Uninhibited and pain free movement in the shoulders, arms, and hands is something we all too often take for granted. We rely on our upper extremities for everything, but that blithe reliance can work against us in cases of nerve damage and neuropathy. Here at Grant Chiropractic, we are happy to help those suffering from brachial plexus neuropathy. Dr. Grant can treat patients with the condition whether it is the result of an accident or a chronic concern.

What Is Brachial Plexus Neuropathy?

Brachial plexus neuropathy is a form of peripheral neuropathy that occurs when the brachial plexus is damaged. The brachial plexus is a network of nerves that provides sensation and movement to the shoulder, arms, and hands. Any damage to that network can limit movement, minimize feeling in the arm and shoulder, and inspire pain.

Symptoms

The most common symptom of brachial plexus neuropathy is numbness in the affected region (shoulders, arms, or hands). Along that same line, the upper extremities can experience debilitating weakness. In more extreme cases, the numbness may be replaced with pain that feels like tingling or burning. Patients may also feel abnormal sensations in the shoulders, arms, wrists, or hands. 

Causes

Brachial plexus neuropathy is generally caused by one of two issues: a herniated cervical disc in the neck or thoracic outlet syndrome.

Herniated Cervical Disc

The spine is made up of bones (vertebrae) and the rubbery cushions (disks) that sit between them. These discs have been compared to jelly donuts. The exterior, the annulus, is similar to a tough rubber, supporting the vertebrae and keeping them from scraping against each other. The interior, the nucleus, is much more pliable, often compared to jelly.

A herniated disc (also called slipped or ruptured discs) occurs when the nucleus pushes through a tear in the annulus. When this happens, the disc often puts unnatural pressure on the spinal cord, causing neuropathy. While herniated discs happen most frequently in the low back, they can happen anywhere along the spine. The cervical discs are in the neck and chiefly affect the shoulders and arms.

Thoracic Outlet Syndrome

The term thoracic outlet syndrome (TOS) describes a group of disorders that occur when the nerves or blood vessels between the collarbone and first rib (the thoracic outlet) are compressed. Thoracic outlet syndrome is often the result of an injury, perhaps sustained on the field or in an auto accident. It can also be caused by congenital conditions—such as having an extra rib—and pregnancy. In some cases, the cause of the condition may be unknown. 

Because the nerves in cases of thoracic outlet syndrome are compressed, affected patients may suffer from neuropathy of the brachial plexus or other areas.

Diagnosing

Neuropathy of the brachial plexus can be diagnosed through clinical examination and tests, including ultrasound, chest x-ray, and MRI of the head, neck, and shoulder. However, sometimes a simple examination of the arm, hand, and wrist can reveal a problem with brachial plexus nerves without all the fuss. 

Treating Brachial Plexus Neuropathy

Fortunately, the prognosis for neuropathy patients is generally promising, especially if the condition is identified and treated early on. If the underlying cause is not identified or treated in time, the result may be prolonged nerve pain and partial or complete loss of movement or sensation. Patients should seek help as soon as they experience symptoms.

The treatment for brachial plexus neuropathy is most effective when it is geared toward treating the underlying cause of the condition. Occasionally the problem will resolve itself on its own, though it is wise to seek professional help. A general practitioner is likely to recommend braces, splints, physical therapy, or even surgery in addition to prescribing pain medication. A chiropractor, on the other hand, will have effective natural strategies that get to the root of the issue.

Neuropathy Caused by Herniated Disc

Those suffering from brachial plexus neuropathy caused by a slipped disc will find that chiropractic care is the best solution. A chiropractor can deliver spinal adjustments and decompression services that help restore the disc to its proper position and relieve the pain caused by misalignment. Such procedures are mechanical, delivered either by chiropractic instrument or by the chiropractor’s hands, and nonsurgical. This means that they are safer and that the initial relief is essentially instantaneous instead of waiting months for recovery.

Electrical stimulation, functional stretching, and trigger point myofascial release are also highly effective methods for relieving neuropathy pain. As a doctor of the spine, a chiropractor helps patients take care of their bodies to avoid further injury in the future.

Neuropathy Caused by Thoracic Outlet Syndrome

If your brachial plexus neuropathy is the result of thoracic outlet syndrome, chiropractic adjustment can provide relief. The process is natural, simple, and straightforward, and the result is restoring the skeleton to its proper alignment, again protecting the brachial plexus. A chiropractor is also likely to recommend stretching and myofascial release of the anterior scalene muscles.

Shoulder injuries are no laughing matter. They can seriously inhibit daily activities and lead to a lot of pain besides. Chiropractic care for shoulders is the best way to avoid pain and keep yourself healthy and strong.

