By Jerry Moczerniuk PT, DPT
Cervical spine symptoms can vary greatly in humans. Symptoms can be focal, localized primarily to the neck. They can also be peripheral, extending farther away from the spine to the arms and legs, and may even affect balance. Most times the pain of cervical radiculopathy, or nerve root entrapment/compression starts at the neck and travels down the arm in the areas served by the affected nerve. Radiating pain into the upper limb happens to be the most common symptom of nerve entrapment in the neck. Most often patients report pain in the shoulder blade and upper arm, but the symptoms can extend farther. Other fairly common symptoms are numbness and tingling in the arm, and even weakness in the hand, elbow and shoulder.
My nearly 10 years of practice has allowed me to work with many patients with multitude of symptoms and ailments. My experience has been extremely valuable in allowing me to understand how very complex our bodies really are. The most complicated and intriguing relationship to me has been that of the cervical spine (neck) and its effect on the shoulders, arms and hands. This is a relationship that has been proven to exist. At times however the relationship is not that clear symptomatically, and clinicians must rely on clues from patient history and a thorough physical exam to help better determine the origin of the symptoms. Differentiating whether the symptoms are orthopedic in nature or cervicogenic (coming from the neck) is crucial.
I can recall multiple cases in my practice in which a client came in with what seemed to be purely orthopedic symptoms; however the symptoms were coming from the neck. In two specific instances the patients were medically diagnosed with tennis elbow. The patient history, however, was lacking physical reasoning (repetitive overuse in athletic or job related activities), and the symptoms were present in the non-dominant hand. In fact, in both of those instances the patients had some symptoms in both forearms and both hands. Physical examination revealed orthopedic symptoms mimicking tennis elbow, however physical correlation was lacking.
Another particular case involved an individual diagnosed with trigger fingers and bilateral carpal tunnel syndrome. Just like in the previous cases mentioned there was very little history suggestive of those conditions. In all of those cases, a thorough cervical spine evaluation in our practice revealed a reproduction of symptoms with movement of the neck and special tests implicating the cervical spine. Due to physical findings and clinical symptom correlation we focused our time on treatment of the neck, rather than the orthopedic symptoms. This approach has been successful in treating symptoms of cervical radiculopathy, reducing and often completely abolishing symptoms. The key to treatment however remains proper and accurate identification of symptom origin.
Physical therapy should be considered as primary option for treatment of upper extremity pain. The scope of a physical therapist (PTs) practice allows PTs in New Jersey to see patients without a referral, examine them thoroughly, identify musculoskeletal vs non-muskuloskeletal origin of symptoms, and develop a plan of care (treatment) to improve function, decrease pain, regain mobility, and most importantly improve the patients quality of life. These services are typically covered by health insurance, even without a prescription for PT.
Dr. Moczerniuk is a Doctor of Physical Therapy, member of American Physical Therapy Association, and a clinical director at db Orthopedic Physical Therapy of Manalapan, located at 120 Craig Road, Suite 2. Dr. Moczerniuk can be reached at 732-462-2162 or via email at Jerry@dborthopt.com. You can also find out more at dborthopt.com.