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Cervical Radiculopathy (Arm Pain)

Cervical radiculopathy is the term used to describe radiating nerve pain that begins in the neck region and runs down the shoulder, arm, forearm, and into the hand, and is associated with a neurologic deficit such as numbness or weakness. The term radiculitis indicates that there is only pain, without associated numbness or weakness, shooting down the arm into the hand and fingers. Although radiculopathy and radiculitis can be used to describe the above-mentioned signs and symptoms in the arms or legs, many people often used the term sciatica when referring to lower extremity and back problems.

Causes of Cervical Radiculopathy (Arm Pain)

There are numerous conditions that can cause cervical radiculopathy, but the most common is a herniated disc (herniated nucleus pulposus). When an intervertebral disc is injured and protrudes into the spinal canal, it can impinge on the spinal cord and nerves and cause pain. The pain may be in the neck or arms(s), or both. If the pain radiates into the arms(s), it is called radiculopathy. Other conditions may also cause radiculopathy, such as a bone spur (osteophyte) pinching a spinal nerve, or more rarely a tumor or infection. Conditions affecting the brachial plexus and nerves in the shoulder or the median, ulnar, and radial nerves in the arm and wrist can also cause neurologic dysfunction similar to cervical radiculopathy.

Symptoms of Cervical Radiculopathy (Arm Pain)

Radiculopathy is typically present in one arm only, but occasionally occurs in both arms. The arm and hand symptoms may manifest as a shooting electricity pain down the shoulder, arm, forearm, hand, and into specific fingers. The radicular pain may also have a component of numbness, tingling (parasthesia), and/or weakness. Patients may have difficulty turning their head because of the pain. Shoulder pain that arises from within the shoulder joint, particularly with abduction and raising the arm and shoulder generally indicates a shoulder problem such as bursitis or a rotator cuff injury. This type of pain is called referred pain, when the pain of a nearby joint causes the entire region or extremity to be painful.

Physical Findings of Cervical Radiculopathy (Arm Pain)

Since the majority of patients with cervical radiculopathy have the underlying diagnosis of a herniated disc, the physical findings are usually the same. Patients with cervical radiculopathy may have decrease cervical (neck) range-of-motion, especially rotation (looking from side to side). There may be significant weakness in one or more muscle groups and numbness in a specific dermatomal distribution. Patients with longstanding nerve compression and muscle weakness may demonstrate atrophy (decreased size) of the affected muscle(s), and this may be quite noticeable when comparing it with the opposite arm. Deep tendon reflexes may be diminished or absent for the particular spinal nerve that is affected.

Investigation for Cervical Radiculopathy (Arm Pain)

An MRI of the spine is most useful to evaluate a patient with cervical radiculopathy. An MRI utilizes a powerful magnet and computer system to generate images in three dimensions of all structures, including the intervertebral disc, spinal cord and nerves, muscles, bone, and other soft tissues. Regular x-rays are most useful to evaluate fractures, instability, or arthritis changes of the spine. However, x-rays do not allow one to visualize the soft tissues of the spine such as disc, nerves, or muscles, and usually will not identify the cause of sciatica symptoms.

Diagnosis of Cervical Radiculopathy (Arm Pain)

The diagnosis of radiculopathy is typically made by taking a detailed patient history alone. Physical examination can further clarify the diagnosis. However, an MRI of the cervical spine will often be required to confirm the actual cause of the radicular pain. It is important for the clinician to conduct a thorough history and clinical examination prior to formulating the final diagnosis so as not to misdiagnose this condition.

Treatment Options for Cervical Radiculopathy (Arm Pain)

The natural history of a cervical herniated disc and radiculopathy is favorable, meaning that the majority of patients improve with conservative treatments and do not require surgery. Quite often, patients with cervical radiculopathy will quickly improve with a few days of rest, use of a soft cervical collar, and oral anti-inflammatory medications and pain medications. Muscle relaxant medications can also be used for severe pain and muscle spasms. Cervical epidural steroid injections and/or nerve root blocks may also be utilized for severe pain or moderate pain that is no longer responding to other conservative measures. Surgical options, such as anterior cervical discectomy and fusion or microscopic posterior cervical foraminotomy may be recommended for patients who fail conservative treatments. These surgical treatments, when indicated, demonstrate a high rate of success in relieving pain and restoring function, and often a rapid return to normal activities.

