Pain in one's arm can be caused by a variety of conditions located in the upper extremity including joint sprain, muscle strain or tear, tendonitis, bursitis, arthritis, or nerve entrapment conditions such as carpal tunnel syndrome.  Arm pain can also be generated from a source located away from the location of the pain, most notably, the neck.  Pain generated from the neck that is felt in one or more areas of the arm is a symptom of a type of condition that is often successfully treated in physical therapy.  This condition, commonly referred to as a “pinched nerve”, is called a cervical radiculopathy.    Causes: Cervical radiculopathy is caused when a nerve in the neck is compressed, irritated, or inflamed.  This can occur for several reasons. Most commonly a pinched nerve results from wear and tear of the spine as we age which results in inflammation of the joints of the spine around the nerve and reduced space for the nerve to exit the spinal column.  Cervical radiculopathy in younger people is often a result of a herniated disc related to a traumatic injury such as a car accident or a fall.   Anatomy and physiology:  Your neck (cervical spine) consists of 7 bones, or vertebrae, that are stacked on top of each other. Each vertebrae is separated from the other by a disc in-between.  A key role of the spine is to act as a sturdy column, to protect the spinal cord and its nerve branches.  The spinal cord in the cervical spine branches into 8 nerve roots that exit the spinal column between two vertebrae.  These nerve roots join to form peripheral nerves that course from the neck to the shoulder, arm, and hand.  The job of this network of nerves is to provide movement information to the muscles of the upper extremities. They also function to provide sensory information (pain, temperature, touch, pressure) received from receptors in the upper extremity, and carry it back to the spinal cord and brain for interpretation.  Cervical radiculopathy, as described above, occurs when the nerve root is compressed or irritated where it leaves the spinal column.  This can cause distinct symptoms.    Symptoms:  Pain felt in the arm can be described as radiating, sharp, or dull over a region.  Other symptoms can include numbness, tingling (like pins and needles), loss of sensation, and potentially weakness of muscles.  The location of symptoms is dependent on which of the 8 nerve roots are being pinched.  Symptoms are often reproduced with movement or certain position of the neck.  This information helps the healthcare provider establish an accurate diagnosis and treatment plan.    Physical therapy can help.  Cervical radiculopathy is one of many nervous system conditions that can be effectively treated by a physical therapist with the goal of restoring pain free function by restoring space for the nerve.  It is important to note that cervical radiculopathy can be a serious condition and seeing your doctor as soon as possible is recommended. Your doctor will help to determine if physical therapy is appropriate for you.   Nick Monday, DPT Orthopedic Manual Physical Therapist Mid- Michigan PT Clinical Team   #PainInArm #MisdiagnosedArmPain #MisdiagnosedArmProblem #CervicalRadiculopathy #WhatsCausingPainInMyArm  

1. See your family physician and/or physical therapist   There are several reasons that a person may experience pain in the low back region, while pain due to a lumbar disc bulge (characterized by increased pain with movement, leg pain and possibly numbness, tingling and weakness) can be a serious problem, in some cases necessitating surgery. So step 1, if you suspect you have a lumbar disc bulge, don't wait for the pain to go away on its own because it probably will not resolve without some form of treatment! Instead, make an appointment to see your physician or a physical therapist so they can correctly evaluate your complaints and prescribe an appropriate management plan.    2. Take appropriate medication   NSAIDs (Nonsteroidal anti-inflammatory drugs) such as Ibuprofen, Naproxen, and Aspirin can help relieve pain and inflammation in the area surrounding the disc. Only take these as recommended by your physician.   3. Avoid the activities that are causing pain   Often, pain from a bulging disc increases with certain movements especially heavy lifting, bending forward or twisting your back, as well as prolonged sitting.  Avoid these movements to allow the disc to begin to heal! It can be compared to having a cut on your knuckle. The more you bend your finger and pull on the cut, the longer it will take to heal.    4. Sit with support   Sitting is often a position that increases pain from a disc bulge, however, sitting with a towel rolled up and placed at your belt line can be helpful in tolerating those times when you need to sit (especially at work or when riding in a car). This helps you sit up straight and keeps the natural curve in your low back which adds support to the injured disc.    5. Avoid low chairs    Sitting in a low chair or a soft piece of furniture will likely lead to "slouched" sitting. This places excessive stress on the bulging disc, will cause pain, and lengthen the recovery time.   6. Exercise   It is helpful to perform gentle stretches when healing from a bulging disc. Often it is helpful to lie on your stomach while propping your upper body up on your elbows. Rest here 5-10 seconds and return to lying flat. Repeat 10 times and if this is comfortable repeat every 2-3 hours. Working up to walking 20-30 minutes for cardiovascular exercise will be important when you can tolerate this. Your physical therapist can be very helpful in teaching you other effective exercises.   7. Wear a lumbar support brace   If you have a physically demanding job or cannot completely avoid more strenuous activity, a lumbar support brace may be helpful in unloading the injured disc while you continue what you need to do. These are relatively inexpensive and your physical therapist or physician may be able to assist in selecting the best one for you to wear.   8. Have patience   After beginning treatment, it's important to realize that a bulging disc will heal over several weeks or months before pain is no longer present. It will take time to heal, but most people will heal without requiring surgery and knowing this may provide peace of mind during the healing process.   