Expert: Scott F. Gillman, DC, DACBSP - 2/27/2011

Question
Around November of last year (around the same time I got my flu shot) I began experiencing sharp, searing pain in my left shoulder that radiates down the upper arm to the elbow.  The pain is deep....almost too deep to be a muscle because massage doesn't seem to help....and I only get it when I raise my arm a certain way or reach for something just a certain way and it only goes away when I let my arm hang limply at my side for several minutes.  And I am unable to sleep on my left side because any pressure on the upper arm caused by laying in that position causes it to start aching.  I have not fallen, dislocated and relocated my shoulder, done anything to pull a muscle or injure it in any way.  I have been having some issues with the vertebrae in my neck (specifically C7 and 8) going out of alignment every few days which causes the muscles in my neck, shoulder and upper back to get all knotted up resulting in a migraine headache and my chiropractor has been working with me on that....but otherwise I haven't stressed any muscles out or injured them.  These are my questions. (which my chiropractor can't answer (won't answer).

1. How do you test for a pinched nerve?
2. Does this sound like a pinched nerve?
3. If yes to question #2....could it somehow be related to my issues with my neck?
4. If no to question #3...since I haven't injured myself...how could the nerve have gotten pinched?
5. If yes to #2....what can be done to fix the problem?

Oh....and I am 59 years old and I suffer from asthma and C.F.I.D.S.

Answer
Hi Candy,

Your excellent description of symptoms clearly points to a diagnosis of nerve root impingement.  The spinal cord makes nerves that branch off of it and exit out of canals that the neck vertebra form.  These canals are called "foramen."   The "root" of the nerve lies in the foramen.  The nerve, therefore, attaches from the spinal cord, exits the foramen, and then tunnels its way down your shoulder and arm to the hand, making attachments near the end of its path.   Some nerves go to the lateral side of the arm to the thumb and index finger, while others go to the inside of your arm and along the pinkey (for example).  With these attachment points, cord and hand/arm, when you lift your arm you make the nerve a little slack, taking pressure off of it.  If you put your arm down and behind you, it stretches the nerve.  If you have a herniated/protruded disc in your neck, it will often touch against the nerve root.  Go and google "cervical spine nerve anatomy" to see these structures (here's one: http://catalog.nucleusinc.com/generateexhibit.php?ID=5116).   So to test for a pinched nerve, the chiropractor should turn your head and extent it, then press down on your head/neck to compress the foramina.  If you have a disc herniation or any compromise to the nerve, then likely this will duplicate your symptoms.  Also, pulling your arm back behind you in various ways tensions the nerves, and any duplication of symptoms is a sign that something is against the nerve in some way.  Also, if you have significant impingement to the nerve, you will lose some of the strength of to the muscles the nerve directly connects to, e.g. biceps, triceps, finger flexors, or thumb pinch muscles.  All doctors, including doctors of chiropractic, are supposed to go through all these tests to determine if you have nerve root compromise or not. If so, then the severity must be assessed.  If your examination points towards nerve irritation but not compromise (e.g. compression of the nerve in the foramen), then you simply can try various treatments.  Home cervical traction is one that can be helpful, as well as manual tractioning in the chiropractor's office.  Joint manipulation for some folks with nerve root irritation can make it worse, and for others better.  You have to find out (but it sounds like you have).  If there are signs of nerve compromise, e.g. the cervical disc is herniated and pushing up against the nerve and you are losing some of your strengths or reflexes, then MRI is the standard to diagnose your condition.    Keep in mind that spinal discs can degenerate and bulge just from age.  They also can be developed from mechanical strains over time.  You are asthmatic so likely you have tight neck muscles and a forward head posture (each putting strain on your discs);  There is a genetic component, too, and folks that have parents with arthritic joints will also likely have arthritic joints, including arthritic neck joints.  The degenerative changes of arthritic joints often included bulging and herniating of discs as well as bone spur formation around the vertebra.   If there is spur formation anywhere near the foramen, then the nerve gets poked by the bone spurs.   We often see a "disc/spur complex" on MRI, where there is a combination of disc bulging and spur formation that surrounds the foramen such that the nerve loses its roomy canal space and is up against the disc and also the spurs.  For some folks, they try an "epidural steroid injection" into the canal area to try to unirritate the tissues.  Others get surgery to remove the disc bulge.   This is another topic...   If you have no signs of direct nerve compromise, then you need to avoid surgery.   If the chiropractor cannot provide a VARIETY of treatment options, and only just "cracks" your neck, then you are in the wrong place: find a new chiropractor.   My last thought, regarding CFIDS is to be sure that you are not vitamin-D (D3) deficient.  If you are D3 deficient you will have a issues with CFIDS (go to www.vitamindcouncil.org to learn about this);  

'Hope this was helpful.

Dr. G'