Back Clinic Nerve Injury Team. Nerves are fragile and can be damaged by pressure, stretching, or cutting. Injury to a nerve can stop signals to and from the brain, causing muscles not to work properly and losing feeling in the injured area. The nervous system manages a great majority of the body’s functions, from regulating an individual’s breathing to controlling their muscles as well as sensing heat and cold. But, when trauma from an injury or an underlying condition causes nerve injury, an individual’s quality of life may be greatly affected. Dr. Alex Jimenez explains various concepts through his collection of archives revolving around the types of injuries and condition which can cause nerve complications as well as discuss the different form of treatments and solutions to ease nerve pain and restore the individual’s quality of life.
The information herein is not intended to replace a one-on-one relationship with a qualified healthcare professional or licensed physician and is not medical advice. We encourage you to make your own health care decisions based on your research and partnership with a qualified health care professional. Our information scope is limited to chiropractic, musculoskeletal, physical medicines, wellness, sensitive health issues, functional medicine articles, topics, and discussions. We provide and present clinical collaboration with specialists from a wide array of disciplines. Each specialist is governed by their professional scope of practice and their jurisdiction of licensure. We use functional health & wellness protocols to treat and support care for the injuries or disorders of the musculoskeletal system. Our videos, posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate to and support, directly or indirectly, our clinical scope of practice.* Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We provide copies of supporting research studies available to regulatory boards and the public upon request.
We understand that we cover matters that require an additional explanation of how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900.
Excessive alcohol consumption: what is alcoholic peripheral neuropathy?
Alcoholic Peripheral Neuropathy
Alcoholic peripheral neuropathy (ALN) is a condition that damages the nerves in the body due to chronic alcohol consumption. It can cause sensory, motor, and autonomic dysfunction, which can lead to disability. This damage prevents the nerves from communicating information. Most symptoms generally start as mild but typically worsen over time as the neuropathy progresses. The most common symptoms are: (National Library of Medicine, 2023)
Numbness or tingling sensation in the extremities
Pain or a burning sensation in the extremities
Difficulty walking
Difficulty urinating
Difficulty talking or swallowing
Affected nerves include the peripheral and autonomic nerves, which help regulate internal body functions. Around 46% of chronic alcohol users will eventually develop the condition. (Julian T., Glascow N., Syeed R., & Zis P. 2019)
Causes
The exact cause of alcoholic neuropathy is unclear. But it is directly related to heavy and long-term alcohol consumption. (Julian T., Glascow N., Syeed R., & Zis P. 2019) It is believed overconsumption of alcohol can directly harm and hinder the nerves’ ability to communicate information. Unhealthy nutritional habits are often associated with it as well. Research shows that decreased thiamine/B vitamin plays a role, while others suggest an overall dietary deficiency may play a role. (Julian T., Glascow N., Syeed R., & Zis P. 2019) However, alcoholic neuropathy can also occur without the presence of malnutrition. (Julian T., Glascow N., Syeed R., & Zis P. 2019)
Neuropathy Development and Progression
Alcoholic peripheral neuropathy develops depending on many factors, including the amount of daily/nightly alcohol consumed, age and overall health, nutritional intake, and other individual factors. In most cases, the neuropathy takes several years or decades to develop, depending on the amount of alcohol consumed.
Pain or burning sensation in the arms, legs, or feet.
Symptoms that occur in the arms and legs typically affect both sides.
Cramps, aches, or weakness of the muscles.
Constipation or diarrhea.
Nausea and vomiting.
Difficulty urinating or incontinence.
Difficulty walking.
Difficulty talking or swallowing.
Heat intolerance.
Erection difficulties.
Most symptoms begin as mild and usually worsen over time as the neuropathy progresses. Alcoholic neuropathy affects individuals who consume excessive amounts of alcohol over a long time. (Julian T., Glascow N., Syeed R., & Zis P. 2019)
Healthcare providers will collect data involving past medical history and all current symptoms.
Physical Exam
This exam looks at other medical conditions contributing to symptoms, like diabetes or high blood pressure.
Neurological Exam
This is a noninvasive exam to determine the location and extent of neurological damage.
Healthcare providers may ask patients several questions and have them complete a series of small movements to check neurological function.
Blood and Urine Tests
These tests can detect diabetes, liver and kidney problems, infections, vitamin deficiencies, and other conditions that can cause neuropathic conditions.
Chronic alcohol use can also affect how the body stores and uses vitamins necessary for healthy nerve function. Vitamin levels that a healthcare provider may check include: (National Library of Medicine, 2023)
Vitamin A
Biotin
Folic acid
Niacin, or vitamin B3
Pyridoxine, or vitamin B6
Pantothenic acid
Liver Disease
Individuals with chronic liver disease often have neuropathy. The severity and stage are associated with a higher incidence of neuropathy. (Pasha MB, Ather MM, Tanveer MA, et al. 2019)
Treatment
Alcoholic neuropathy is not reversible, even when quitting drinking. However, individuals with the condition can make healthy changes to minimize symptoms and receive help for chronic alcohol use. The first step is stopping alcohol consumption. (Chopra K., & Tiwari V. 2012) Talk to a healthcare provider about what options are available. Treatment can include:
In-patient or outpatient rehab
Therapy
Medication
Social support from groups like Alcoholics Anonymous
A combination of treatments will likely be utilized. Other treatment options involve symptom management and preventing further injuries and may include:
Physical therapy
Keeping the head elevated while sleeping.
