Video of a MRI of your Neck

In the above video by chiropractor and medical doctor, Dr Donald Corenman , Donald talks about the MRI done on a patient with a right arm pain. In this case a pinched spinal nerve root was the cause of the arm pain.

MRI stands for magnetic resonance imaging and is a very detailed scan done by doctors to see the nerves and spinal discs in more detail than an x-ray.

Pinched nerves in your neck can also be called a cervical radiculopathy and do not have to cause lots of neck pain as well as the arm pain. This patient had no spinal cord compression from a herniated or bulging disc, which could cause a condition called myelopathy. Instead it was bony spurs (a.k.a. osteophytes) that were the cause of the nerve pain.

The bony spurs are a sign of osteoarthritis of the spine and degenerative changes in the disc (a.k.a. degenerative disc disease). The uncovertebral joints of the cervical spine are usually involved. The MRI example showed this patient with these extra bony growths at their C5-6-7 spinal levels. So they could have an irritation to both the right C6 and C7 nerve roots coming out of their necks. This could cause the nerve pain.

So the key points for you if you are looking at your cervical MRI scans and the video example are that:

1. Spinal nerve roots  have small spaces to exit either side of the spine.
2. This is an example of a compressed right C7 nerve root.
3. Neck disc bulges are not always the cause of pain.
4. Degenerative bony spurs can pinch the nerve.
5. MRI scans are the best to see spinal discs and nerve roots.

Have you had an MRI scan of your neck done and been told that you have compressed nerve? Well I hope this video helped clear up some of your questions. In the meantime here are some self-help tips for trapped nerve neck pain relief you could read.

Bakody’s Sign

Bakody’s sign is an orthopaedic test. Bakody’s sign is noted in the physical examination by health practitioners, like chiropractors, that a patient feels better when the place the painful arm in the bakody’s sign position.

So the bakody’s sign is actually an test used to screen for cervical radiculopathy. It is thought that a positive bakody’s sign is when a patient feels relief of the arm pain when in the bakody’s sign position.

What Does Bakody’s Look Like?

So if you are wondering what the bakody’s sign position looks like then have a look at the picture on the left:

It is when you lift the painful arm on top of your head.

It is as simple as that!

The process is that a trapped nerve coming out your cervical spine will be under tension. Especially when your arm is hanging by your side. So to take the pressure off the spinal nerve think of it like a rope. To take the slack (tension) out of the rope you would lift it up.

I hope this helps clarify the bakody’s sign for you. If you do have a pinched nerve causing a painful radiculopathy in your arm, I hope it may give you some pain relief when you don’t know what to do to get some rest.

First what chemical can cause the neuropathic pain? First we must look at Reactive oxygen species (ROS).

Reactive Oxygen Species (ROS)

What is Reactive Oxygen Species? Reactive oxygen species are free radicals produced in biological systems that are involved in various degenerative brain diseases ¹. So it has been found that these reactive oxygen species free radicals can cause problems in the nervous system. These free radicals are normally produced with no problems, but there are times that they might contribute to neuropathic pain.

Vitamin C Helps Neuropathic Pain

Vitamin C is an anti-oxidant. This means it lowers the amount of free radicals produced from oxidation, like the reactive oxygen species. A recent study² looked into the supposed help vitamin C could have in lowering neuropathic pain. The study looked at postherpetic neuralgia patients and normal healthy patients vitamin C levels in the plasma of their blood.

What was found is that healthy individuals have a much higher level of plasma vitamin C than the neuralgia patients. The researchers gave both healthy and neuralgia patients 3 separate saline intravenous drips with or without the anti-oxidant, vitamin C. What they found is what was is interesting for the neuropathic pain patients.

The neuropathic pain patients Vitamin C levels returned to normal and their percieved level of spontaneous pain improved. So the study concluded that vitamin C plasma levels play a role in PostHerpetic Neuralgia, & that intravenous vitamin C helps relieve spontaneous pain in these neuropathic pain patients.

Your Trapped Nerve Pain Relief Diet

This finding may in the future be of help to people suffering a trapped nerve in their necks or trapped nerve in the lower back. Your diet affects your nutrition status. What you eat is important for your pain levels. It would look like people suffering trapped nerve neuropathic pain may have poorer levels of the good vitamins and minerals in their bodies.

Earlier this year scientists also looked at omega-3 fish oils supplements.These case studies also found increasing omega-3 fish oils in your diet can help neuropathic pain and other musculoskeletal conditions.

Now it would seem something as simple as getting your vitamin C levels in your blood right and back on track are another important for natural trapped nerve pain relief technique.

I guess what we can all learn again is that a healthy, balanced diet is important for your health. If you are suffering a neuropathic pain condition then not only should you look at the pharmaceutical drug solution, but make sure you are eating properly and taking supplements, if needed. Have you found vitamin C helped your neuropathic pain levels, let me know with a comment below.

