May 2006

Visceral dysfunction and the upper extremity

by Dr. Howard Loomis

In previous columns, I have discussed a five‑minute source of stress examination. This month, I will cover a quick inspection of the upper extremity and possible correlations to visceral problems of the thyroid, lungs, bronchi, and heart. This exam takes only a very brief amount of time but will yield many answers for locating hidden causes of pain.

An important part of any examination of the upper extremity should be to search the forearm for tender points and differentiate between those found on the radial side of the arm from those on the ulnar side. For example:

***  Tender points (stress points) on the radial surface of the arm can be traced from the anterior neck and mid‑supraclavicular space to the tip of the shoulder and down the arm to the elbow, along the radius to the wrist, and onto the thumb and index finger. Muscle contraction associated with these areas will also be found by pressing medially from the lateral border of the Erector spinae muscle at the level of the fourth, fifth, and sixth cervical spinous processes.

***  Stress points on the ulnar surface of the arm can be traced from the sternum laterally to the mid‑axillary line of the rib cage, and from the upper posterior ribs across the scapula, to the shoulder, and down the posterior arm, onto the ulna down to the wrist and the middle, ring, and little fingers. Muscle contraction is often found within the spinal muscles covering the 7th cervical and upper two thoracic vertebrae.

Anterior neck, clavicle and radius

Contact the carotid tubercle on the anterior portion of the 6th cervical transverse process. This is usually large and prominent. This would be a good time to check all the muscles over the anterior cervical transverse processes because the sympathetic nerve supply to the head and neck originates from T1 to T3 and runs through the three cervical ganglion to the eyes, sinuses, salivary glands, and thyroid gland. In fact, my experience has taught me that stress points in this area and along the radial surface of the upper extremity are associated with thyroid hyperactivity. Stress points located in this area are usually involved with complaints in the upper extremity; however, great care must be taken in palpating this area because of the carotid artery.

Next, with your thumb, palpate in the triangular space behind the clavicle searching for muscle contraction and painful stress points. These are often associated with lymphatic congestion. From here a tender path may be followed over the shoulder down the anterior portion of the upper arm and humerus across the radius to the wrist, thumb and index finger.

Sternum, lateral rib cage, and ulna

Palpate along the supraspinatus fossa of the scapula, searching the upper trapezius muscle for stress points. These are often associated with muscle contractions covering the seventh cervical and upper two thoracic vertebrae. Spinal nerves in this region make their exit from the spinal column anterior to the superior articulating processes of the first dorsal vertebra under the lamina of the seventh cervical vertebra. For this reason, it may be necessary to palpate much further laterally from the spine before tenderness can be elicited.

Painful areas may be found between the ribs and be traceable posteriorly along the lateral intercostal spaces and around to the anterior surface of the body where these ribs join the sternum. Pan here may be associated with irritation to the pleura and/or diaphragm because they share neurological connections with the intercostal nerves. The diaphragm is also innervated by the phrenic nerve; therefore, irritation can be coming from the mid‑cervical spine or even the organs of digestion!

Muscle contractions may be found extending from the posterior margin of the shoulder downward over the posterior of the arm, onto and along the ulna to wrist and onto the middle, ring, and little fingers.

Symptoms

Painful stress points can be classified as acute or chronic, based on the symptomatology and reaction of the patient. For example, acute symptoms are characterized by pain on "light" pressure and can include spasms, contractions, and edema as well as signs of inflammation, such as heat, redness, and swelling. Chronic signs manifest as dull pain on deep palpatory pressure and may require some goading of the palpated contraction before pain is elicited. This is due to exhaustion of the tissues. Additional signs may include lack of skin tone, numbness or tingling, surface coldness, and even muscular atrophy or motor paralysis.

(Dr. Loomis welcomes input on the subjects covered in this column. To make a comment or ask a question, write to him at 6421 Enterprise Lane, Madison, WI 53719. Visit http://www.loomisenzymes.com online or call 800‑662‑2630 for information on upcoming Loomis Institute seminars.)