Orthopedic splints to maintain limb function and positioning.
Wearing compression stockings.
Adding vitamins and supplements.
Eating extra salt for those without hypertension
Medications to reduce pain and discomfort.
Intermittent catheterization or manual expression of urine for those with difficulty urinating.
Individuals with neuropathy may have reduced sensitivity in the arms and legs. If this occurs, additional steps need to be taken to prevent other injuries, that include (National Library of Medicine, 2023)
Wear special footwear to prevent foot injuries.
Checking feet daily for wounds.
Prevent burns by ensuring that bath and shower water is not too hot.
Injury Medical Chiropractic and Functional Medicine Clinic
Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to build optimal health and wellness solutions. We focus on what works for you to relieve pain, restore function, prevent injury, and help mitigate issues through adjustments that help the body realign itself. They can also work with other medical professionals to integrate a treatment plan to resolve musculoskeletal problems.
Julian, T., Glascow, N., Syeed, R., & Zis, P. (2019). Alcohol-related peripheral neuropathy: a systematic review and meta-analysis. Journal of Neurology, 266(12), 2907–2919. doi.org/10.1007/s00415-018-9123-1
Chopra, K., & Tiwari, V. (2012). Alcoholic neuropathy: possible mechanisms and future treatment possibilities. British journal of clinical pharmacology, 73(3), 348–362. doi.org/10.1111/j.1365-2125.2011.04111.x
Can understanding how nociceptors function and their role in processing pain signals help individuals who are managing injuries and/or living with chronic pain conditions?
Nociceptors
Nociceptors are nerve endings that detect harmful stimuli, such as extreme temperatures, pressure, and chemicals, and signal pain. They are the body’s first defense against potentially damaging environmental inputs.
Nociceptors are in the skin, muscles, joints, bones, internal organs, deep tissues, and cornea.
They detect harmful stimuli and convert them into electrical signals.
These signals are sent to the brain’s higher centers.
The brain interprets the signals as pain, which prompts the body to avoid the harmful stimulus.
Nociceptors, often called pain receptors, are free nerve endings all over the body. They play a pivotal role in how the body feels and reacts to pain. The main purpose of a nociceptor is to respond to damage to the body by transmitting signals to the spinal cord and brain. (Purves D, Augustine GJ, Fitzpatrick D, et al., editors. 2001) If you bang your foot, the nociceptors on the skin are activated, sending a signal to the brain via the peripheral nerves to the spinal cord. Pain resulting from any cause is transmitted this way. Pain signals are complex, carrying information about the stimuli’s location and intensity. This causes the brain to fully process the pain and send communication back to block further pain signals.
Thermal nociceptors respond to extreme hot or cold temperatures.
For instance, when touching a hot stove, the nociceptors, which signal pain, are activated immediately, sometimes before you know what you’ve done.
Mechanical
Mechanical nociceptors respond to intense stretching or strain, such as pulling a hamstring or straining a tendon.
The muscles or tendons are stretched beyond their ability, stimulating nociceptors and sending pain signals to the brain.
Chemical
Chemical nociceptors respond to chemicals released from tissue damage.
For example, prostaglandins and substance P or external chemicals like topical capsaicin pain creams.
Silent
Silent nociceptors must be first activated by tissue inflammation before responding to a mechanical, thermal, or chemical stimulus.
Most visceral nociceptors are located on organs in the body.
Polymodal
Polymodal nociceptors respond to mechanical, thermal, and chemical stimuli.
Mechano-thermal
Mechano-thermal nociceptors respond to mechanical and thermal stimuli.
Pain Transmission
Nociceptors are also classified by how fast they transmit pain signals. Transmission speed is determined by the type of nerve fiber known as an axon a nociceptor has. There are two main types.
The first type is A fiber axon, fibers surrounded by a fatty, protective sheath called myelin.
Myelin allows nerve signals/action potentials to travel rapidly.
Because of the difference in transmission speed, the pain signals from the A fibers reach the spinal cord first. As a result, after an acute injury, an individual experiences pain in two phases, one from the A fibers and one from the C fibers. (Ngassapa D. N. 1996)
Pain Perception Phases
When an injury occurs, the stimulated nociceptors activate the A fibers, causing a person to experience sharp, prickling pain.
This is the first phase of pain, known as fast pain, because it is not especially intense but comes right after the stimulus.
During the second phase of pain, the C fibers are activated, causing an intense, burning pain that persists even after the stimulus has stopped.
The fact that the C fibers carry burning pain explains why there is a short delay before feeling the sensation.
The C fibers also carry aching, sore pain caused by organs within the body, such as a sore muscle or stomachache. (Ngassapa D. N. 1996)
Injury Medical Chiropractic and Functional Medicine Clinic
Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to build optimal health and wellness solutions. We focus on what works for you to relieve pain, restore function, prevent injury, and help mitigate issues through adjustments that help the body realign itself. They can also work with other medical professionals to integrate a treatment plan to resolve musculoskeletal problems.
