Shooting pain in joints
Almost any type of joint affliction can cause shooting pains. For example, there is a condition called brachial neuralgia or cervical radiculopathy. Brachial neuralgia is defined as pain radiating down the arm. It is similar to sciatica or pain radiating down the leg. The presence of the brachial and lumber plexuses at the junction of the upper and lower limbs to the trunk makes this similarity of symptoms possible. The reason this condition occurs is that nerves can be pinched as they exit the spinal cord in the neck and the low back. A knowledge of the anatomy helps one to understand the neurological symptoms in the common disorders in the neck. There are7 cervical vertebrae but 8 cervical nerves. All the nerves as they come through the foramen, lie above the vertebrae bearing the same number i.e. C6 nerve lies above C6 vertebra. T1 lies above the T1 vertebra. Hence C5-C6 disc prolapse will pinch the 6th cervical nerve. Objective signs like loss of sensation or motor power is caused by direct compression of a nerve root. Purely subjective pain is due to referred pain from the capsules and ligaments of the posterior intervertebral joints of the spine. This condition is common in the middle aged or elderly patients. The pain usually starts as a pain in the neck or shoulder and later spreads down the arm either as a diffuse boring pain or a sharp shooting pain down to the tips of the fingers. When the pain radiates to the index finger and thumb, it is due to an irritation of C5 C6 cervical nerve roots. A similar shooting pain to the tips of the little or ring finger is due to irritation of the C8 or T1 nerve roots. It is essential to take a detailed history and do a systematic clinical examination. On inspection, one may note the presence of stiffness and muscle spasm. On palpation, one can feel the spasm and palpate the spine for localized tenderness. The whole trapezius muscle must be palpated for tender spots and tender nodules along the attachment of the muscle to the spine of the scapula. Palpate the root of the neck for any lumps or tenderness. Movements of neck flexion, extension and lateral flexion must be tested and any painful limitation noted. Examine the shoulder joint for painful limitation of movements and tender points. The neurological examination of the upper extremity must be done first. Look for sensory deficiency or loss in the fingers and thumb. Look also for motor weakness of the muscles supplied by the nerve roots (C5,C6,C7,C8) of the brachial plexus. The biceps triceps and brachioradialis jerks are tested for. The sensory and motor deficiency will help to localize the root involved and the level of the causative leison. Evidence of cord compression must be looked for in the lower limbs. Radial pulse should be felt on both sides for any difference. Causes of shooting pain in the arm coming from the neck include poor posture, sprains or strains, herniated disc, arthritis, tumors, fractures, and anatomic abnormalities (accessory ribs). Shoulder pathology that can lead to shooting pains include arthritis, bursitis, and tendonitis. Shooting pain can also arise from referred pain such as the heart causing left arm pain and gall bladder disease causing right arm pain. Metabolic disorders such as diabetes may lead to shooting pains usually the leg from femoral nerve damage. This condition is called mononeuritis multiplex. One of the most common causes of shooting pains into the arm is a herniated disc in the neck. This condition is a common cause for acute brachial neuralgia. This is common in young adults and middle aged persons. There is usually a history of a sudden catch in the neck. The patient presents with an acute pain the neck, radiating down the arm to the tips of the fingers. On examination, the neck is held stiff and the cervical muscles are in spasm. There may be tenderness over the C5, C6 or C7 spinous processes. Flexion and extension movements are markedly limited. Holding the arm in abduction at the shoulder and elbow in flexion often relieves the pain. Pain is worse on coughing and sneezing. Neurological examination will determine the level of the disc prolapse and the root compressed. The most common level of prolapse is the C5 C6 disc which compresses the C6 nerve root. There is decreased pain sensation in the outer border of the forearm, thumb and index finger. The biceps jerk will be diminished or absent. There will be mild weakness of the biceps. Prolapse of C6 C7 disc involves the C7 nerve root. There is diminished sensation in the index and middle fingers. There is weakness of the triceps muscle and diminished or absent triceps jerk. In the acute stage of the attack, the patient must be put to bed rest. Intermittent cervical traction with 10 to 15 pounds will relieve the pressure on the nerve root and the pain will subside. The patient is also given analgesics and anti-inflammatory drugs. When the pain subsides, the patient is given a cervical collar and advised to avoid jerks to the neck. Shoulder bracing exercises are prescribed which help to maintain proper posture and relieves the irritation of the nerve roots. The exercises prevent further attacks of brachial neuralgia. Cervical spondylosis is defined as arthritis of the posterior intervertebal joints in the cervical vertebrae. It is common in the middle aged and in the elderly particularly in those occupation involves a posture of prolonged neck flexion. In the early stage it is localised to two or three cervical vertebral segments due to degeneration of the intervertebral disc with narrowing and osteophyte formation at the anterior and posterior margins. The osteophytes cause narrowing of the intervertebral foramen resulting in nerve root irritation. In the later stage there is a generalised degenerative arthritis of the posterior intervertebral joints of the whole cervical spine. In the extreme form there is compression of the spinal cord with myelopathy and symptoms of cord lesion. The patient presents with chronic pain in the neck with or without radiating pain down the arm. There will be diffuse tenderness in the cervical spine with limitation of all