References:

1. Kim HK, Park SK, Zhou JL et al. Reactive oxygen species (ROS) play an important role in a rat model of neuropathic pain. Pain. 2004 Sep;111(1-2):116-24.
2. Chen JY, Chang CY, Feng PH, et al. Plasma vitamin C is lower in postherpetic neuralgia patients and administration of vitamin C reduces spontaneous pain but not brush-evoked pain. Clin J Pain. 2009 Sep;25(7):562-9.

Photo by: Kevin Wong

History of De Quervain Tenosynovitis

Swiss surgeon, Fritz de Quervain, in 1895 published 5 case reports of his patients with wrist pain. The paper was called “On A Form Of Chronic Tendovaginitis”. He found that they had a tender, thickened first dorsal compartment at the wrist. It was from this paper the musculoskeletal wrist condition was subsequently named, De Quervain tenosynovitis.

A funny fact is Dr. de Quervain credits another doctor, Dr. Kocher, with the first description of the wrist pain condition and its first surgical treatment ¹. However, Dr. de Quervain is the famous one.

De Quervian’s is also referred to, by some, as De Quervian’s Disease, De Quervian’s Tendonitis, De Quervian’s Stenosing Tendovaginitis & De Quervian’s Syndrome

Anatomy of De Quervain’s

So what anatomy in your body is causing this wrist pain. The two culprits are the tendons of the abductor pollicis longus (APL) and the extensor pollicis brevis(EPB) muscles.

So the APL and EPB tendon sheaths become inflammed and cause the pain over the area of the wrist called the first dorsal compartment. It is called the first dorsal because your thumb is the numbered as the first finger on your hand. It is very close to the anatomical “snuff box”.

A septum separating the first dorsal compartment into distinct sub-compartments for the abductor pollicis longus tendons and the extensor pollicis brevis tendon is often noted at surgery.

Tenosynovitis?

The first thing you are probably wondering is what is a tenosynovitis?

De Quervian’s Tenosynovitis is an inflammation of the synovium of the tendon sheath. The synovium is a lining of the sheath that protects and covers the tendons. So again, the cause of the Tenosynovitis is inflammation. The source of the inflammation is likely to be unknown, or it can be a result of repetitive strain injury (overuse), trauma or an infection. Most cases of de Quervain’s Tenosynovitis are idiopathic (unknown cause).

The tendon is inside of the tendon sheath. So De Quervian’s is not a tendonitis. This means in medical terms it should not really be called De Quervian’s Tendonitis.

By definition a tendonitis is symptomatic degeneration of the tendon with vascular disruption due to a partial rupture of the fibers. This is not the case with De Quervian’s Tenosynovitis.

Symptoms of De Quervain’s

The main symptom of de Quervain’s Tenosynovitis is pain. The pain would be over the wrist at the base of the thumb. Sometimes another symptom of a chronic de Quervain’s tenosynovitis is that the first dorsal compartment, over the radial styloid, becomes thickened and can be seen as a raised bump.

Patients may explain it as being very sore to pick things up, excruciating pain trying to lift a coffee cup, cannot pinch fingers together or a deep ache at the base of their thumbs etc…

Causes of De Quervain’s

As mentioned earlier, it is usually unknown why de Quervain’s Tenosynovitis starts. It has been found that mothers of infants aged 6-12 months tend to complain of the wrist pain condition. The pain for these mothers can be in both wrists. This is most likely due to the repetitive lifting of the child, which is getting heavier with age.

Anyone who has had a direct hit or trauma blow to the first dorsal compartment of the wrist may also develop the wrist pain condition.

Test for De Quervain’s

The main way to test for de Quervain’s is an orthopaedic test called Finkelstein’s Test, which you can see in the video below. Other than that the story you tell the chiropractor or doctor helps. Occasionally an x-ray if an arthritis or fracture is suspected.

De Quervain’s Surgery/Injection/Treatment Videos

So you have consulted an orthopaedic surgeon and they suggested either having a cortisone injection or the de Quervain’s surgery or maybe even using a wrist splint. You might be interested in the following videos below.

The first de Quervain’s video is a very basic patient information video with cartoon graphics what de Quervain’s surgery would be like. The second video shows you the orthopaedic test called “Finkelstein’s Test” used to diagnose de Quervain’s tenosynovitis. The third video goes through an actual surgery on the abductor pollicis longus tendons and the extensor pollicis brevis tendon sheath. The fourth video is by Gary Moller talking about natural ways to try help and treat de Quervain’s tenosynovitis. The last is the wikipedia entry about de Quervain’s tenosynovitis.

De Quervain’s Self-Help Treatment

Some basic things you could do to help the pain are:

• Avoiding repetitive thumb movements, whenever possible,
• Avoiding pinching with your thumb and another finger together when moving your wrist from side to side,
• Use a cold pack over the pain area,
• Massaging the muscle to unload the tendons,
• Using cross-friction moves over the adhesions (caution),
• Speaking with your GP about using nonsteroidal anti-inflammatory drugs

A tendon takes longer to heal than a muscle. So you could expect to wait several weeks to try get the wrist pain to calm down naturally. If you are worried get an opinion from your chiropractor or doctor to see if it is a case of de Quervian’s disease.