From Injury To Recovery With Chiropractic Care
References
Purves D, A. G., Fitzpatrick D, et al., editors. (2001). Nociceptors. In Neuroscience. 2nd edition. (2nd ed.). Sunderland (MA): Sinauer Associates. www.ncbi.nlm.nih.gov/books/NBK10965/
Ngassapa D. N. (1996). Comparison of functional characteristics of intradental A- and C-nerve fibres in dental pain. East African medical journal, 73(3), 207–209.
Can understanding the anatomy and function of the long thoracic nerve help individuals make informed healthcare decisions after an injury to the nerve?
Long Thoracic Nerve
Also referred to as the posterior thoracic nerve, the long thoracic nerve/LTN is a thin superficial nerve that runs from the cervical spine to the chest wall side of the trunk. It supplies motor function to the thorax’s serratus anterior muscle, helping stabilize the shoulder blade. Injury to this nerve can cause limited or abnormal shoulder and shoulder blade motion, including difficulty raising the arm during overhead reaching.
Anatomy
The long thoracic nerve originates from the ventral rami of cervical nerves C5, C6, and C7. (Waxenbaum JA, Reddy V, Bordoni B. 2023) In some individuals, the root from C7 is absent; in others, a small nerve root branches from C8. The nerve roots from C5 and C6 go through the medial scalene muscle to join the C7 nerve. It travels behind the brachial plexus axillary artery and vein and courses down the lateral side of the thorax. The long thoracic nerve terminates at the lower portion of the serratus anterior muscle, sending small nerve tendrils to each muscle’s projections, which attach to the ribs. Because the long thoracic nerve is located on the lateral side of the chest, it is vulnerable to injury during sports or surgical procedures. The nerve also has a smaller diameter than other cervical and brachial plexus nerves, which increases its potential for injury.
Function
The long thoracic nerve attaches to the underside of the shoulder blade and inserts as muscular slips into the ribs. It supplies motor function to the serratus anterior muscle, essential for normal shoulder motion. When it contracts, it pulls the shoulder blade against the ribs and thorax, helping to move and stabilize the arm as it moves forward and up during shoulder motions. Injury to the long thoracic nerve causes a condition called scapular winging. This occurs when the serratus anterior muscle becomes weakened or paralyzed after injury. (Lung K, St Lucia K, Lui F. 2024)
Susceptibility to Injury
The LTN is relatively unprotected and can be damaged by several things, including:
Heavy backpacks
Sports
Activities the body is not used to, like digging
Using crutches
Conditions
Injury to the long thoracic nerve may occur as a result of trauma, lifting heavy weights above the shoulder, or a surgical procedure. Surgical procedures that may place the nerve at risk for injury may include: (Lung K, St Lucia K, Lui F. 2024)
Axillary lymph node dissection
Improperly placed intercostal drains
Chest tube placements
Mastectomy
Thoracotomy
The long thoracic nerve is protected during these procedures by the surgeon and proper surgical technique, but occasionally, difficulties arise during surgery, and the nerve may become injured. Individuals may also have an anatomical variance that places their nerves in varying positions. The surgeon may not see it and accidentally injure their nerves during surgery.
The superficial long thoracic nerve may also be injured during sports or trauma to the trunk. A blow to the side or a sudden overhead stretch to the shoulder may be enough to damage the nerve, paralyzing the serratus anterior muscle.
Weakness or paralysis of the serratus anterior muscle will result in a winged scapula. To test for this:
Stand about two feet from a wall, facing it.
Place both hands on the wall and gently push against it.
If one of the shoulder blades sticks out abnormally, it could be a winged scapula.
Have a family member or friend stand behind you and check the shoulder blade position.
If you suspect a winged scapula, visit a physician who can assess the condition and determine if there is a long thoracic nerve injury.
Winging the scapula may result in difficulty lifting the arm overhead. The serratus anterior muscle works with other scapular stabilizers, such as the upper trapezius and levator scapula, to properly position the shoulder blade when lifting the arm. Failure of the serratus to stabilize the shoulder blade may make lifting the arm impossible.
Clinical examination is usually used to diagnose a long thoracic nerve injury. X-rays and MRIs cannot show the nerve injury directly, although an MRI can show some secondary signs to help confirm the diagnosis. An electromyographic or EMG test may also be performed to examine the function of the long thoracic nerve.
Treatment and Rehabilitation
Treatment for LTN pain and reduced movement may include:
Rest
Heat or ice
Anti-inflammatory pain medication
Neck support or a pillow
Avoiding strenuous activity and driving
If the long thoracic nerve is severely injured and the serratus anterior is completely paralyzed, the best course of action is to be active and monitor the condition. Full recovery of arm function can take one to two years. If permanent nerve injury has occurred, surgery may be an option to restore shoulder motion and function. Several different kinds of surgery can be used to address winged scapula. (Vetter M. et al., 2017)
One involves transferring the pectoralis major tendon to the scapula (Vetter M. et al., 2017) so it functions as the serratus.