Chiropractic for Shoulders

While many people think that chiropractors only treat the spine, the truth of the matter is that chiropractors have a keen understanding of both the skeletal and nervous systems and can provide relief to other areas of the body. 

The shoulder is the body’s largest joint and is very complicated. This allows it to provide such a wide range of motion. Shoulder injuries are common because the joint is so intricate and is put to such frequent use. They often follow sports or other athletic activity, vehicular accidents, and even sitting at a desk.

Shoulder pain can seriously disrupt your daily quality of life, and you do not simply have to grin and bear it. Chiropractic care can correct shoulder injuries naturally without the need for surgery

What Shoulder Injuries Do Chiropractors Treat?

Shoulder injuries manifest in many different ways, but these are some of the most common:

• Frozen shoulder—Technically termed adhesive capsulitis, frozen shoulder results in thickened and tightened connective tissue near the shoulder joint. Frozen shoulder commonly occurs after shoulder injuries and limits the joint’s range of motion. 
• Arthritis—Arthritis is a common condition in adults, with a recent conservative estimate indicating 54 million cases in the United States. The symptoms are inflammation and joint pain. Some strains of arthritis, i.e. rheumatoid arthritis, are the result of autoimmune disorders, while others like osteoarthritis follow common wear and tear.
• Tendonitis—Tendonitis of the shoulder leads to irritation and inflammation in the rotator cuff tendons or biceps. Tendonitis most commonly affects those whose work includes repetitive motions, not excluding practicing athletes. Tendon injuries are notoriously painful and slow to heal.
• Bursitis—The bursa is a fluid-filled sac which is designed to protect the tendons. Inflammation or irritation of the bursa is referred to as bursitis. It can result in pain and serious restriction of the shoulder joint and can even be a precursor for frozen shoulder.
• Pinched nerve—Pressure on the nerves in the neck or shoulder (perhaps as the result of another condition) can lead to pain, numbness, and tingling in the upper extremities.
• Rotator cuff injuries—The rotator cuff is a group of muscles and tendons that surround the shoulder joint, attaching the humerus to the shoulder blade and facilitating the lift and rotation of the arm. Injuries to the rotator cuff include everything from mild irritation to sprains to serious tears. The injury can come on gradually with regular wear and tear or result from a trauma like the collision of a vehicle or another athlete.
• Dislocation—Dislocated joints can follow heavy impacts. When the dislocation is in the shoulder, the humerus pops out of the glenoid cavity. The subsequent pain is sharp, and if the nerves are pinched in the impact, numbness may follow. An AC joint subluxation describes a partial dislocation of the shoulder. Once a bone becomes dislocated, the risk of future dislocation is significantly higher. 

How Does a Chiropractor Fix Shoulder Pain?

Once a chiropractor has determined the source of shoulder pain, then it is time to get to work. A chiropractor understands that shoulder injuries often stem from other physiological issues, even in other locations like the spine. Damage to the neck or even rib cage can lead to pain or discomfort around or in the shoulder. A chiropractor treats the body like the interconnected system that it is, offering holistic relief. 

A chiropractor focuses on overall wellness, not just relieving pain. If pain in the shoulder is caused by misalignment to the spine or neck, perhaps the result of a car accident, your chiropractor can adjust the alignment, restoring proper nerve, skeletal, and muscular function for overall relief. 

This holistic approach is well-understood to be effective. A study conducted in 2012 indicated that chiropractic treatment for frozen shoulder yielded 82% complete recovery. Our Dr. Grant can restore up to a 10 degree improvement in range of motion with just one visit.

Consulting a chiropractor for shoulder injuries has the added benefit of professional and individual strategies for strengthening the joint for the future. A chiropractor will never rattle off a list of pain medications and send you out the door. When you work with a chiropractor regularly, you can strengthen your shoulders and spine, reducing your risk of injury in the future. 

How to Avoid Shoulder Pain

While it is impossible to plan for every shoulder pain contingency, you can minimize your risk of further damage by strengthening your shoulders and improving their flexibility. Neck release stretches can keep your shoulder muscles and ligaments loose while regulated lifting exercises can strengthen them. Work with your chiropractor to find the best exercises and stretches for you.

Last month, we discussed the details of traumatic brain injuries and sports-related concussion (SRC). The topic is one of great import among physicians, and a regular conference is held in Berlin to examine the most current research and come to conclusions. The Berlin Consensus has given “11 R’s of SRC Management,” and here we explore each of them in greater depth.

Recognize

The first step of SRC management is to recognize the problem. Unfortunately, there is no perfect diagnostic test for immediate diagnosis of concussion in sporting environments. Most sports related concussions do not present frank neurological signs, and it can be difficult to recognize concussion immediately after an inciting event. 

