by Christina Abbott on March 11, 2010
This is part of a series on the causes of arm and hand pain. To see the general list, go back to the checklist of causes.
The supinator and both pronator muscles are located right in the forearm. They cause pain locally and down into the wrist and thumb. The brachioradialis is a longer muscle but has a referred pain pattern similar to the supinator and a similar function.
The supinator muscle (in red to the left here) is known mostly for causing “tennis elbow” and lateral epicondylitis, or pain in the outer part of the elbow. It nestles deep around the bones of the joint, wrapping around the radius bone of the forearm on the thumb side, attaching below to the ulna bone near your elbow. It’s job is to turn your arm so your palm faces upward. Local pain can be felt both with movement and at rest. Referred pain from Trigger Points is felt in the elbow, but also down into the base of the thumb and the back side of the web between the thumb and index finger.
The brachioradialis attaches between the upper arm bone (humerus) and the head of the radius bone at the thumb side of the wrist. The reason I include it here is that it causes pain in the outside of the elbow like epicondylitis and performs the same motion of twisting the arm as the supinator, like opening doors with a doorknob. Referred pain also goes down into the base of the thumb and the back of the web between the thumb and index finger.
The pronator teres turns the palm downward, opposite to the supinator, and attaches between the inner elbow and the middle of the radius bone of the forearm. The pain it causes from Trigger Points is in the inner fleshy part of the forearm and down into the wrist and base of the thumb. The pronator quadratus spans the space between the ulna and radius at the wrist and has the same action as the pronator teres. It occupies a similar position to the carpal ligament that forms the top of the carpal tunnel. It’s Trigger Points are not recorded, but local pain would be at the wrist, more toward the base of the thumb.
by Christina Abbott on February 19, 2010
This is part of a series on the causes of arm and hand pain. To see the general list, go back to the checklist of causes.
The scalene muscles have two important contributions to arm and hand pain. First is that the scaleni are the first point of entrapment for the nerves and blood vessels that serve the arm, an area called the thoracic outlet of which the scaleni are the first part. The second contribution is that this little set of 4 muscles have major Trigger Point referrals to the arm and hand. (scaleni [say sk-ahh-lay-nee] in Latin is the plural of scalenus used to name the 4 muscles of this group)
You’ve probably heard of thoracic outlet syndrome, a description of symptoms occurring when blood and nerve supply to the upper extremity is compromised. Symptoms vary, but usually include tingling and numbness and various degrees of pain depending on the degree of neurovascular entrapment or nerve compression. One of the obvious signs is numbness, especially with the arm raised above the shoulder. When nerves are entrapped, there is loss of sensation and muscle function.
When blood vessels are trapped, pain can occur. Think of a heart attack. There is local and referred pain. Cells can’t live without blood because it carries the oxygen and nutrients necessary for health and removes waste products that cause irritation and pain. There are severe warning signs from the body when blood is lacking because it is necessary for life!
The Trigger Points from these little muscles are major in comparison to their size. They are almost always part of the pain puzzle that needs to be solved when thinking about the causes of arm and hand pain. Treatment involves manual treatment, specific stretches for the neck and shoulder and deep breathing.
In my Neuromuscular Therapy center near Boston, arm and hand pain is treated every week using manual techniques. We also instruct patients in corrective stretches and positional changes that affect the muscles of the neck and anterior shoulder.
by Christina Abbott on February 5, 2010
The muscles that move the arm from the shoulder are often implicated in painful conditions in the arms and hands. In my Neuromuscular Therapy practice near Boston, I find this often to be the original source of pain in the arms and the last problem spot to be corrected.
Pain in the arms and hands originating from the shoulders is usually due to Trigger Points in the rotator cuff muscles, the pectoral and subclavius muscles, the latissimus dorsi and serratus anterior. There are lots of muscles who’s business it is to move the arms. Look at the illustration on the left to see just those that are in the front of the shoulder.
Of all of these, I find the latissimus dorsi (part of it in yellow in the illustration) to be the most important for computer users because it moves the arm back and forth like when you’re moving the mouse. Trigger Points from the “lats” spread out over the lower part of the shoulder blade, down the side body and inside of the arm all the way down to the pinkie finger.