Often, the tendon has to be lengthened, which may be done using part of the hamstring tendon.
After surgery, individuals will likely wear a sling on their arm for a few weeks, and then gentle range-of-motion exercises will be initiated.
After eight to ten weeks, gentle progressive strengthening of the new tendon can begin.
Full shoulder motion and strength recovery are expected six to 12 months after surgery.
Vetter, M., Charran, O., Yilmaz, E., Edwards, B., Muhleman, M. A., Oskouian, R. J., Tubbs, R. S., & Loukas, M. (2017). Winged Scapula: A Comprehensive Review of Surgical Treatment. Cureus, 9(12), e1923. doi.org/10.7759/cureus.1923
Berthold, J. B., Burg, T. M., & Nussbaum, R. P. (2017). Long Thoracic Nerve Injury Caused by Overhead Weight Lifting Leading to Scapular Dyskinesis and Medial Scapular Winging. The Journal of the American Osteopathic Association, 117(2), 133–137. doi.org/10.7556/jaoa.2017.025
Can individuals with nerve injuries incorporate non-surgical treatments to reduce pain sensations and restore motor function to their bodies?
Introduction
The human body is a complex machine of nerves, bones, organs, tissues, and muscles that help the individual be mobile, flexible, and stable during various activities without pain and discomfort. However, when numerous factors start to hurt the body, it can lead to multiple overlapping risk profiles that can affect the body’s extremities and nerve injuries. Dealing with nerve injuries can lead to referred pain in the musculoskeletal system, and many people think it is muscle pain instead of nerve injury. When that happens, many individuals will begin to seek treatment to reduce not only the symptoms of nerve injuries but also reduce the pain associated with the nerves. In today’s article, we will look at what causes nerve injuries and how non-surgical treatments like chiropractic care and acupuncture can help with reducing the overlapping symptoms of nerve injuries and provide relief to the body. We discuss with certified medical providers who inform our patients about how nerve injuries can impact the musculoskeletal system. While asking informed questions to our associated medical providers, we advise patients to incorporate non-surgical treatments like chiropractic care and acupuncture to restore motor function to the body. Dr. Alex Jimenez, D.C., encompasses this information as an academic service. Disclaimer.
What Causes Nerve Injuries?
Do you constantly feel tingling or numbness in your legs, arms, feet, and hands? Do your muscles feel so weak that holding objects seems difficult? Or do you feel pain in your extremities, making it difficult to do everyday tasks? The body has trillions of nerves that branch out from the central nervous system and are intertwined with the muscles, tissues, and organs for motor-sensory function. Traumatic injuries, accidents, and normal environmental factors impact the nerves and cause overlapping risk profiles. More often than not, many individuals deal with non-mechanical and mechanical nerve injuries that can occur to the body. With nerve injuries, many individuals can feel various symptoms depending on the severity. Neuropraxia, a moderate form of nerve injury, causes nerve compression in the upper and lower extremities that causes motor dysfunction. (Carballo Cuello & De Jesus, 2024)
Additionally, neuropraxia can lead to functional impairment to the motor-sensory dysfunction that disrupts the peripheral nervous system, signaling this blocks nerve conduction and transient weakness or paresthesia. (Biso & Munakomi, 2024) When this happens, many individuals dealing with peripheral nerve injury that is associated with neuropraxia can experience structural and functional impairment to the sensory-motor skills in the extremities, which leads to physical disability and neuropathic pain, thus affecting a person’s quality of life. (Lopes et al., 2022) Many individuals dealing with nerve injuries can have various recovery periods depending on the severity. Many people often think they are dealing with musculoskeletal pain in their neck, shoulders, back, and extremities, but it is associated with nerve injury. When this happens, many individuals can seek out treatment to reduce the pain-like symptoms from nerve injuries.
Is Motion The Key To Healing?- Video
Non-Surgical Treatments For Nerve Injuries
When it comes to treating nerve injuries, it depends on the severity of the symptoms they cause. Surgical options are recommended to restore motor-sensory function if severe mechanical factors cause nerve injury. However, many individuals will opt out of surgical treatments due to their high cost and will often take over-the-counter medication to ease the pain. However, if the nerve injury is non-mechanical, many individuals can seek non-surgical treatments to reduce the nerve injury affecting the musculoskeletal system. Many non-surgical treatments are preferable to many people because they are cost-effective and can ultimately enhance a person’s care and improve their recovery outcome. (El Melhat et al., 2024) Non-surgical treatments can come in many forms, from chiropractic care to acupuncture, to help reduce the effects of non-mechanical nerve injuries and help restore the sensory-motor function of the musculoskeletal system.
Chiropractic Care
Chiropractic care is one of the many non-surgical therapies that use mechanical and manual manipulation of the spine to realign the body and help restore the sensory-motor function to the extremities. With nerve injuries, chiropractic care can help with neural mobilization to release trapped nerves in the affected muscle areas, thus reducing pain-like symptoms of tingling sensations. (Jefferson-Falardeau & Houle, 2019) Additionally, chiropractic care can help increase ROM (range of motion) in the extremities and reduce numbing and tingling sensations.