To recognize SRC, we must first clarify that it is often defined as the representation of immediate and transient symptoms of traumatic brain injury (TBI). Unfortunately, this definition can only take physicians so far. While on-hand physicians should consider the symptoms, they should recognize that sometimes they do not manifest immediately. One response to be cautious of is the bilateral fencer response, in which the athlete’s arms are held rigidly in the air after impact. This posture is an indication of traumatic brain injury and usually only lasts a few seconds.

More serious abnormal involuntary physical responses include Decorticate (Flexor Posture) and Decerebrate (Extensor Response). The former manifests as rigidly straight legs, clenched fists, and arms bent to hold the hands at the chest, and the latter sees the upper extremities and head extended and the back arched. The flexor posture following TBI has only a 37% survival rate, and the extensor response’s survival rate is a mere 10%.

Remove

An athlete who is suspected to have concussion must be removed from play and from the field, court, or track in order to benefit from further SRC management strategies. He or she should undergo medical assessment and monitoring for deterioration without delay. Preliminary first aid should be administered, and SCAT5—a standardized tool for evaluating concussions—performed.

SCAT5 is used as a screening evaluation in the diagnosis of sports-related concussion. It does have a limited role in tracking recovery, so it should not be used by itself to make or exclude the diagnosis of concussion.

Only trained professionals should move the athlete or remove the helmet or other equipment. The evaluation should be performed by a physician or other healthcare professional. After the injury, the player should not be left alone. Monitoring should be constant. If concussion is diagnosed, the athlete should not be allowed to return to play until the concussion has abated.

Re-Evaluate

In the ER or a doctor’s office, further evaluation should be performed. This should take into account medical history, the improvement or deterioration from the time of injury, a neuropsychological assessment, and a neurological examination, including cognitive fxn, mental status, vestibular function, sleep/wake disturbance, ocular function, gait and balance.

Rest

Rest is the most commonly prescribed intervention for SRC management, despite the lack of evidence that such a prescription is helpful. However, to avoid the risk of exacerbating the damage, patients should refrain from activity for at least 48 hours. Rest can ease discomfort during the recovery period by mitigating symptoms and minimizing the demands on the brain.

Rehabilitation

The rehabilitation stage of SRC management is often paired with rest, especially in the initial Berlin Consensus. Athletes should be aware that treatments vary by patient, but careful monitoring is a necessity. 

Refer 

A definition of persistent symptoms is required to describe the failure of normal recovery after an injury to the brain. These “persistent symptoms” encompass a wide array of non-specific post-traumatic symptoms that may be linked to other factors, and they fall beyond the “normal recovery time” for such injuries (>10-14 Days for adults and > 4 weeks for children).

Recovery

Though information exists online that cites a concussion recovery period of 10 days, know that that number is far too low. Most concussed athletes recover—clinically speaking—within the first month of injury. The exact window is highly dependent on the SRC management strategies employed during recovery. Athletes should work with their physicians to track recovery, taking advantage of diagnostic tools such as functional magnetic resonance imaging (fMRI), fluid biomarkers, and transcranial magnetic stimulation.

Return to Sport

The process for concussed athletes to return to sport should be graduated, following a stepwise rehabilitation strategy. Athletes should work with their physicians to follow a timetable that works with their symptoms and recovery speed. The first step recommended is to keep all activity to levels that does not exacerbate symptoms. After a reasonable time, athletes may return to light aerobic exercise and then sport-specific exercise. The fourth stage is non-contact training drills, and the fifth is full-contact practice. Once these stages have been completed incrementally, an athlete is likely to be cleared to return to sport.

Reconsider 

The high incidence of sports-related concussions does not have to be a foregone conclusion. We can adjust the way we play, and schools especially can implement an SRC policy. All athletes, regardless of level of participation, should be addressed with the SRC management strategies outlined in the Berlin Consensus. 

Residual Effects and Sequelae

Further research is required to fully understand the long-term effects of SRC. Though it has been suggested that repeated concussion or subconcussive impacts cause chronic traumatic encephalopathy (CTE), the true relationship between the two remains uncertain.

Risk Reduction

Prevention is the best medicine, the list of SRC management strategies would be incomplete without suggestions for SRC prevention. This includes effective protective equipment, such as helmets (especially common for skiing, snowboarding, and American football) and mouthguards (though the evidence for their effectiveness in preventing SRC is mixed). Preventions can also be behavioral, such as limiting the use of body checking or contact in general during practice.

Prevention begins with understanding the problem, so improving our education about concussions and SRC management plays a critical role in limiting the issue. Further research, especially about the effectiveness of SRC prevention interventions, is a must.