Archive for March, 2007
Muscle pain| neck pain| thumb flexion
March 31, 2007 8:16 pmSaturday, March 31, 2007
Muscle pain| neck pain| thumb flexion
Patients with neck pain and discomfort may complain of pain in the thumb region with difficulties in moving the painful thumb muscles.
Pain at the base of the thumb may be due to arthritis at the joint between the wrist bone and the knuckle bone known as the carpometacarpal joint. Arthritis at this joint is very common. Arthritic pain of this joint at the base of the thumb is made worse when there is nerve related pain and spasm in the muscles that cross the carpometacarpal joint (joint between the thumb wrist bone and the thumb knuckle bone).
Treatment of thumb pain must involve treating all muscles that participate in moving the thumb in all its many capable movements of flexion, extension, abduction, adduction and opposition.
The many complex movements of the thumb are essential in producing fine manipulation such as writing, picking up small objects, turning the key, stitching, knitting cutting up food, turning the doorknob, etc.
Thumb flexion consists of moving the thumb along the plane of the palm.
Muscles responsible for performing this motion include:
- flexor pollicis brevis (superficial head supplied by the median nerve and the deep head supplied by the ulnar nerve). This muscle is supplied by the C8 and T1 nerve roots.
- extensor pollicis longus supplied by the radial nerve (C7, C8).
When the flexor pollicis brevis is not functioning, the supplementary action of the extensor pollicis longus muscle together with that of the flexor pollicis longus supplied by the anterior interosseous branch of the median nerve by causing simultaneous flexion of the tip of the thumb will be able to flex the thumb along the plane of the palm.
© 2007 copyright all rights reserved www.stopmusclepain.com Muscle pain| neck pain| thumb flexion
Photograph showing the flexor pollicis brevis (below)
Muscle pain| neck pain| thumb adduction
March 30, 2007 9:07 amFriday, March 30, 2007
Muscle pain| neck pain| thumb adduction
Patients with nerve related muscle pain leading to neck pain/discomfort often complain of pain in the region of the thumb.
Thumb pain can be due to pain and spasm in muscles that perform movements of the thumb.
If the thumb is held at right angles to the plane of the palm with the palm facing up, adduction is the movement of the thumb down toward the plane of the palm.
Muscles that perform adduction of the thumb are:
- adductor pollicis supplied by the ulnar nerve (C8, T1)
This adduction movement has to be assisted by the following muscles:
- extensor pollicis longus supplied by the posterior interosseous nerve of the radial nerve (C7, C8)
- opponens pollicis supplied by the median nerve (C8, T1)
- flexor pollicis longus supplied by the anterior interosseous branch of the median nerve (C8, T1)
- flexor pollicis brevis supplied by the median nerve to the superficial head and the ulnar nerve to the deep head. Both the superficial and deep heads of the flexor pollicis brevis is supplied by the C8 and T1 nerve roots.
© 2007 copyright all rights reserved www.stopmusclepain.com Muscle pain| neck pain| thumb adduction
Photograph of dissection showing the adductor pollicis (below)
Muscle pain|neck pain| wrist palmar flexion
March 29, 2007 9:57 amThursday, March 29, 2007
Muscle pain| neck pain| wrist palmar flexion
Patients with neck pain may present with muscle pain and pain in the wrist area. They may have difficulty with making a fist and picking the wrist up so that the front (palm aspect) of the wrist is toward the face. This may be related to pain, spasm or tightness of the muscles that perform this movement.
Although it is the wrist flexors that seemingly have a problem, it is usually the tightness of the wrist dorsiflexors that initiate muscle pain in the wrist flexors. In treating problems with the wrist flexors, the entire upper limb evaluation should be done including the neck for muscle strength and range of motion.
Treatments must first begin with the large and powerful muscles that must perform lengthening contractions to stabilize the joints of the shoulder, elbow and wrist.