Acupuncture
Acupuncture is another non-surgical treatment that can also help reduce non-mechanical nerve injuries to the body. When a professional acupuncturist uses small, thin needles at different pressure points to rewire the neuron signaling and restore the body’s energy flow, acupuncture can help improve the clinical efficacy of nerve pain intensity and help enhance the person’s quality of life. (Li et al., 2023) Additionally, acupuncture can help improve nerve injury’s emotional and cognitive function and can be combined with other non-surgical treatments. (Jang et al., 2021) When it comes to reducing pain-like symptoms correlated with nerve injury, non-surgical treatments can provide the relief many individuals seek and lead to a happier, healthier life.
El Melhat, A. M., Youssef, A. S. A., Zebdawi, M. R., Hafez, M. A., Khalil, L. H., & Harrison, D. E. (2024). Non-Surgical Approaches to the Management of Lumbar Disc Herniation Associated with Radiculopathy: A Narrative Review. J Clin Med, 13(4). doi.org/10.3390/jcm13040974
Jang, J. H., Song, E. M., Do, Y. H., Ahn, S., Oh, J. Y., Hwang, T. Y., Ryu, Y., Jeon, S., Song, M. Y., & Park, H. J. (2021). Acupuncture alleviates chronic pain and comorbid conditions in a mouse model of neuropathic pain: the involvement of DNA methylation in the prefrontal cortex. Pain, 162(2), 514-530. doi.org/10.1097/j.pain.0000000000002031
Jefferson-Falardeau, J., & Houle, S. (2019). Chiropractic Management of a Patient With Radial Nerve Entrapment Symptoms: A Case Study. J Chiropr Med, 18(4), 327-334. doi.org/10.1016/j.jcm.2019.07.003
Li, X., Liu, Y., Jing, Z., Fan, B., Pan, W., Mao, S., & Han, Y. (2023). Effects of acupuncture therapy in diabetic neuropathic pain: A systematic review and meta-analysis. Complement Ther Med, 78, 102992. doi.org/10.1016/j.ctim.2023.102992
Lopes, B., Sousa, P., Alvites, R., Branquinho, M., Sousa, A. C., Mendonca, C., Atayde, L. M., Luis, A. L., Varejao, A. S. P., & Mauricio, A. C. (2022). Peripheral Nerve Injury Treatments and Advances: One Health Perspective. Int J Mol Sci, 23(2). doi.org/10.3390/ijms23020918
An axillary nerve injury can cause pain, weakness, and shoulder mobility loss. Can physical therapy help restore and maintain shoulder joint flexibility?
Axillary Nerve
The axillary nerve, or the circumflex nerve, is a peripheral nerve that runs through the shoulder and supports movement and sensation in the upper limbs. It originates in the neck at the brachial plexus, a network of nerves that extends from the neck and upper torso to the shoulders and arms. Its primary purpose is to supply nerve function to the shoulder joint and three muscles in the arm and also innervates some skin in the region.
Anatomy
Except for the cranial nerves, all the body’s nerves branch off from the spinal cord, emerge from between vertebrae and continue to branch off as they travel to various muscles and other structures. The axillary nerve is named after the axilla, the medical name for the armpit. Individuals have two, one on each side. After leaving the spinal column, the axillary nerve runs behind the axillary artery and continues to the shoulder blade’s lower edge of the subscapularis muscle. It winds back and travels down the arm along the posterior humeral circumflex artery, which then passes through the quadrangular space (a small area of the shoulder blade just above the armpit where there is a gap in the muscles that allows nerves and blood vessels to pass through to the arm before it divides into terminal branches, which are:
Anterior Division
Supplies motor innervation to the deltoid’s anterior and middle heads, allowing the arm to abduct or move away from the body.
It winds around the neck of the humerus/funny bone, goes beneath the deltoid muscle, and then connects to the forward edge of the deltoid.
A few small cutaneous branches serve the skin in that area.
Posterior Division
Innervates the teres minor muscles and the lower part of the deltoid.
It enters the deep fascia and becomes the superior lateral cutaneous nerve.
It then wraps around the lower edge of the deltoid, connects to the skin over the lower two-thirds of the muscle, and covers the long head of the triceps brachii.
Articular Branch
Comes from the trunk of the axillary nerve and enters the glenohumeral joint, which is in the shoulder, below the subscapularis muscle.
Anatomical Variations
In a case report, healthcare providers noted an incidence of the nerve branching directly off the upper trunk of the brachial plexus rather than the posterior cord. (Subasinghe S. K. and Goonewardene S. 2016) In this case, it innervated the subscapularis muscle, latissimus dorsi, and the deltoid and teres minor muscles and also had a communicating branch to the posterior cord. Another case documented multiple abnormalities in the course of the axillary nerve in an individual with pain and severely limited shoulder mobility. (Pizzo R. A. et al., 2019) During reverse shoulder arthroplasty, the surgeon discovered that the axillary nerve ran beside the coracoid process instead of underneath and stayed close to the subscapularis muscle instead of traveling through the quadrangular space. The case noted earlier reports of axillary nerves not running through the quadrangular space. In those cases, the nerve pierced the subscapularis muscle or split into branches before reaching the quadrangular space.
