Arm, Neck, and Shoulder Pain What’s the Diagnosis?
JoAnn came to Caring Medical with a big stack of medical records. The most common diagnosis she carried from all of the doctors she saw was Thoracic Outlet Syndrome. JoAnn exhibited some of the classic symptoms including pain in the arm, neck, and shoulder. She had a tired feeling in her arm, especially doing overhead work. She experienced some numbness in the ring and little finger that would come and go. One of her doctors presented her with the surgery option. She was looking for an alternative!
On initial physical examination in our office, her muscle strength and sensation in the left upper extremity were fine. She presented with classic tender points in the neck, left shoulder, and left medial elbow. I showed her the Hackett-Hemwall-Hauser referral drawings which show how ligaments in the neck refer pain to the head, hands, and fingers. (See Figure 1.)
Figure 1: Hackett-Hemwall-Hauser Ligament Referral Patterns in the head and neck.
By treating these areas with Prolotherapy, we thought we could help her get rid of her pain. Just treating the neck, in my opinion, would produce positive results, though I recommended we treat the neck, shoulder, and elbow.
As many first time patients are, JoAnn was nervous about receiving Prolotherapy, so she decided to start with having her neck treated. When she returned four weeks later for her follow-up appointment, she reported that the neck treatment helped with 10% of her pain complaints. We treated all of the areas on her second visit. This made a major difference in the numbness she was experiencing. Overall she needed a total of seven visits. She is back to full activities and grateful that she can weight lift and do her aerobic classes again.
Thoracic Outlet Syndrome is actual very rare. It is a condition whereby the space at the base of the neck and shoulder (thoracic outlet) is narrowed. This encroaches on blood vessels and nerves. Classically it is caused by an extra rib (cervical rib). The condition does exist but it is quite rare. Most of the patients we see at Caring Medical have thoracic outlet “symptoms,” but actually have injury to ligaments and tendons that are causing the localized and referred pain, not the actual syndrome.
Let’s look at JoAnn’s case. Ligaments at the base of the neck can refer pain into the shoulder, down the arm, and into the fingers. Ligament injury and rotator cuff tendon injury can also produce pain that may refer to other areas when you perform overhead activities. The numbness in the ring and little finger can come from ligaments in the base of the neck or the ulnar collateral ligament in the elbow. JoAnn received Prolotherapy to all of these structures with subsequent abatement of her symptoms.
The take home message here is if you or a loved one has been diagnosed with Thoracic Outlet Syndrome and you would like some treatment options, visit an experienced Prolotherapy doctor. Prolotherapy is a great alternative treatment for Thoracic Outlet symptoms!