Could it be vascular?
There are many causes of pain of the whole arm in adults. This type of pain can be horrible and significantly affect function of the arm. In most conditions a specific part of the arm is affected – usually depending on where the problem is and what specific structure is affected. With some conditions however, the pain and symptoms are more general and influence the whole arm. Here we will discuss some of the less common but often overlooked causes of whole arm pain – symptoms that can occur and how they might be properly assessed and treated.
Thoracic Outlet Syndrome:
This condition can involve the nerves of the Brachial Plexus or the blood vessel of the arm. Typically, symptoms of Thoracic Outlet include a general ache in the whole arm, heaviness or a feeling that the muscles of the arm become easily and quickly fatigued. The symptoms are usually made worse by having the hands above the head or in elevated positions for a period of time. Symptoms might start consistently after a certain amount of this activity but then ease quite quickly once the arms are lowered again. Rarely do the symptoms last when the arm is resting again. Because either the nerves or the blood vessels can be affected in thoracic outlet syndrome, there are some differences in the symptoms that might occur:
1) Neurogenic (nerve) thoracic outlet symptoms:
These may include pins and needles or numbness in the arm with activity. It can also include pain in the arm (sometimes burning in nature) and sometimes this pain can follow a pattern in the arm that follows particular nerves if they are affected. If the conditions have been going on for a while, and the nerves have been significantly influenced, the muscles that those nerves supply have also been affected in the hand. Often it is the lower nerves from the neck that are affected. These present as symptoms in the little finger and ring finger and under side of the forearm but this is not always exclusively the case.
2) Vasculogenic (blood vessel) thoracic outlet symptoms:
If the blood vessels have been affected then the pain is often described as aching, heavy and like the arm gets tired or fatigued very quickly. If the blood vessels are affected it can mean that the blood supply for the rest of the arm is not 100% and so changes can occur in the quality of the arm. This can include changes to the colour of the arm and increased prominence of small veins in the arm and hand. It is less likely that symptoms of pins and needles and numbness will occur but this can still be the case, making differentiating between vascular and neurogenic symptoms challenging.
A large proportion of the assessment for these conditions is based on a clear and accurate discussion of the clinical symptoms with the patient. Identifying this clear ‘on/off type’ pain with above head activities and the description of the pain would give a good idea of the diagnosis. In addition to this there are some clinical tests used to add strength to a diagnosis. Some of these include the Adsons Test, Allens Test and Roo’s Test procedures. These tests all look to add extra stress to the vascular tissues that are in question so that symptoms may start or blood flow (assessed by checking the pulse at the wrist) can be monitored. Other tests used to determine if nerves are being effected include neurodynamic tests which stress the nerves and look for reproduction of symptoms.
Once a clear diagnosis has been reached, then treatment can be aimed at the structures that may be causing irritation of the blood vessels or nerves. Clear diagnosis is the primary aim as it leads to clear explanation to the patient and understanding of their condition and what might aggravate it. Treatment aimed towards reducing stress on the irritated structures can then be given. For example, this might include postural changes to take pressure off nerves or blood vessels by increasing space around the shoulder and rib cage. Stretching or reducing tension in muscles that might be compressing tissues or changing the way these are performed can also enable better movement and overall glide of tissues.
If you think these symptoms sound familiar or you would like more information on these conditions, consider a specialist physiotherapy assessment of your symptoms and a presentation now.