Function
The axillary nerve functions as a motor nerve that controls movement and a sensory nerve that controls sensations like touch or temperature.
Motor
As a motor nerve, the axillary nerve innervates three muscles in the arm and includes:
Deltoid
Allows flexing of the shoulder joint and rotating the shoulder inward.
Long Head of the Triceps
It runs down the back of the outer arm, allowing straightening, pulling the upper arm toward the body, or extending it backward.
The radial nerve can also innervate this muscle.
Teres Minor
One of the rotator cuff muscles starts outside the shoulder and runs diagonally along the bottom edge of the shoulder blade.
It works with other muscles to allow for the external rotation of the shoulder joint.
Sensory
In its sensory role, the nerve carries information to the brain from the following:
Glenohumeral joint or the ball-and-socket joint in the shoulder.
The skin on the lower two-thirds of the deltoid muscle through the superior lateral cutaneous branch.
Injuries and Conditions
Problems with the axillary nerve can be caused by injuries anywhere along the arm and shoulder and by disease. Common injuries include:
Dislocations
Of the shoulder joint, which can cause axillary nerve palsy.
Fracture
Of the surgical neck of the humerus.
Compression
This stems from walking with crutches, also known as crutch palsy.
Direct Trauma
This can be from an impact sports, work, automobile accident, collision, or laceration.
Added Pressure
This can be from wearing a cast or splint.
Surgical Accidental Injury
An injury or damage can come from shoulder surgery, especially arthroscopic surgery on the inferior glenoid and capsule.
Quadrangular Space Syndrome
This is where the axillary nerve is compressed where it passes through that space, which is most common in athletes who perform frequent overhead motions)
Nerve Root Damage
Between the fifth and sixth cervical vertebrae, where the nerve emerges from the spinal cord, which can be caused by traction, compression, spinal disc prolapse, or a bulging disc.
Systemic Neurological Disorders
Example – multiple sclerosis
Erb’s Palsy
A condition often is the result of a birth injury called shoulder dystocia, in which a baby’s shoulder/s becomes stuck during childbirth.
Axillary Nerve Palsy
Damage can result in a type of peripheral neuropathy that can cause weakness in the deltoid and teres minor muscles.
This can result in losing the ability to lift the arm away from the body and weakness in various shoulder movements.
If the damage is severe enough, it can cause paralysis of the deltoid and other minor muscles, resulting in flat shoulder deformity, in which individuals cannot lay their shoulders flat when lying down.
Axillary nerve damage also can lead to a change, reduction, or loss of sensation in a small part of the arm just below the shoulder.
Nerve Injury Statistics
Three times more common in men than women.
It may be present in as many as 65% of shoulder injuries.
The risk of injury due to dislocation is significantly increased after age 50.
Tests
If a healthcare provider suspects a problem with axillary nerve function, they’ll test the shoulder’s range of motion and skin sensitivity. A difference in the range of motion between the shoulders can indicate a nerve injury. Individuals may be sent for electromyography and a nerve conduction study to verify nerve palsy. In some cases, an MRI and/or X-rays may be ordered, especially if the cause of possible nerve damage is unknown.
Rehabilitation
Depending on the severity and cause of the injury, non-surgical treatments may be recommended, with surgery as a last resort. Non-surgical treatment can include some combination of immobilization, rest, ice, physical therapy, and anti-inflammatory meds. Physical treatment typically lasts about six weeks and focuses on strengthening and stimulating the muscles to prevent joint stiffness, which can impair long-term function.
Surgery
If conservative treatments don’t work, surgery may be recommended, especially if several months have passed without improvement. Surgical outcomes are generally better if surgery is performed within six months of the injury, and regardless of the time frame, the prognosis is considered positive in about 90% of cases. Surgical procedures performed for axillary nerve dysfunction or injury include:
Neurolysis
This procedure involves targeted damage/degeneration of nerve fibers, interrupts the nerve signals, and eliminates pain while the damaged area heals.
Neurorrhaphy
This procedure stitches a severed nerve back together.
Nerve Grafting
Grafting involves transplanting a portion of another nerve, usually the sural nerve, to reconnect severed nerves.
This helps, especially when the damaged portion is too large to be repaired by neurorrhaphy.
It allows a pathway for signals and encourages the regrowth of nerve axons.
Neurotization or Nerve Transfer
Similar to grafting but used when the nerve is too damaged to heal.
This procedure involves transplanting a healthy but less important nerve, or a portion of a nerve, to replace the damaged one and restore function.
Injury Medical Chiropractic and Functional Medicine Clinic
Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop an optimal health and wellness solution. We focus on what works for you to relieve pain, restore function, and prevent injury. Regarding musculoskeletal pain, specialists like chiropractors, acupuncturists, and massage therapists can help mitigate the pain through spinal adjustments that help the body realign itself. They can also work with other medical professionals to integrate a treatment plan to resolve musculoskeletal issues.
