Wednesday, 3 October 2012

Cervical Spine Scapegoats


Headaches, shoulder pain, pins and needles in your hand might sound like very separate injuries but in fact can all potentially be traced back to dysfunction at the cervical spine. In this post we’ll look at some of the pathologies, signs and symptoms that can be attributed to problems occurring at the neck.

Cervical headaches

Cervical headaches or cervicogenic headaches are tricky to differentiate from migraines or regular headaches but are defined as being caused by dysfunction and resultant inflammation of the upper cervical spine (Jull, 1994) and usually feel like a dull aching pain spreading up into the head and predominantly on one side (Sjaastand and Fredriksen, 2000). These can arise suddenly after a traumatic injury such as whiplash or gradually from poor head posture sustained for long periods (e.g. at work working at the computer too far ahead of you). Other causes for cervical headaches include compression or entrapment of the greater occipital nerve as it runs through the neck muscles such as semispinalis and the upper fibres of trapezius. (Rosenholtz et al, 2003.)

A forward head or “pokey chin” posture is one of the common correlates with cervical headaches. (Griegel-Morris et al, 1992; Haughie et al, 1995). This can arise from tightness in certain muscle groups placing excessive stress on the joints of the upper cervical spine. Muscles that are commonly tight are: sternocleidomastoid, suboccipitals, upper traps, pecs and weakness in the deep neck flexors lower and middle fibre traps (Janda, 1994).

Referred pain into shoulder, arm or hand
Inflammation, disc protrusions or degenerative changes in the cervical spine such as narrowing of joint space or the formation of small bony growths called osteophytes can impinge on nerves resulting in: pain (often described as shooting or burning), sensory disruption (e.g. tingling, numbness, altered sensation, pins and needles), and in more severe cases motor dysfunction (muscle weakness, reduced reflexes).

Dermatomes are areas of skin innervated by predominantly one nerve root. While there is invariably some overlap of these areas, pain in a certain dermatomal region can indicate the corresponding level of the cervical spine where the dysfunction is originating from.

C2 - Posterior occipital headaches, temporal pain
C3 -
Occipital headache (back of head), retro-orbital (behind eyes) or retroauricular (behind ears) pain
C4 - Base of neck, trapezial (upper shoulder) pain
C5 -
Side of upper arm pain
C6 -
Thumb side forearm pain, pain in the thumb and index fingers
C7 - Middle finger pain
C8 -
Pain in the ring and little fingers
T1 -
Little finger side forearm pain

In conclusion don’t be too quick to assume that where you’re experiencing symptoms is necessarily where the source of problem is. Your physiotherapist through a comprehensive assessment of your history and physical examination will be able to determine the most likely cause of referred pain and discuss the most appropriate treatment approach.

J.Glover BSc Physiotherapist MCSP