Hopefully you enjoyed learning a bit more today about De Quervian’s Tenosynovitis and if you are suffering from this wrist pain condition I hope you get some relief soon. If you found anything else helpful for treating De Quervian’s Tenosynovitis please leave a comment I would love to know your thoughts.

Reference:

1. de Quervain F. “On a form of chronic tendovaginitis by Dr. Fritz de Quervain in la Chaux-de-Fonds. 1895.” Am J Orthop. 1997 Sep;26(9):641-4.

First I think you should know a bit of the general anatomy of the area concerned.

The area of the back (spine) between the two shoulder baldes is called the thoracic spine. The shoulder baldes are called scapula. The major muscles are the rhomboids (major/minor), trapezius, levator scapula, infraspinatus and supraspinatus.

So looking at the picture above of the mid and upper-back and the muscles can you see where your shoulder blade pain could be. I hope it helps you visualise your mid and upper-back better.

Symptoms of Pain Between the Shoulder Blades

As I mentioned earlier there are many times a person will come into the chiropractic clinic because of this pain they cannot get rid of between their shoulder blades. This is what I might hear:

1. It’s sore to take a deep breath
2. I need to push my shoulder into the corner of the wall to get some relief
3. The pain is a deep ache
4. I can’t put my chin to my chest now
5. It is sore to stretch between my shoulder blades
6. I want to twist my shoulders to try get a click for relief

Does this sound familiar at all? These are just some of the typical things I hear people say to me.

What Causes Shoulder Blade Pain

This is the next question you want answered. Well these are some of the normal mechanical causes and the more serious causes of thoracic pain.

1.Mechanical Back Pain

1. Rib Dysfunction
   You have twelve ribs either side of your thoracic spine. The ribs move like a bucket handle going up and down with breathing. There are times the movement of the rib head on the vertebral body can cause pain. I usually find the 3rd and 4th ribs are the most painful.
2. Muscle Trigger Point
   A trigger point is basically a muscle knot. These trigger points in one of the upper back muscles, especially the levator scapulae, I find to be a problem. This is when you want people to rub your shoulders or you try get something to push into your shoulder blade area. Trigger points can also cause referred pain, which could create pain in other places. Here is a picture of some trigger points in the shoulder blade and neck area muscles.
   
3. Thoracic Dysfunction
   The spinal joints (facets) can, like the ribs, move causing pain between the shoulder blades. You may have heard your chiropractor mention a condition called T4 syndrome. I find that a lot of people have tenderness over the T4 vertebrae region. I think this is because we tend to slump our shoulders through this area of the thoracic spine.
4. Trapped Nerve Pain
   A trapped nerve in your neck can also cause pain between the shoulder blades. I have written more about trapped nerve pain in the shoulder and neck which you can read also.

Chiropractor Assessing Thoracic Spine

You can watch the video below of a chiropractor performing a basic mechanical assessment of the middle back.

2. Serious Causes of Shoulder Blade Pain

There are times when you can get an organ in your body causing the pain. This is called visceral pain and is a referred pain from an organ like your liver, gall bladder, stomach, spleen, lungs, or pericardial sac. You could also have shingles starting. You can see a picture of where different organs can send pain.
If you want to find out more you could read medical student Brad’s post about referred organ pain.

Pain Between Shoulder Blades Relief

So now you know what some of the symptoms and causes of pain around your shoulder blades. Now lets look at some of the things you could do to get relief from your shoulder blade pain.

1. See a Chiropractor or Doctor
   As you may have read there are times a back pain can be coming from a more serious cause. If you are worried it is easy to have a health professional help you out. You can find a UK chiropractor here.
2. Heat
   This is a simple self-treatment. Using a microwaveable wheat bag, hot water bottle or an warm moist towel apply the heat to the painful muscle to try relax the muscle knot.
3. Massage
   Using a massage machine you could try use the massager to try relax any muscular tension in the area. You could also see a massage therapist for a deep tissue massage.
4. Cat Stretch
   This is when you  slowly try round your shoulders as much as you can whilst pushing your spine backwards to get a stretch between the shoulder blades. Sometimes this is easier when you are warm like after a shower or bath. You can see the video below of the cat stretch.
5. Good Night Sleep
   It is amazing how a good nights sleep can help the body to heal itself. So try get a good nights sleep to see if that helps the pain.
6. Gentle Exercise
   Sometimes poor posture for too long causes the muscle knots and irritated rib or spinal joints. So if you have been doing lots of desk work or computer work then try go do some gentle exercise to see if it can help stimulate your posture.
7. Thoracic Spine Mobilisation
   You can watch the videos below where you can see using a foam roller and thoracic spine movement with breathing to try get some pain between the shoulder blades relief.
   

I hope this helps you understand pain between the shoulders blades a bit better. The above self-help list is not meant to be exhaustive but it is something very simple for you to try if you wish.