The main muscles that perform wrist flexion (palmar flexion) are:
- flexor carpi radialis supplied by the median nerve (C6, C7)
- flexor carpi ulnaris supplied by the ulnar nerve (C8, T1)
- abductor pollicis longus supplied by the radial nerve (C7, C8)
- flexor digitorum superficialis supplied by the median nerve (C8, T1)
- flexor digitorum profundus supplied by the ulnar nerve (C8, T1)
- palmaris longus supplied by the median nerve (C6, C7)
© 2007 copyright all rights reserved www.stopmusclepain.com muscle pain| neck pain| wrist palmar flexion
Photograph showing the muscles that perform wrist palmar flexion (below)
Neck pain| wrist dorsiflexion
March 28, 2007 10:20 amWednesday, March 28, 2007
Neck pain| wrist dorsiflexion
Patients with neck pain may present with wrist symptoms and have difficulty with making a fist and picking the wrist up so that the back of the wrist is toward the face. This may be related to pain, spasm or tightness of the muscles that perform this movement.
The main muscles that perform wrist extension (dorsiflexion) are:
- extensor carpi radialis longus supplied by the radial nerve (C5, C6)
- extensor carpi radialis brevis supplied by the posterior interosseous branch of the radial nerve (C6, C7)
- extensor carpi ulnaris supplied by the posterior interosseous branch of the radial nerve (C7, C8)
- extensor digitorum supplied by the posterior interosseous branch of the radial nerve (C7, C8)
© 2007 copyright all rights reserved www.stopmusclepain.com neck pain| wrist dorsiflexion
Photograph showing the muscles that perform wrist dorsiflexion (below)
Neck pain| pronation of the forearm
March 27, 2007 1:47 pmTuesday, March 27, 2007 Neck pain| pronation of the forearm Patients with neck pain may have difficulties with movements in turning the palm downward toward the floor (pronation) either due to weakness or tightness of the muscles that perform this movement.
The best way to test pronation is to keep the forearm bent to a right angle with the elbow at the side of the trunk. You should be able to completely turn the palm down so that the forearm and all the fingers including the thumb are parallel to the floor.
If there is weakness or tightness of the muscles that perform pronation, you will find that the plane of the forearm and hand cannot be made parallel to the floor. You can test the strength of the pronators by trying to turn the forearm into supination so that the palm of the hand can be turned up.
Muscles that perform pronation are:
- pronator teres supplied by the lateral head of the median nerve (C6-C7)
- pronator quadratus supplied by the anterior interosseous branch of the median nerve (C7-C8)
- flexor carpi radialis supplied by the lateral head of median nerve (C6, C7)
- palmaris longus supplied by the lateral head of the median nerve (C6, C7)
- brachioradialis supplied by the radial nerve (C5, C6)
© 2007 copyright all rights reserved www.stopmusclepain.com neck pain| pronation of the forearm
Photograph showing the muscles that pronate the forearm (below)
Neck pain| forearm supination
March 26, 2007 8:38 amMonday, March 26, 2007
Neck pain| forearm supination
Patients with neck pain may have difficulties with movements in turning the palm up toward the ceiling (supination) or turning the palm downward toward the floor (pronation).
Difficulties with these movements may be related to pain, spasm or tightness of the muscles that perform these motions of supination and pronation respectively.
The best way to test supination is to keep the forearm bent to a right angle with the elbow at the side of the trunk. You should be able to completely turn the palm up so that the forearm and all the fingers including the thumb are parallel to the floor. If there is weakness or tightness of the muscles that perform supination, you will find that the plane of the forearm and hand cannot be made parallel to the floor.
You can test the strength of the supinators by testing the resistance that the supinators provide as you try to rotate the forearm in order that you can turn the patient's palm down to the floor.
Muscles that perform supination are:
- biceps brachii supplied by the musculocutaneous nerve (C5, C6)
- supinator supplied by the posterior interosseous branch of the radial nerve (C6, C7)
- brachioradialis supplied by the radial nerve (C5, C6).
© 2007 copyright all rights reserved www.stopmusclepain.com neck pain| forearm supination
Photograph showing the muscles that supinate the forearm (below)
Neck pain| elbow extension
March 25, 2007 12:13 pmSunday, March 25, 2007
Neck pain| elbow extension
Patients with neck pain often complain of elbow pain.
Likewise, many patients may not complain of primary neck pain and can present with elbow pain and yet the main cause of the elbow pain is related to cervical nerve root irritation.
Muscles responsible for extending (straightening) the elbow are:
- triceps comprising of the long head, medial head and lateral heads supplied by the radial nerve and carries the fibers of primarily the C7 nerve root (C6-C8).