The serratus anterior moves the shoulder blade rather than the arm directly, but has a Trigger Point referral pattern similar to the lats.
The four rotator cuff muscles move the arm and have multiple TrP patterns as illustrated below.
The last group, the pectorals and subclavius have similar TrP patterns. A picture is worth a thousand words.
by Christina Abbott on January 26, 2010
The thumb is used in virtually all activities that involve the arm and hand. The thumb muscles, both the short ones in the hand (intrinsic) and the long ones (extrinsic) that control movement from the forearm are an important source of pain. Activities like texting on cell phones with buttons or emailing on Blackberries cause overuse of those muscles.
The ones that are used with texting and Blackberries are the ones that flex the thumb, or bend the tip of the thumb inward toward the palm. The long flexor in the forearm bends the end joint of the thumb first, next the middle joint, third the joint at the base of the thumb and finally the wrist itself. The short flexors are in two layers both of which attach from the middle joint of the thumb to the middle of the wrist where it meets the bones of the fingers. They assist the long flexor in moving that joint toward the wrist.
The muscles which bring the thumb across toward the opposite side of the palm are the two parts of the adductor pollicis brevis that attach the middle joint of the thumb to the bone of the middle finger in the palm.
The long flexor of the thumb (flexor pollicis longus) refers pain from its Trigger Point right into the thumb itself and as with the finger flexors, it can feel as if it’s going out the tip of the thumb. Dysfunction in the muscle itself can cause local tension and pain in the forearm where it is located.
The short flexors refer pain more into the base of the thumb and the fleshy part called the thenar eminence. Compression of the long flexor tendon between the layers can cause “trigger thumb” or “locking thumb.”
The muscle that brings the thumb toward the index finger is called the aDductor pollicis. It crosses the space between the index finger and thumb along with the 1st dorsal interosseous. The illustration shows it’s attachment to the bone of the middle finger in your palm (metacarpal). The aBductor pollicis brings the thumb away from it. The opponens pollicis brings it toward the pinkie and attaches the long bone of the thumb (metacarpal) to the wrist. All of these muscles have Trigger Points that refer into the thumb and base of the thumb.
On the back side of the forearm above the wrist are the other extrinsic thumb muscles. These are directly related to deQuervain’s syndrome and cause pain in the radial side of the wrist near the base of the thumb, along the radius bone and just above it.
Analyzing the movements of the thumbs in everyday activities as well as in technology, being specific about which muscles are being overused, and networking that information with the pain patterns experienced, together shed light on how I target treatment for arm and hand pain in my Neuromuscular Therapy center near Boston.
by Christina Abbott on January 19, 2010
This is a series on arm and hand pain causes. If you missed the beginning, go back to the Checklist. Treating arm and hand pain is an important part of my Neuromuscular Therapy practice near Boston.
The flexor muscles are on the fleshy belly side of the forearm and attach to the bony prominence of the elbow closest to your body (medial epicondyle), to the two bones of the forearm and to the connective tissue between them. The finger flexors are arranged in two layers between and under the wrist flexors. The wrist flexors are arranged like the bread of a sandwich on either side of the forearm closest to the two bones (radius and ulna). The pronator teres and some of the finger flexors are nestled in the middle like the sandwich filling with the remainder of the finger flexors spread underneath.
The function of the finger flexors is to close the hand (or individual fingers) around an object or to make a fist. The superficial layer is more specific to the middle joint of the fingers and the deep layer to the tip joint, but they assist each other. The function of the wrist flexors is to bend the hand toward the forearm (flexion) or to the right and left (deviation). Wrist and finger flexors assist each other and they all work together in forceful gripping motions. Even the extensor muscles get involved in these actions.
Symptoms of dysfunction occur when using scissors or pruners, especially when forceful or repeated use is required. Any cupping motion like squeezing a hair clip can be painful. Gripping a mouse can cause chronic tension. Drying hair using a brush and hair dryer can affect both hands and arms. Pulling weeds can be painful or any strong pulling and twisting motion with the hands in construction, even twisting a sticky doorknob. Driving when tense, gripping the steering wheel with a flexed wrist can aggravate the muscles.
