Is It Really Neck Pain?
A 48-year-old male had left sided neck pain with intermittent left arm
tingling, numbness, and aching for 2.5 months. The pain was described as
a deep nagging ache on the left side of the neck with a more intense
pain in the left shoulder blade that occurred without any specific
activity. Also, no particular position of the neck or head changed the
symptoms in the neck or left arm. The patient described having periodic
episodes of neck and left arm pain/numbness 4 or 5 times over the last
10 years, and he felt that this episode was similar to the previous
episodes. He had utilized chiropractic treatment previously with good
results and was considering calling for an appointment once again.
Everything "looks and sounds" like a neck condition with an associated
pinched nerve causing pain and tingling radiating down the arm - but is
it?
After carefully questioning, it was discovered that no specific date of
onset could be tied to a trauma (specific injury), over-use activity,
or any other identifiable cause. Similarly, he stated that no specific
position of the head/neck or arm changed the intensity or length of time
the pain lasted. This is unusual for a pinched nerve in the neck as
the nerves are stretched when the arm hangs down at the side increasing
the pain, and less stretched when the arm is raised over the head
resulting in less arm symptoms. Another inconsistent finding was that
the whole arm rather than a specific part of the arm was symptomatic.
Usually, a pinched nerve follows a specific course down the arm
affecting either the 4th and 5th fingers or the thumb side of the hand,
but not the whole arm and hand. The physical examination was fairly
typical for neck pain sufferers - limited ranges of motion of the neck,
neck pain reduction with manual traction and increased with compression
tests. However, there were no arm symptom changes during the neck
ranges of motion tests, compression tests, or elevating the arm.
These history and examination findings should alert the health care
provider of a possible "organic" cause for the symptoms rather than the
"pinched nerve" diagnosis. When considering a list of possible
"organic" causes, heart disease must be first on the list since it has
life threatening potential.
In the case presentation above, the patient was indeed having a heart
attack where the blood vessels to part of the heart wall were blocked
and the blood carrying oxygen to the heart muscle couldn't get through,
thus was causing the "referred pain" to the left side of the neck,
shoulder blade and down the left arm. It is important to know that this
heart related referred pain pattern never involves the right arm - only
the left. Other potential symptoms can include left jaw (TMJ) pain,
and the more obvious left sided chest pain, even though these were not
present in this case.