movements. The neurological signs will be confined to one or two roots. The treatment includes physical therapy with short wave diathermy to the neck, ultrasound, intermittent cervical traction, and analgesics. When the pain is controlled the patient is taught shoulder bracing and neck exercises. In the acute painful stage, a cervical collar is prescribed. Cervical rib is a congenital condition characterised by the presence of an extra rib at the seventh cervical vertebral level. Symptoms similar to those caused by cervical rib, can also be produced by the abnormal insertion of the scalenus anterior or scalneus medius muscle, which produce compression of the lowest trunk of the brachial plexus and the subclavian vessels as they cross the first rib. These are referred to as Scalene syndrome or Thoracic outlet syndrome. Although it is present from birth, symptoms appear only in the 3rd or 4th decade, when there is sagging of the shoulders. The presenting symptoms may be local, neural or vascular. The patient presents with the complaint of diffuse pain in the root of the neck or pain, tingling or numbness down the medial border of the arm extending to the tips of the little and ring fingers. On examination, there may be some prominence in the root of the neck in the posterior triangle, just above the clavicle. Palpation will cause tenderness and even tingling down the arm. There will be diminished sensation in the ulnar nerve distribution in the hand. In late cases, there may be motor weakness of the intrinsic muscles and wasting of the hypothenar muscles (little finger side). Some vascular signs are due to the pressure of the abnormal rib on the subclavian artery. Adsons Test : This test demonstrates the compression of the subclavian artery by the cervical rib. With the patient sitting or standing he is asked to turn his head on the side of the symptom. With your fingers feeling the radial pulse, ask the patient to raise his chin upwards and take a deep breath. If the radial pluse disappears, the sign is positive. Pulsation may be prominently palpable above the clavicle and a bruit may be felt. There may be decrease in the strength of the radial pulse on applying downward pull on the hands. In most cases, where symptoms are mainly neurological they can be relieved by toning up the muscles by bracing of the shoulders by exercise therapy. In cases, where the vascular signs are predominent and neurological signs are severe, surgical decompression of the brachial plexus and the subclavian vessels is done by resecting the cervical rib or the scalnus anterior muscle. Sciatica is pain that runs along the large sciatic nerve that extends from the lower back down through the buttocks and along the back of each leg. It is a relatively common form of back pain that also causes shooting pain down the leg. Pain along the sciatic nerve is usually caused by pressure on the nerve from a herniated disc or pinched nerve. Sciatica pain can be infrequent and irritating or severe and debilitating depending on the individual. This condition usually only affects one side of the body. Common symptoms may include: pain in the buttocks and/or leg that is worse when sitting, burning or tingling down the leg, weakness, numbness or difficulty moving the leg or foot, constant pain on one side of the buttocks or shooting pain that makes it difficult to stand. Carpal tunnel syndrome can be caused by compression of the median nerve at the wrist, which can lead to pain and weakness in the hand. The median nerve supplies sensation to the thumb and first two fingers, and also to some of the muscles of the hand. The carpal tunnel is composed of two walls -- the deep wall is the bones of the wrist and the superficial wall is a thick ligament located just under the skin on the palm side of the wrist. The tendons which flex the fingers (to form a fist) and the median nerve pass through this tunnel. Certain conditions like wrist fractures and over-use syndromes can cause swelling in the carpal tunnel. Sometimes there is no identifiable cause. Because the walls of the tunnel are rigid, the swelling increases pressure. Nerves are very sensitive to pressure, and when the median nerve is compressed, the muscles it supplies become weak and the skin over the thumb, index, and middle fingers becomes painful, tingly, or even numb. Patients who have symptoms consistent with carpal tunnel syndrome (pain in the first three fingers, shooting pain from the wrist to the fingertips, hand weakness, pain when the palm side of the wrist is tapped) will usually undergo non-surgical treatment first. This includes anti-inflammatory medications, wrist splints, occupational therapy, and workplace modification. If this fails to improve symptoms, an injection of steroids into the carpal tunnel may be helpful. If all these modalities fail to help, then most surgeons will use an examination called a nerve conduction velocity to test the electrical activity of the median nerve. If the results of the test are consistent with carpal tunnel syndrome, carpal tunnel release surgery can be done. Post Herpetic Neuralgia is a condition that is caused by nerve damage that occurs as a result of a shingles infection. There are three primary components to the discomfort associated with post herpetic neuralgia: 1. constant burning or gnawing pain Myofascial (my-oh-FAY-shall) pain is a condition that causes pain in the broad muscle overlying your shoulder blade and spine. It usually affects people over 30 (unless they are very active in sports). It usually lasts a short time, unless involved tissues are continuously irritated. Symptoms include trigger points that when touched can produce a shooting pain that travels down your shoulder to your arm and back. It is caused by the strain or improper use of a muscle.
Treatment Options Braces or slings Shooting pain in the arm or leg may also be due to a condition called peripheral neuropathy. This is a problem where the small nerves in the limb are damaged. There are many potential causes including infections, diabetes, nutritional deficiencies, and metabolic disorders.
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