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Arm Fracture in Children

An arm fracture is a crack or break in one or more of the bones in your child’s arm.

Anatomy of the Arm

What causes an arm fracture?

The following are the most common causes of arm fractures:

  • Trauma: A direct hit to your child’s arm may cause a fracture. Car and sports accidents are some examples of trauma that can cause an arm fracture.
  • Fall: The pressure when your child lands on his hands after a fall may cause his arm bone to break.
  • Stress fracture: This is a tiny fracture that happens when your child’s arm muscles become tired from overuse. Stress fractures happen most often during sports when the same motion happens over and over.

What are the different types of arm fractures?

  • Nondisplaced: The bone breaks but the pieces stay in place.
  • Displaced: The bone breaks, and the pieces move out of place.
  • Open fracture: The broken bone breaks through your child’s skin.
  • Salter-Harris fracture: The bone breaks through your child’s growth plate.

What are the signs and symptoms of an arm fracture?

  • Arm and shoulder pain
  • Swollen and bruised arm
  • Abnormal arm position
  • Severe pain when your child moves his arm
  • Weakness or numbness in your child’s arm, hand, or fingers

How is an arm fracture diagnosed?

Your child’s caregiver will ask about his injury and examine him. Your child may need the following tests:

  • X-ray: An x-ray will show the type of fracture your child has.
  • CT scan: This test is also called a CAT scan. An x-ray and computer are used to take pictures of your child’s arm. He may be given dye before the test. Tell caregivers if your child is allergic to iodine or seafood. He may also be allergic to the contrast dye.
  • MRI: This scan uses a powerful magnet and a computer to take pictures of your child’s arm. Your child may be given dye before the test. Tell caregivers if your child is allergic to iodine or seafood. He may also be allergic to the contrast dye. Your child will need to lie still during his test. Never enter the MRI room with any metal objects. This can cause serious injury.
  • Bone scan: This is a test to look at your child’s arm bones. He is given a small, safe amount of dye in an IV. Pictures are taken of his injured arm. The pictures will help caregivers see your child’s arm fracture better.

How is an arm fracture treated?

Treatment will depend on what kind of fracture your child has, and how bad it is. He may need any of the following:

  • Brace, cast, or splint: A brace, cast, or splint will decrease your child’s arm movement and hold the broken bones in place. This will help decrease pain, and prevent further damage to his broken bones.
  • Medicines:
    • Pain medicine: Your child may be given medicine to take away or decrease pain. Do not wait until the pain is severe before you give your child his medicine.
    • Antibiotics: This medicine is given to help prevent or treat an infection caused by bacteria.
  • Physical therapy: A physical therapist can teach your child exercises to help improve movement and decrease pain. Physical therapy can also help improve strength and decrease your child’s risk for loss of function.
  • Surgery: Your child may need debridement before his surgery if he has an open fracture. Debridement is when damaged tissue is removed and the wound is cleaned. Debridement helps prevent infection and improve healing. Your child’s caregiver will use pins, screws, wires, or other materials to hold the bones straight so they can heal. Your child may have pins coming out of his skin.

What are the risks of an arm fracture?

Your child’s arm may not be straight, even after treatment. The nerves in his arm may be damaged, which can make his arm numb or weak. His arm may not heal properly or work as well as it did before your injury. He may have a scar if he has surgery.

When should I seek immediate help for my child?

  • The pain in your child’s injured arm does not get better or gets worse, even after rest and medicine.
  • Your child’s arm, hand, or fingers feel numb.
  • Your child’s arm is swollen, red, and feels warm.
  • You see blood on your child’s splint or cast.

For more information or to schedule for an appointment, please call +65 6471 2744 or Email to: info@boneclinic.com.sg