Barking up the wrong tree?

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The body is complicated and just because pain is felt in a particular area doesn't actually mean that this is where the pain is coming from.


Firstly you don't have to have neck pain for it to be coming from your neck:


"Cervical radiculopathy may or may not be associated with neck pain (Caridi et a 2011)."


For example Golfer's elbow:


In a study by Lee & Robinson (2010) they had fifty-five patients that were diagnosed with medial epicondylitis (Golfer's elbow). Of these, 44 had C6 and C7 radiculopathy whereas, 11 presented with just C6 radiculopathy. What this means is that either the Radiculopathy was mimicking the Golfer's elbow or it created a neurological weakness thereby causing the Golfer's elbow to develop.

Bottom line is that you need to treat the neck and if you just treat the elbow you are barking up the wrong tree!

It's the same problem with Tennis elbow too: This study  indicates that lateral epicondylitis symptoms are present in nearly 70% of patients who have a diagnosis of C6 or C7 radiculopathy or both (Rheumatology network 2010).

It also works the other way too!


For example somebody could have symptoms of tennis or Golfer's elbow and you think maybe its' the neck so you get an MRI of this and you see a disc prolapse, so bingo, that's it right?

Well maybe not, as this research shows:
86.7% of normal asymptomatic individuals show a disc bulge on Cervical spine MRI scans (Nakashima et al 2015).



Carpal Tunnel Syndrome is another common misdiagnosed area.


This study shows that the symptoms cross over but are more common in one or the other depending:
Hand paraesthesia is common in both Neck and Carpal tunnel issues. In Carpal tunnel syndrome, 84% had nocturnal paraesthesia, 82% had hand paraesthesia that was aggravated by hand activity, and hand pain occurred in 64%. The incidences were only 10%, 7% and 10%, respectively in Cervical spondylosis. Neck pain was present in 76% of Cervical spondylosis but only in 14% of Carpal tunnel syndrome, and lower limb symptoms were present in 44% of Cervical spondylosis and only 9% in Carpal tunnel syndrome (Chow et al 2005).

This is all well and good in a large sample but clearly an individual with true Carpal tunnel syndrome could be in the 16% of people with no nocturnal paraesthesia, in the 18% with no aggravation from hand activity, in the 36% who have no hand pain and could be in the 14% with neck pain and the 9% with lower limb symptoms. In this individual you would clearly think neck and you'd be wrong!!!

So overall what all this shows is that it is very easy to bark up the wrong tree so always think about all the possibilities and never rule something out completely as you could be wrong!



So if you want to get assessed and looked at, then you can contact me on any of the following:

Telephone: 01782 771861
Mobile: 07866195914
Email: mathewhawkesphysiotherapy@gmail.com



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