Shoulder Pain Chiropractic Treatment
References
Subasinghe, S. K., & Goonewardene, S. (2016). A Rare Variation of the Axillary Nerve Formed as Direct Branch of the Upper Trunk. Journal of clinical and diagnostic research : JCDR, 10(8), ND01–ND2. doi.org/10.7860/JCDR/2016/20048.8255
Pizzo, R. A., Lynch, J., Adams, D. M., Yoon, R. S., & Liporace, F. A. (2019). Unusual anatomic variant of the axillary nerve challenging the deltopectoral approach to the shoulder: a case report. Patient safety in surgery, 13, 9. doi.org/10.1186/s13037-019-0189-1
Can determining whether arm numbness occurs suddenly or gradually and whether there are other symptoms help healthcare providers diagnose and treat the condition?
Arm Numbness
Arm numbness or tingling are common symptoms that various medical conditions can cause. Numbness can be caused by a sudden health emergency, nerve disorder, or nutritional deficiency. (National Institute of Neurological Disorders and Stroke, 2024) Sometimes, this symptom results from an arm falling asleep and could resolve after just a few minutes. The sensation may be temporary, caused by something like sleeping in the wrong position. However, arm numbness and tingling may also be caused by neuropathy and chronic and progressive nerve damage and can also suddenly occur due to serious conditions, such as a heart attack or a stroke.
Circulation Issues
Deficient blood circulation in the arm could cause numbness and tingling as the nerves cannot receive enough oxygen. Conditions can interfere with normal blood flow and include: (Bryan L. and Singh A. 2024)
Atherosclerosis – plaque buildup in the arteries that may require medication or surgery.
Severe frostbite can damage the blood vessels but can be resolved with proper warming and wound care.
Vasculitis – is inflammation of the blood vessels that can be treated with medication.
Sleeping Position
A common example of sudden numbness and tingling is the feeling that the arm has fallen asleep. This usually occurs after sleeping awkwardly or leaning on the arm for a long time. Known as paresthesia, this sensation is related to the compression or irritation of nerves. (Bryan L. and Singh A. 2024) Sleeping in certain positions has been associated with nerve compression, especially when the hands or wrists are tucked or curled under the body, as well as maintaining proper spine alignment when sleeping, is the best way to prevent arm numbness.
Nerve Injuries and Conditions
Numbness that persists may be related to an injury or underlying health problem that affects the brachial plexus, a group of nerves that runs from the lower neck to the upper shoulders and controls movement and sensation in the arms. (Mount Sinai, 2022) Possible injuries that affect these nerves include: (Smith, S. M. et al., 2021)
A herniated disc caused by aging or trauma causes the disc to leak out and press on the nerve root.
Many medications, like gabapentin, can be used to alleviate the sensations of arm numbness.
Some medications can cause numbness as a side effect.
Some medications can cause complications, and arm numbness could be a symptom of those complications.
Inform healthcare providers about medications being taken to determine the relationship between them and any sensory changes.
Vitamin Deficiency
Peripheral neuropathy can also be caused by nutritional deficiencies and vitamin imbalances, which can damage nerves and cause sensation loss in the left or right arm. The most common sources are vitamin B12 deficiency and excess vitamin B6. (National Institute of Neurological Disorders and Stroke, 2024) Excessive alcohol consumption and other disorders that affect nutritional intake can also lead to nerve damage.
Injury Medical Chiropractic and Functional Medicine Clinic
At Injury Medical Chiropractic and Functional Medicine Clinic, our areas of practice include Chronic Pain, Personal Injury, Auto Accident Care, Work Injuries, Back Injury, Low Back Pain, Neck Pain, Migraine Headaches, Sports Injuries, Severe Sciatica, Scoliosis, Complex Herniated Discs, Fibromyalgia, Chronic Pain, Complex Injuries, Stress Management, Wellness & Nutrition, Functional Medicine Treatments, and in-scope care protocols. We focus on what works for you to relieve pain and restore function. If other treatment is needed, individuals will be referred to a clinic or physician best suited to their injury, condition, and/or ailment.
Chiropractic Care: The Natural Way to Recover From Injuries
Smith, S. M., McMullen, C. W., & Herring, S. A. (2021). Differential Diagnosis for the Painful Tingling Arm. Current sports medicine reports, 20(9), 462–469. doi.org/10.1249/JSR.0000000000000877
Senderovich, H., & Jeyapragasan, G. (2018). Is there a role for combined use of gabapentin and pregabalin in pain control? Too good to be true?. Current medical research and opinion, 34(4), 677–682. doi.org/10.1080/03007995.2017.1391756
Individuals experiencing pain, numbness, tingling, or a burning sensation in the front and outer thigh could have meralgia paresthetica, a nerve entrapment. Can understanding the condition help healthcare providers develop an effective treatment plan?
Meralgia Paresthetica
Meralgia paresthetica, or MP, is also known as Bernhardt-Roth syndrome, lateral femoral cutaneous nerve syndrome, or lateral femoral cutaneous neuralgia. It occurs when the lateral femoral cutaneous nerve, a sensory nerve that passes over the brim of the pelvis and down the front of the thigh, becomes compressed. The nerve supplies information about sensations over the front and outside of the thigh. This can happen for several reasons, including:
Recent hip injuries, such as from a motor vehicle collision/accident.
