Arm and hand pain causes: Tissue degeneration and atrophy (incl. enthesopathy and Trigger Points)

Arm pain, Hand pain, Understanding pain / Monday, November 23rd, 2009

This is a series on arm and hand pain causes. If you missed the beginning, go back to the Checklist.

“Use it or lose it,” the saying goes, and with muscles, there’s a lot of truth to that. If you’ve ever seen the before and after view of someone who has had a cast for a broken limb, you’ve probably seen how much the muscles can shrink. It only takes two weeks to lose immobilized muscle tissue and much longer than that to build it back up.

The tendency is to rest a muscle when it is painful to use it. That’s logical if using it is causing harm.  It isn’t always clear that movement is doing that, however, which is why Physical Therapists and doctors prescribe strengthening exercises to improve these conditions. Understanding why arm and hand muscles are in pain is key to deciding whether to rest it or use it.

Trigger Points
are a major concern in this regard, and often not considered in the diagnosis and treatment of acute and chronic muscle and joint pain. Trigger Points cause the muscle in which they occur to contract constantly. Giving such a muscle extra work to do only makes it worse. The reason is that a working muscle is burning metabolic fuel. Every time fuel is burned, a waste product is produced. In the case of muscles, metabolic waste products are acidic, like lactic acid. Acids can damage soft tissue and cause degeneration if they aren’t cleared away. Degenerated tissue becomes chronically irritated and weak, eventually bcoming atrophied.

Another cause of pain and damage to soft tissue is caused by chronic irritation to tendons by microtears caused by overuse. These tiny tears at the attachments of the muscles cause a “non-specific inflammatory response” that promotes healing unless the tendon is continuously damaged. The condition is called tendonitis when the damage is chronic. Tendonitis can become enthesopathy (according to Travel and Simons, a disease process at the attachments of tendons or ligaments to bones or joints). Enthesopathy can turn into enthesitis, a chronic condition that can cause fibrosis and calcification at these attachment sites.

So this is a little like arthritis where chronic inflammation causes changes in the bone. Once that happens, it’s hard to stop the process and harder to cure the condition. Paying attention to keeping the soft tissue healthy in the beginning stages is very important. Getting appropriate and effective treatment and doing your home care is crucial to bringing your muscles back to health. Rest has it’s place when movement causes friction and inflammation, but releasing the tension that causes irritation is the key to recovery. This is the work I do in my Neuromuscular Therapy center near Boston.