Repetitive Motion Injuries
Repetitive Motion Disorders are Frequently Misdiagnosed, so the question is: Is your diagnosis correct?
Notice that different conditions can cause similar symptom patterns. These pictures illustrate areas of pain, numbness and/or tingling associated with the conditions next to them. Many conditions look alike on the "surface." There are 35 nerve entrapment conditions affecting the upper extremity. This is only a partial list. See if you can find your symptom picture.
Carpal Tunnel Syndrome (CTS)
CTS is a collection of symptoms that involves pain, numbness and/or tingling to the inside of the palm, the thumb, and the first two and a half fingers (See picture). The Carpal Tunnel is formed by the 8 wrist bones called Carpals. These bones form a C-shape. The "C" is closed by a ligament called the Carpal Tunnel ligament. Through this tunnel passes 9 tendons and 1 nerve, the Median Nerve. CTS results from compression of the Median Nerve at the Carpal Tunnel Ligament. There are actually FOUR common entrapment sites of the Median Nerve other than at the Carpal Tunnel. Make sure your doctor checks all of them.
Pronator Teres Syndrome (PTS)
Often the same symptom pattern as CTS because this also results from compression of the Median Nerve, this time at the Pronator Teres Muscle (which extends from the inside of the elbow to the middle of the arm.) Most commonly mistaken for Carpal Tunnel Syndrome.
Lateral Epicondylitis (A.K.A. Tennis Elbow)
Causes pain at the outside of the elbow joint that is very tender to the touch. The pain can radiate down to the wrist. Usually there is no finger numbness or tingling in this condition. Often causes pain to the back side of the thumb web and back side of the wrist. Results from inflammation and excessive use of the wrist extensor muscles (like in "mousing" or constant use of the mouse) and can cause compression to the Radial Nerve.
Radial Nerve Compression
Can have the same pattern of pain as Lateral Epicondylitis. Often there is a localized area of pain and/or numbness on the back of the thumb web. Typically more severe than Lateral Epicondylitis and often difficult to diagnose.
Medial Epicondylitis
(also known as - "Golfer's Elbow") Is similar to Lateral Epicondylitis but located on the inside of the elbow. This condition involves the overuse of the wrist flexors or the muscles involved in bending the wrist (as in golf). Can mimic symptoms of Ulnar Neuropathy because often effects the Ulnar Nerve.
Ulnar Neuropathy
Causes pain, numbness and tingling down the inside of the elbow, through the hand to the last two fingers (pinky and ring fingers), due to compression of the Ulnar Nerve. If the compression is at the elbow, it is called Cubital Tunnel Syndrome. Also a certain Nerve Root Compression disorder (originating in the neck) results in a very similar pain pattern. Make sure your doctor checks your neck if your symptom pattern looks anything like this picture.
Cervicobrachial Syndrome
Causes pain, numbness, and/ or tingling from the neck, down the arm and to the hand. Most commonly results from overly tight muscles on the side of the neck compressing all or part of the Brachial Plexus.
Nerve Root Compression
Depending on which nerve roots and how many are compressed, you could have symptoms in the whole arm (colored area) or just "strips" of pain, numbness, and/or tingling similar to the pictures above. Only a doctor trained and specializing in nerve entrapment syndromes can tell the difference.
Cervical Subluxations
Even a minor misalignment of a vertebra or "stuck joints" in your neck can cause muscle spasms and/or pressure on nerves that go to the arm resulting in pain, numbness and tingling. This condition is very common and can only be corrected by a chiropractic adjustment. If left untreated, degeneration can occur with the formation of bone spurs and disc bulges, which can result in persistent problems.
Thoracic Outlet Syndrome
Results from the compression of nerves and/or blood vessels as they travel from the neck under the collar bone (clavicle) and down into the entire arm. Can cause cold hands, brittle fingernails, numbness, severe soreness, or "burning" pain in the hands all the way up to the shoulder. Can also cause shooting pain, numbness and tingling. There are several types of Thoracic Outlet Syndrome (meaning the compression can occur in different areas) - make sure your doctor knows them all and checks each possible source for your specific problem.
Double Crush Syndrome
Results from compression of any of the nerves mentioned in two or more places. Most commonly, these compressions or "crushes" to the nerves occur in the neck and one (or more) entrapment site(s) somewhere in the arm. You may or may not have neck pain. Typically just one of the compression sites alone is not enough to cause the symptoms, but add just one more area of tightness on that same nerve and then you've got a problem. Fixing the arm compression could cause a return of symptoms soon after as the problem in the neck gets worse. Your doctor must always evaluate your neck whenever you have arm problems. (Symptom area shown is a Double Crush of the Median Nerve).
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