9. Stop Smoking   If you're a smoker, another reason to quit is that you're placing yourself at a higher risk for developing back pain including from a bulging disc. Smoking has been shown to weaken the lumbar discs over time by reducing the body's ability to deliver nutrients to the discs. Smoking may also lead to a higher sensitivity to pain.   10. Try heat or ice   Either heat or ice may be helpful in managing pain. They will not cure the problem, but applying them for 15-20 minutes several times per day may help to at least reduce symptoms as part of your overall treatment plan.   Aaron Treiber, DPT Orthopedic Spine Physical Therapist Mid-Michigan PT Clinical Team   #LumbarDiscBulgePain #RelieveLumbarDiscPain #BulgeinLumbarDisc #StepstoRelieveLumbarDiscPain  

1.Do You Really Need A Joint Replacement? Often times as we get older and our joints become stiffer, many people start to believe that someday in the future that they are going to need a joint replacement ( just like their mother or their brother or a close friend) and then finally they  go to the doctor and learn after an X-ray  that their hip or knee joint is ‘ bone on bone' with zero joint space! But, does that person REALLY need a joint replacement? The answer is – sometimes Yes and sometimes No! The decision should not be made based on an X-ray, but instead how that joint is impacting the person's life. That said, when a person is taking medication like candy for pain relief, they are starting to notably reduce their activity due to pain and other joints are starting to hurt as they try to compensate for that arthritic joint, the likelihood is, it's time to consider that joint replacement!   2.Who Should You Choose To Do Your Surgery? Often times, your family physician will have a surgeon that they recommend, while reading on-line reviews and speaking with friends who have had joint replacements can be helpful. The best person to ask however can actually be a Physical Therapist, as they see the RESULTS from many different surgeons and we can provide you with some very helpful guidance. So, don't hesitate to contact us!   3.Should You Have Physical Therapy Beforehand? It is often a good idea to have what is referred to as ‘ Prehab' prior to your surgery, however the decision to receive therapy beforehand is most often dependent upon the patient's insurance plan. If a person's insurance plan only allows a limited number of PT visits thru'out the year, then it is often a better idea to save their visits for AFTER their surgery.   4.What Is The Best Time Of The Year For You To Elect To Have Surgery? The number one thing to think about, is what life has in store for you the weeks that follow your surgery. So, if you are planning a trip to Florida in February, having your surgery just a few weeks prior would not be a good idea. Other things to think about include who will be available to help you after surgery and how you have used your insurance benefits thru'out the year.   5.How Long Will It Take Before I Am Back To Normal? Obviously there are a lot of factors that will influence a person's rate of recovery, while for a hip or knee replacement, ‘most' people will be back to doing 80% or more of their daily activities within 3 months and sometimes sooner than that.   6.How Long Will I Be In Hospital After My Surgery? Nowadays, sparing any type of complications, patients are now commonly discharged after a joint replacement the same day or within 24 hours   7.Is There Any Special Equipment I Will Need To Purchase? Yes, there is a number of things that should be purchased in advance of your surgery, while these items may include a walker, a cane, an elevated toilet seat, non- slip mats for the bathroom, ice packs and perhaps a wedge to elevate your legs after a knee of hip replacement   8.Will I Need To Go To A Rehab Center Or Will A Nurse Or Therapist Come To My Home? The decision to send someone to a rehab. center after a joint replacement is typically dependent upon their medical status and whether or not that person has someone to help them in their home after surgery or not, while accessible in and out of the home is also a factor. Often times, if a person does not go to a rehab. center, it will be arranged for the person to receive Physical Therapy and perhaps nursing assistance in their home for 1-2 weeks.   9.Will I Need To Take Pain Medication After My Surgery? Your surgeon will prescribe a specific medication regimen for you following your surgery, while you should endeavor to fill your prescriptions 1 or 2 days before your surgery. It is critically important that the person's pain is under control following surgery so they have less difficulty sleeping and also to boost their general level of activity and exercise tolerance   10.When Will I Be Allowed To Resume Driving You should consult with your surgeon regarding this question before deciding to drive. The effect of anesthesia can last up to 10 days following surgery, while taking some medications after surgery will impair a person's ability to drive. This a great question to ask, when you see the surgeon 1-2 weeks after your surgery.   11.How Soon Do I Get To Start Outpatient Physical Therapy? Baring any complications, most people should expect to start outpatient Physical Therapy within 2 weeks after surgery. If the person goes to a rehab. center 1st, then the timeframe is more likely to be 4-6 weeks.   12.Can I Choose Where To Attend For My Physical Therapy? YES. Many surgeons will have a preference for you to receive therapy within the hospital system where they work, but YOU CAN CHOOSE where you attend for your Physical Therapy, just as you choose your surgeon, while at Mid-Michigan PT Specialists, we have extensive experience helping people with partial and full joint replacements and revision surgeries including ankle, knee, hip and shoulder replacements.