Local pain from these muscles can be generated by dysfunction or injury to the muscles themselves, systemic factors like lack of blood or oxygen, toxic pain from accumulated chemicals and waste or irritation of the ulnar nerve near the elbow.
Dysfunction would be from spasm, weakness, and hyperactivity, but mostly from Trigger Points (TrPs). Referred pain from these hypersensitive nodules in the finger flexors goes down into the individual fingers and can feel like it’s shooting out the fingertips. TrP pain from the wrist flexors is felt mostly along the inner crease or sides of the wrist. Other symptoms are a weak or painful grip, pain bending the wrist, “golf (inner) elbow,” difficulty bending the fingers and “trigger finger” or “locking finger.” Referred pain can also come from the pectoralis minor, latissimus dorsi and serratus posterior superior muscles of the upper body.
In making decisions about the causes of a patient’s arm and hand pain, local dysfunction should be differentiated from Trigger Point symptoms, but both are usually present simultaneously.
by Christina Abbott on January 10, 2010
This is a series on arm and hand pain causes. If you missed the beginning, go back to the Checklist. Treating arm and hand pain is an important part of my Neuromuscular Therapy practice near Boston.
The extensor muscles are located on the back of the arm (dorsum, like the dorsal fin of a fish) and attach to the bone at the outer side of the elbow called the lateral epicondyle of the humerus, (the upper arm bone). The extensors are arranged like a sandwich with the muscles that move the wrist on the outside, like the bread, closest to the two bones (radius and ulna) and those that move the fingers down the middle like the sandwich filling.
The extensors function to raise the fingers up as when preparing to strike a key on the piano or keyboard or before clicking a mouse. They help lift the wrist. They are also used in a power grip, like opening a jar or shaking hands.
Local pain from these muscles can be generated by dysfunction or injury to the muscles themselves, systemic factors like lack of blood or oxygen, or toxic pain from accumulated chemicals and waste.
Dysfunction would be from spasm, weakness, old traumas, and hyperactivity, but mostly from Trigger Points. Referred pain from these hypersensitive nodules goes down the forearm away from where it originates into the dorsum of the hand and often to the fingers. Patients will often rub the back of their hand when describing their symptoms. Pain can feel like arthritis in the fingers or tennis elbow. Other symptoms are a weak grip, difficulty bending the tip joint of the finger and stiffness or loss of range of motion.
Trigger Points in the finger extensors are tricky to distinguish, but can be isolated by identifying a painful point in the forearm, then wiggling the fingers to feel which band of the muscle group is contracting at that tender point. Each band controls a specific finger and it’s TrP refers to that finger. The Trigger Point in the middle finger extensor is one of the most commonly found in the body. Pain from the ring finger and pinkie can project near to the outside of the elbow (lateral epicondyle), and pain from the short secondary pointer finger muscle is usually found where the wrist and the back of the hand meet.
In making decisions about the causes of a patient’s arm and hand pain, local dysfunction should be differentiated from Trigger Point symptoms, but both are usually present simultaneously.
by Christina Abbott on January 6, 2010
This is a series on the causes of arm and hand pain. There is a checklist for you at the beginning of this series.
We all hold our stress in different places depending on our personalities and life situations. I think we all understand from our own experience that negative emotions produce muscle tension. Healing Back Pain: The Mind-Body Connection by John E. Sarno, M.D. is an excellent reference. Dr. Sarno believes that withheld or subconscious rage is a major cause of pain and states that “As long as the person’s attention remains focused on the pain syndrome, there is no danger that the emotions will be revealed.” (p.49) Further, he states that “Anything that heightens anxiety will increase the severity of symptoms.”
In my Neuromuscular Therapy practice near Boston I hear this often. Just recently three patients connected the return of pain with anxious thoughts or stressful situations. On another level of understanding, Carolyn Myss, a gifted medical intuitive, Barbara Brennan, the energy healing guru, Louise Hay, a popular teacher of the mental causes of physical illness, and Dr. James Oschman, a cell biologist, all connect negative energy with pain and dysfunction in our bodies.
