NERVE IMPINGEMENT – CERVICAL SPONDYLOSIS

A careful history which is suggestive pain with radiation in arms associated with tingling numbness is suggestive of cervical pain.

The network of nerves that service all parts of the body originates in the spinal cord. The spinal cord runs through the spinal canal inside the spine or backbone. Smaller nerves branch off the spinal cord at various points along the neck and back and exit through openings along the spine. If one of these nerves becomes pinched or partially blocked where it exists the spine, pain can result. Nerve impingement also occurs when one or more of the soft discs that serve as shock absorbers between the bones of the spine become are damaged or “slip out of place”. Impingement of the nerves by either of these processes can produce sharp “shooting” pain in the shoulders, arms, neck, or chest. These pains often are triggered by certain movements of the neck or arms.

Cervical Spondylosis is the disease of the bones of the neck. A disease commonly associated with ageing, it results in lack of flexibility of these bones and narrowing of the spaces which are present in between two bones. As a result of narrowing, the nerve roots get compressed. This can result in referred pain on the chest and the arm if the concerned the nerve happens to be supplying area over the chest and arm. These are called dermatomes. Thus a chest pain with arm pain can mimic the chest pain caused by angina/heart attack. A careful history which is suggestive of constant pain with radiation in arms associated with tingling numbness is suggestive of cervical pain. This pain will not be associated with aggravations during physical activities. Rather the pain may get aggravated with neck movements. An X-ray of the neck shows the changes in the cervical bones. The condition is treated with pain killers and neck exercises. Severe cases may warrant the use of cervical color, especially in those who have associated giddiness.

                                                                                                                                    

SHINGLES – HERPES

Because the onset of discomfort or pain associated with shingles can precede the appearance of vesicles by several days, a person can experience pain in a certain area of the chest for several days before the cause becomes apparent.

The chickenpox that most people experience as children is caused by a virus. Although the symptoms of chickenpox usually pass quickly, the virus itself can remain in the body, lying dormant for years. Occasionally, the virus can become “reactivated” and spread through a nerve to a specific area of the skin. When this occurs, it can cause pain, and later, the development of vesicles on the skin. This condition is called shingles. Because the onset of discomfort or pain associated with shingles can precede the appearance of vesicles by several days, a person can experience pain in a certain area of the chest for several days before the cause becomes apparent. This discomfort often manifests as a dull, constant burning or pain in a localized area of the chest. Prompt recognition and diagnosis of shingles is important because medications now are available which, if administered early enough, can minimize the pain and shorten the duration of the attack.

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This article is written by Dr. Bimal Chhajer (India’s leading heart specialist)