Not always the radiating pain to upper limb/arm is cervical in origin (cervical stenosis/cervical disc prolapsed), sometimes a severe fibromyalgia around neck and shoulder gives rise to referred pain in the arm mimicking the symptoms of cervical radiculopathy. It’s very difficult to differential diagnose it, let us try to understand it by a interesting case study which gave excellent result when we treated it.
Case Study
A 80 years old female house wife complained of severe pain around right neck and shoulder region with radiation of pain to right arm index and ring finger. Pain was a continuous, dull, deep aching type felt over the right side of neck from tip of the shoulder to the occipit. Pain was also on the inner side of the right shoulder blade. Pain was aggravated by using right arm and she had episode of sudden aggravation of pain on attempting to move her neck. For two weeks she had been experiencing the worst pain which kept her awake I the night.
She visited her family orthopaedic doctor and was diagnosed as cervical spondylitis pain. Accordingly analgesics and anti-inflammatory was prescribed and advised to rest with cervical collar. After one week when there was no significant improvement, they decided to take another orthopaedic doctors suggestion. This time also doctor advised her to continue with the analgesics and referred to physiotherapist of the further management. She received physiotherapy session for around a week with some relief but again without any significant improvement. In physiotherapy she was prescribed with intermittent cervical traction followed by ultra sonic therapy. After this she approached us.
She is an old lady with average body built a short heighted obese. She was restless with pain and complained of weakness in fingers described it as weak grip strength. Upon palpation the whole region was found tender from tip of the right shoulder to neck and inner side of the right shoulder blade. On giving pressure on right supraspinatus and region on inner side of right shoulder blade reproduces the symptoms of radiation to right arm.
To summarise it two tender spots where found.
1: At erector spinae at the root of neck.
2: Vertebral body of scapula (trapezius & rhomboids).
The tender spots where deactivated with deep transverse friction massage and ultra sonic therapy followed by hot fomentation. One week later she was quite free from symptoms and had full range of neck movement.
The author is a physiotherapist who has been practising for the last 17 years. He owns a successful physiotherapy clinic named "Physiofirst" in Rourkela, Odisha, India.
He holds a Bachelor's in Physiotherapy (BPT) from SVNIRTAR (Swami Vivekananda National Institute of Rehabilitation and Research), one of the prestigious physiotherapy schools in India.
Taking every pain and disability case as a challenge is his motto. Whatever he learns dealing with his patient, he shares it with the world through blogs and e-books.
He also owns a blog, www.physiosunit.com and a YouTube channel, "Sunit Physiotherapist" with over 8 lakh active subscribers. Here, he shares everything he gets to learn serving the patient. His knowledge and invaluable experience in the field are proving beneficial to many.
Case Study