While repressed emotions can certainly result in pain, this is not always the case. However, it is an opinion that is rapidly gaining ground in medicine and one which anyone with chronic pain would benefit from exploring.
On a physiological level, strong emotions produce chemical and hormonal reactions. Adrenalin rushes are a good example. When emotions don’t dissipate and become like tapes spinning in our heads, the chemicals and hormones produced build up and continue to cause physical reactions. Repressed or withheld emotions work the same way even though they have become subconscious. They still trigger physiological reactions that irritate the muscles and nerves.
by Christina Abbott on January 5, 2010
This is a series on the causes of arm and hand pain. There is a checklist for you at the beginning of this series.
“Sit up straight!” your mother would correct you. It wasn’t only because you looked bad slumped over, she knew that it was bad for your back, probably because she suffered from back pain herself, but she didn’t know the effect on your arms and hands in this computer-oriented culture. This is going to be a damaged generation because of it.
The two most common postural causes of arm and hand pain are slumping and keeping the arms out in front on a keyboard or mouse or steering wheel. Both the rounded back and the forward-arm positions cause chest tension that leads to entrapment of nerves and blood vessels and the resulting pain in the upper extremities.
The primary postural stress is a slumped posture. Unfortunately, this is our popular casual American look. It is the equalizer, keeping you looking cool and relaxed, not standing out in the crowd. Sitting back on the base of your spine between your butt bones (sacrum and coccyx) rounds the lumbar vertebrae in the lowest part of your back outward toward the chair. These five chunky vertebrae are slightly wedge-shaped and are meant to stack up in a curve. In architecture, the arch is the strongest form of support. In the low back, this foundation structure supports the weight of the torso. When the curve is reversed as in the slumped posture, it disrupts the strength of the arch and forces the back to work harder to maintain the curve. Eventually the muscles get weak and vulnerable from the mild overuse, leading to shortening and tightening of chest and abdominal muscles, rounding the shoulders and forcing the head-forward, all of which can eventually lead to arm and hand pain.
The easy correction is to change the position of your lumbar spine to reestablish the natural curve, that strong architectural arch. To do that, rock your pelvis forward until you are positioned just in front of the highest part of the bones you sit on. When you do that, just like stacking kids blocks, the opposing curves of the mid-back and neck will naturally correct and you’ll be sitting straighter with your head back and balanced on top of your spine. It takes no effort to make this change, but your muscles will tire since they have become weak, returning you to the slumped position. Strengthening the core muscles and upper back muscles will help you maintain this as a comfortable posture and significantly reduce arm and hand pain.
A secondary postural stress is caused by the imbalance of the weight of the arms held out in front. The weight of the arms and hands plus the added weight of gravity puts a strain on the muscles of the upper back and shoulders as they try to hold that position. Pain is caused either by overuse of the muscles, lack of blood flow or distortion of nerve signals.
Positional stress is caused by any position that must be held for a while, like sitting at a computer or standing over a counter or a workbench. If there is a weight involved like holding the arms forward on the keyboard, controlling a tool, driving long distances or carrying a child the stress load is increased. The muscles work harder, the blood flow slows down with the tension, nutrients and oxygen don’t get delivered, waste products build up and you’ve got pain!
Posture and positional stress factors are evaluated in patients presenting with arm and hand pain at my Neuromuscular Therapy center near Boston.
by Christina Abbott on December 28, 2009
Repetitive stress and Repetitive Strain Injuries (RSI) are, in my opinion, the most common cause of arm and hand pain. Treatment of these injuries are a specialty in my Neuromuscular Therapy center near Boston. This post is part of a series on the causes of arm and hand pain. If you missed the beginning, go back to my Checklist of Causes.
