatory chemicals residing in surrounding tissues will cause arm pain.
Some reasons for an inflammatory response could be:
- Muscles are held tight and in a shortened position for lengthy periods
- Cervical joints are stiff because they are not encouraged to move fully in all directions.
Cervical Nerve Root Compression’
The cushion between the upper and lower vertebrae is a cervical disc. When a cervical disc bulges, two situations can arise that create pain or other symptoms in the arm.
Firstly an inflammatory response occurs in the tissues around the bulge that may stimulate pain or other symptoms.
Secondly, the bulging cervical disc may place pressure on the nerve root that exits from either one or several vertebral levels, with pain then being felt in a part or the entire nerve distribution.
Cervical Nerve Entrapment
A third possible reason for referred arm pain arises when joint spaces between cervical vertebrae narrow. Exiting cervical nerves may then be trapped. Osteoarthritis, osteoporosis and cervical spondylosis are often associated with joint degeneration and joint space narrowing. Pain and other symptoms (tingling, numbness, weakness) could then be felt anywhere along the nerve distribution of the arm, hand and/or fingers.
Assessment of the affected arm tissues, cervical spine and shoulder by a skilled physiotherapist is essential.
Selecting the appropriate treatment based on the findings may include:
- Muscle tissue and fascial release
- Joint mobilisation
- Nerve mobilisation
- Decreasing tissue inflammation
- Stretching and strengthening muscles
- Home exercise program to self-maintain