Hello! Welcome to the first of many blog posts about pain, it's causes, and ways we treat it in my practice. My hope is that this blog will help patients learn more about their conditions and steps that they can take to self-manage so they can live full and healthy lives.
For our first topic, we're going to talk about neck and arm pain.
To start, let's consider what can cause your neck and arm pain:
This list is not exhaustive but will require multiple posts to cover all numbered items. I will, over subsequent posts, discuss each topic. I will discuss cause, symptoms, diagnosis, treatments, self-management.
So, let’s begin.
Anatomy
The anatomy of the neck and shoulder is complex. There are bones, ligaments, muscles, fascia, skin in addition to blood vessels and nerves.
The neck contains 7 vertebrae. (For completeness, the spine has the skull/or cranial bones, 7 cervical bones, 12 thoracic bones, 5 lumbar bones, the sacrum and the coccyx.)
The spine bones, or vertebrae, have a shape a little like the Star ship Enterprise, from Star Trek. There is a round front part, called the body, and a ring off the body with 3 knobs or wings off the body.
For our first topic, we're going to talk about neck and arm pain.
To start, let's consider what can cause your neck and arm pain:
- Radiculopathy
- Cervical Facet Syndrome
- Muscle strain/sprain and trigger points
- Thoracic Outlet Syndrome
- Referred pain from elsewhere
- Other causes
This list is not exhaustive but will require multiple posts to cover all numbered items. I will, over subsequent posts, discuss each topic. I will discuss cause, symptoms, diagnosis, treatments, self-management.
So, let’s begin.
Anatomy
The anatomy of the neck and shoulder is complex. There are bones, ligaments, muscles, fascia, skin in addition to blood vessels and nerves.
The neck contains 7 vertebrae. (For completeness, the spine has the skull/or cranial bones, 7 cervical bones, 12 thoracic bones, 5 lumbar bones, the sacrum and the coccyx.)
The spine bones, or vertebrae, have a shape a little like the Star ship Enterprise, from Star Trek. There is a round front part, called the body, and a ring off the body with 3 knobs or wings off the body.
These are called “processes”- 2 transverse processes and a spinous process. Remember that I am writing in general terms. The vertebrae have different appearances depending on their level in the spine.
The body has a “joint” with the vertebra above and below. The ring has joints with vertebra above and below through 2 facets on each side of the ring (a total of 4 facets on each ring). The ring itself has different parts that have variable shapes, depending on the level, but in general has 2 pedicles and 2 laminas. The pedicles are immediately off the body and the laminas are between the facet joints and spinous process.
Attached to the spine are various ligaments that strengthen the spine. There are also muscles attached to various points of the spine. In addition, there is connective tissue, called the fascia, that wraps around the bones and muscles. The ligaments, muscles and fascia together are identified as “soft tissue” as opposed to bone which could be called “hard tissue” (although we do not do so), and theses soft tissue allow us to bend, twist, etc. without falling apart!
Unfortunately, in addition to developing arthritis in the joints of the spine, (the same as in you can in knees, hips, fingers), you can develop problems with the “soft tissues” such as sprains and strains (which are degrees of the same), tears, etc. The arthritic or degenerative change that is seen can be along the ligament attachments to the bone as well as in the facet joints. All these tissues and attachments can be areas where pain can arise.
Because there are so many parts in the spine, it is difficult to diagnose problems. X-rays, CAT Scans, MRI’s give us good information, but current technology often does not allow us to be exact in our diagnosis, which is in part why there are so many people with pain that doctors can’t completely treat.
In my next post I will begin to discuss the individual parts in more detail.
- DKP
The body has a “joint” with the vertebra above and below. The ring has joints with vertebra above and below through 2 facets on each side of the ring (a total of 4 facets on each ring). The ring itself has different parts that have variable shapes, depending on the level, but in general has 2 pedicles and 2 laminas. The pedicles are immediately off the body and the laminas are between the facet joints and spinous process.
Attached to the spine are various ligaments that strengthen the spine. There are also muscles attached to various points of the spine. In addition, there is connective tissue, called the fascia, that wraps around the bones and muscles. The ligaments, muscles and fascia together are identified as “soft tissue” as opposed to bone which could be called “hard tissue” (although we do not do so), and theses soft tissue allow us to bend, twist, etc. without falling apart!
Unfortunately, in addition to developing arthritis in the joints of the spine, (the same as in you can in knees, hips, fingers), you can develop problems with the “soft tissues” such as sprains and strains (which are degrees of the same), tears, etc. The arthritic or degenerative change that is seen can be along the ligament attachments to the bone as well as in the facet joints. All these tissues and attachments can be areas where pain can arise.
Because there are so many parts in the spine, it is difficult to diagnose problems. X-rays, CAT Scans, MRI’s give us good information, but current technology often does not allow us to be exact in our diagnosis, which is in part why there are so many people with pain that doctors can’t completely treat.
In my next post I will begin to discuss the individual parts in more detail.
- DKP