When we move, our muscles work by contracting and relaxing, shortening then lengthening. Muscles work in opposing pairs. As one muscle contracts, the opposite muscles relax. That’s how we get movement. For instance, if the biceps contract to bend the arm at the elbow, the triceps must lengthen. If they both contract at the same time movement stops. That happens either for stability or because of diseases such as cerebral palsy. Every time a muscle contracts the blood flow is reduced by about 20%. When it relaxes, blood flows normally. Contracting and relaxing pumps blood in and waste out, keeping the muscles healthy and happily working for you.
Another thing that’s important to understand about muscles is that every time they do work they burn metabolic fuel. Every time you burn fuel you get waste products. Metabolic waste goes into the fluids around the muscles. If the muscles are constantly contracted, the waste can’t get out, so it gets stored in the tissue as acids (like lactic acid). With repetitive use, waste products build up and the blood can’t deliver enough nutrients and oxygen to keep the muscles healthy. Both cause toxic conditions and pain. Over time and with repetitive use the cells of the tissue involved become unhealthy, both because it can’t heal without getting enough blood and because the cells begin to break down in the toxic acidic environment in which they are trying to live.
In order to get rid of the pain and rebuild healthy muscles, it is essential to get blood flowing efficiently through them. Stretching lengthens them and allows more blood through. (Hold for two seconds max and repeat 10 times. This Active Isolated Stretching protocol is especially important for repetitive stress.) Stimulation like short applications of ice or heat increases blood and lymph flow in the capillary beds under the skin. Giving the muscles some time off reduces stress. Add some deep belly breathing. Relaxation has it’s place.
A third thing to remember about muscles is that when one muscle or group of muscles is chronically tight, the muscles that oppose them will be weak. Weakened muscles are more easily injured and cause a muscle imbalance. That leads to muscle compensation and eventually joint problems. The imbalance puts a strain on the wrist, thumb and elbow joints, tightening the muscles that move them, straining the ligaments that hold them together and compressing the nerves between them.
Repetitive stress on arm and hand muscles is common in our computer oriented culture. Taking frequent breaks, finding different ways of working (i.e. switching mouse hands or fingers, working in different positions), drinking enough water, watching posture to prevent tensing shoulder and chest muscles, stretching daily, getting aerobic activity mid-day, reducing stress and getting enough sleep are all preventative measures for avoiding more serious injuries.
by Christina Abbott on December 17, 2009
This is a series about the causes of arm and hand pain. If you missed the beginning, go back to the checklist or just scroll back to read previous entries.
Often the cause of arm and hand pain emerges after delving into a person’s past medical history and finding a forgotten injury or surgery. You wouldn’t think that something that happened when you were a young person so many years ago would cause a problem now!
Injuries that cause trauma to the soft tissue sometimes don’t heal normally, leaving scar tissue adhesions that distort the surrounding structures and prevent normal movement. Sometime those injuries cause joint misalignment as well, translating into nerve irritation that affects the muscles.
Kids who play hard get hurt. Sometimes those hurts cause the body to compensate and move in ways that overwork the muscles and distort the joints. Scar tissue adhesions can pull the whole network of connective tissue (fascia) out of line like a snag in a sweater. Sometimes the damaged tissue isn’t rehabilitated and eventually causes problems in movement or has to be used carefully to avoid pain from use that for a healthy muscle would not be too much. (I still have problems with my right leg from a double fracture 15 years ago and I had months of Physical Therapy.)
The same scenario applies to surgeries. During the healing process the tissue around the incision site changes and distorts any soft tissue connected to it. You can see the results on the skin with an indented scar and skin that doesn’t look like the skin around it. That happens beneath the skin too where muscles and fascia and blood vessels have been cut.
I still treat a woman who fell off a curb in an another country and fractured her elbow. It was set with a new titanium head on one bone, but Physical Therapists were never able to give her full range of motion. She had pain that went down into her arm and even to her hand at times. Over months of Neuromuscular Therapy, we finally were able to achieve full extension and get rid of the pain in her arm. She still requires maintenance, however, to prevent recurring pain from this old injury and surgery.
In my Neuromuscular Therapy center near Boston, the initial evaluation includes a medical history and exploration of any injuries or surgeries, even from years ago. They are often an underlying cause of low back pain.
