Neck Pain

Muscle pain - neck pain - thumb flexion

Patients with neck pain and discomfort may complain of pain in the thumb region with difficulties in moving the painful thumb muscles.

Pain at the base of the thumb may be due to arthritis at the joint between the wrist bone and the knuckle bone known as the carpometacarpal joint. Arthritis at this joint is very common. Arthritic pain of this joint at the base of the thumb is made worse when there is nerve related pain and spasm in the muscles that cross the carpometacarpal joint (joint between the thumb wrist bone and the thumb knuckle bone).
Treatment of thumb pain must involve treating all muscles that participate in moving the thumb in all its many capable movements of flexion, extension, abduction, adduction and opposition.

The many complex movements of the thumb are essential in producing fine manipulation such as writing, picking up small objects, turning the key, stitching, knitting cutting up food, turning the doorknob, etc.

Thumb flexion consists of moving the thumb along the plane of the palm.

Muscles responsible for performing this motion include:

- flexor pollicis brevis (superficial head supplied by the median nerve and the deep head supplied by the ulnar nerve). This muscle is supplied by the C8 and T1 nerve roots.

- extensor pollicis longus supplied by the radial nerve (C7, C8).
When the flexor pollicis brevis is not functioning, the supplementary action of the extensor pollicis longus muscle together with that of the flexor pollicis longus supplied by the anterior interosseous branch of the median nerve by causing simultaneous flexion of the tip of the thumb will be able to flex the thumb along the plane of the palm.

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Muscle pain - neck pain - thumb adduction

Patients with nerve related muscle pain leading to neck pain/discomfort often complain of pain in the region of the thumb.

Thumb pain can be due to pain and spasm in muscles that perform movements of the thumb.

If the thumb is held at right angles to the plane of the palm with the palm facing up, adduction is the movement of the thumb down toward the plane of the palm.
Muscles that perform adduction of the thumb are:

- adductor pollicis supplied by the ulnar nerve (C8, T1)

This adduction movement has to be assisted by the following muscles:

- extensor pollicis longus supplied by the posterior interosseous nerve of the radial nerve (C7, C8)

- opponens pollicis supplied by the median nerve (C8, T1)

- flexor pollicis longus supplied by the anterior interosseous branch of the median nerve (C8, T1)

- flexor pollicis brevis supplied by the median nerve to the superficial head and the ulnar nerve to the deep head. Both the superficial and deep heads of the flexor pollicis brevis is supplied by the C8 and T1 nerve roots.

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Muscle pain - neck pain - wrist palmar flexion

Patients with neck pain may present with muscle pain and pain in the wrist area. They may have difficulty with making a fist and picking the wrist up so that the front (palm aspect) of the wrist is toward the face. This may be related to pain, spasm or tightness of the muscles that perform this movement.

Although it is the wrist flexors that seemingly have a problem, it is usually the tightness of the wrist dorsiflexors that initiate muscle pain in the wrist flexors. In treating problems with the wrist flexors, the entire upper limb evaluation should be done including the neck for muscle strength and range of motion.

Treatments must first begin with the large and powerful muscles that must perform lengthening contractions to stabilize the joints of the shoulder, elbow and wrist.

The main muscles that perform wrist flexion (palmar flexion) are:

- flexor carpi radialis supplied by the median nerve (C6, C7)

- flexor carpi ulnaris supplied by the ulnar nerve (C8, T1)

- abductor pollicis longus supplied by the radial nerve (C7, C8)

- flexor digitorum superficialis supplied by the median nerve (C8, T1)

- flexor digitorum profundus supplied by the ulnar nerve (C8, T1)

- palmaris longus supplied by the median nerve (C6, C7)

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