- anconeus (C6-C8)
Long head of the triceps when in pain and spasm can also cause shoulder pain since it crosses the shoulder joint. The lateral and medial head of the triceps are strong generators of elbow pain. The medial head of triceps when in pain and spasm is often the main cause of traction/compression on the ulnar nerve giving rise to tingling and numbness in the last two digits of the hand (ring and little fingers).
© 2007 copyright all rights reserved www.stopmusclepain.com neck pain| elbow extension
Photograph showing the muscles that extend the elbow (below)
Neck pain| elbow flexion
March 24, 2007 3:24 pmSaturday, March 24, 2007
Neck pain| elbow flexion
Patients with neck pain commonly have pain in the elbow.
Pain and spasm in the elbow flexor muscles (muscles on the front of the arm and forearm involved with bending the forearm toward the body) can be related to irritation of the cervical nerve roots that supply these muscles.
The elbow flexors are:
- brachialis (supplied by the musculocutaneous and radial nerves carrying the C5, C6 spinal nerve roots).
- biceps brachii (supplied by the musculocutaneous nerve-C5, C6 nerve roots)
- brachioradialis (supplied by the radial nerve-C5, C6 nerve roots
- pronator teres (supplied by the median nerve-C5, C6 and C7 nerve roots)
© 2007 copyright all rights reserved www.stopmusclepain.com neck pain| elbow flexion
Photograph showing elbow flexion by the brachialis and biceps (below)
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Neck pain| shoulder abduction
March 23, 2007 10:56 amFriday, March 23, 2007
Neck pain| shoulder abduction
Neck pain due to irritation of C5 and C6 nerve roots can cause pain and spasm in the shoulder abductor muscles. The shoulder muscles responsible for shoulder abduction are:
- deltoid (the middle deltoid is the only muscle that can abduct the shoulder with the shoulder in internal rotation). The deltoid is supplied by the axillary nerve (C5, C6) from the posterior cord of the brachial plexus
- infraspinatus, supplied by the suprascapular nerve C5, C6 from the upper trunk of the brachial plexus.
- Teres minor supplied by the axillary nerve from the posterior cord of the brachial plexus.
- Abduction to 60° is also aided by supraspinatus supplied by the suprascapular nerve from the upper trunk of the brachial plexus.
Trapezius and serratus anterior muscle also act to rotate the scapula on the chest wall for overhead abduction.
© 2007 copyright all rights reserved www.stopmusclepain.com neck pain| shoulder abduction
Photograph showing the deltoid and infraspinatus muscles involved in abduction of the shoulder (below)
Neck pain| shoulder adduction
March 22, 2007 8:38 amThursday, March 22, 2007
Neck pain| shoulder adduction
Neck pain due to cervical nerve root irritation can cause pain and spasm in the shoulder adductor muscles.
Adduction means bringing the limb close toward the midline of the body.
The shoulder adductor muscles are large and powerful and they are also powerful internal rotators.
Patients with pain and spasm in the shoulder adductor muscles usually will have difficulties performing internal rotation.
Also, the muscles that perform external rotation are smaller, fewer and less powerful. Similarly, muscles that perform abduction of the shoulder are also weaker than the muscles that perform adduction and internal rotation.
This natural imbalance in power between the shoulder abductors and external rotators usually results in unopposed pull of the shoulder adductors and internal rotators.
In such situations, these strong shoulder adductor and internal rotator muscles usually become very tight and shortened. This leads to further difficulties with shoulder abduction and external rotation.
The shoulder adductor muscles are as follow:
- pectoralis major, the stronger part of this muscle for adduction is the sternal portion supplied by the medial pectoral nerve (C8, T1) from the medial cord of the brachial plexus. The clavicular portion of the pectoralis major is also a strong adductor muscle and is supplied by the lateral pectoral nerve (C5, C6, C7) from the lateral cord of the brachial plexus.
- teres major supplied by the lower subscapular nerve (C5, C6) from the posterior cord of the brachial plexus.
- latissimus dorsi supplied by the thoracodorsal nerve (C6, C7, C8) from the posterior cord of the brachial plexus.
© 2007 copyright all rights reserved www.stopmusclepain.com neck pain| shoulder adduction
Photograph showing the pectoralis major muscle (below)