Repetitive hip activities, like cycling.
Pregnancy
Weight gain
Wearing tight clothing.
The nerve entrapment condition causes tingling, numbness, and burning pain in the front and/or outer thigh.
Causes
There can be several different causes of this condition, but it is frequently seen in pregnancy, sudden weight gain, wearing tight clothing or belts, and other conditions. (Ivins G. K. 2000) Sometimes, meralgia paresthetica can be caused by medical procedures. For example, the condition can present after an individual has surgery and is in an unusual position for a long period of time, where there is direct external pressure on the nerve. Also, the nerve can become damaged during a surgical procedure. (Cheatham S. W. et al., 2013) This can occur when a bone graft is obtained from the pelvis or anterior hip replacement surgery.
Sensitivity to lightly touching the outside of the thigh.
Worsening of symptoms with certain positions.
Increased symptoms when wearing belts, work belts, or tight-waist clothes.
The symptoms may come and go or be persistent. Some individuals are hardly noticeable and do not impact their lives or activities, while others can be very bothersome and cause significant pain. (Scholz C. et al., 2023)
Treatment
Treatment depends on how long the injury has been present and the frequency and severity of the condition.
Clothing Modifications
If the cause is due to tight clothing, belts, or work belts, then garment modification should alleviate symptoms.
If recent weight gain is thought to contribute to the condition, then a weight loss program may be recommended.
Cortisone Injections
If simple steps do not relieve symptoms, a cortisone injection around the nerve area may be recommended. The goal is to reduce inflammation that contributes to nerve pressure (Houle S. 2012) . Cortisone injections may be a definitive treatment or a temporary treatment.
Chiropractic
Chiropractic care can be an effective, natural, and safe treatment. Adjustments can help relieve pressure on the lateral femoral cutaneous nerve (LFCN) by realigning the spine and restoring nerve function. Chiropractors may also use soft tissue therapies, such as massage, to relieve muscle tension and support the body’s healing process. Other chiropractic techniques that may be used include:
A chiropractic treatment program may include 10–15 treatments over 6–8 weeks, but the number of treatments needed will vary from person to person. If there’s no noticeable progress after 3–4 weeks, it may be time to consult a specialist or surgeon.
Surgery
Surgery is rarely necessary. However, a surgical procedure may be considered when all conservative treatments fail to provide relief. (Schwaiger K. et al., 2018) A surgeon dissects and identifies the nerve, looks for compression locations, and tries to free the nerve from any areas where it may be pinched. Alternatively, some surgeons transect/cut the nerve so it no longer causes problems. If the transection procedure is performed, there will be a permanent area of numbness over the front of the thigh.
Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop a customized treatment plan to relieve pain, treat injuries, improve flexibility, mobility, and agility, and help individuals return to optimal function. If other treatments are needed, Dr. Jimenez has teamed up with top surgeons, clinical specialists, medical researchers, and rehabilitation providers to provide the most effective treatments.
Chiropractic Care for Leg Instability
References
Ivins G. K. (2000). Meralgia paresthetica, the elusive diagnosis: clinical experience with 14 adult patients. Annals of surgery, 232(2), 281–286. doi.org/10.1097/00000658-200008000-00019
Cheatham, S. W., Kolber, M. J., & Salamh, P. A. (2013). Meralgia paresthetica: a review of the literature. International journal of sports physical therapy, 8(6), 883–893.
Chung, K. H., Lee, J. Y., Ko, T. K., Park, C. H., Chun, D. H., Yang, H. J., Gill, H. J., & Kim, M. K. (2010). Meralgia paresthetica affecting parturient women who underwent cesarean section -A case report-. Korean journal of anesthesiology, 59 Suppl(Suppl), S86–S89. doi.org/10.4097/kjae.2010.59.S.S86
Scholz, C., Hohenhaus, M., Pedro, M. T., Uerschels, A. K., & Dengler, N. F. (2023). Meralgia Paresthetica: Relevance, Diagnosis, and Treatment. Deutsches Arzteblatt international, 120(39), 655–661. doi.org/10.3238/arztebl.m2023.0170
Hosley, C. M., & McCullough, L. D. (2011). Acute neurological issues in pregnancy and the peripartum. The Neurohospitalist, 1(2), 104–116. doi.org/10.1177/1941875211399126
Houle S. (2012). Chiropractic management of chronic idiopathic meralgia paresthetica: a case study. Journal of chiropractic medicine, 11(1), 36–41. doi.org/10.1016/j.jcm.2011.06.008
Schwaiger, K., Panzenbeck, P., Purschke, M., Russe, E., Kaplan, R., Heinrich, K., Mandal, P., & Wechselberger, G. (2018). Surgical decompression of the lateral femoral cutaneous nerve (LFCN) for Meralgia paresthetica treatment: Experimental or state of the art? A single-center outcome analysis. Medicine, 97(33), e11914. doi.org/10.1097/MD.0000000000011914
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