Neuropathy "The Painful Enigma"

Individuals experiencing pain symptoms like shooting, stabbing, or electrical sensations to the latissimus dorsi of the upper back could be caused by a nerve injury to the thoracodorsal nerve. Can knowing the anatomy and symptoms help healthcare providers develop an effective treatment plan?

Thoracodorsal Nerve

Also known as the middle subscapular nerve or the long subscapular nerve, it branches out from a part of the brachial plexus and provides motor innervation/function to the latissimus dorsi muscle.

Anatomy

The brachial plexus is a network of nerves that stem from the spinal cord in the neck. The nerves supply most of the sensation and movement of the arms and hands, with one on each side. Its five roots come from the spaces between the fifth through eighth cervical vertebrae and the first thoracic vertebra. From there, they form a larger structure, then divide, re-combine, and divide again to form smaller nerves and nerve structures as they travel down the armpit. Through the neck and chest, the nerves eventually join and form three cords that include:

• Lateral cord
• Medial cord
• Posterior cord

The posterior cord produces major and minor branches that include:

• Axillary nerve
• Radial nerve

The minor branches include:

• Superior subscapular nerve
• Inferior subscapular nerve
• Thoracodorsal nerve

Structure and Position

• The thoracodorsal nerve branches off the posterior cord in the armpit and travels down, following the subscapular artery, to the latissimus dorsi muscle.
• It connects to the upper arm, stretches across the back of the armpit, forming the axillary arch, and then expands into a large triangle that wraps around the ribs and the back.
• The thoracodorsal nerve lies deep in the latissimus dorsi, and the lower edge typically reaches close to the waist.

Variations

• There is a standard location and course of the thoracodorsal nerve, but individual nerves are not the same in everyone.
• The nerve typically branches off the posterior cord of the brachial plexus from three different points.
•  However, different subtypes have been identified.
• The thoracodorsal nerve supplies the teres major muscle in about 13% of individuals. (Brianna Chu, Bruno Bordoni. 2023)
• The lats can have a rare anatomical variation known as a Langer’s arch, which is an extra part that connects to muscles or connective tissue of the upper arm beneath the common connecting point.
• In individuals with this abnormality, the thoracodorsal nerve supplies function/innervation) to the arch. (Ahmed M. Al Maksoud et al., 2015)

Function

The latissimus dorsi muscle cannot function without the thoracodorsal nerve. The muscle and nerve help:

• Stabilize the back.
• Pull the body weight up when climbing, swimming, or doing pull-ups.
• Assist with breathing by expanding the rib cage during inhalation and contracting when exhaling. (Encyclopaedia Britannica. 2023)
• Rotate the arm inward.
• Pull the arm toward the center of the body.
• Extend the shoulders by working with the teres major, teres minor, and posterior deltoid muscles.
• Bring down the shoulder girdle by arching the spine.
• To bend to the side by arching the spine.
• Tilt the pelvis forward.

Conditions

The thoracodorsal nerve can be injured anywhere along its path by trauma or disease. Symptoms of nerve damage can include: (U.S. National Library of Medicine: MedlinePlus. 2022)

• Pain that can be shooting, stabbing, or electrical sensations.
• Numbness, tingling.
• Weakness and loss of function in the associated muscles and body parts, including wrist and finger drop.
• Because of the nerve's path through the armpit, doctors have to be cautious of the anatomical variants so they don’t inadvertently damage a nerve during breast cancer procedures, including axillary dissection.
• The procedure is performed to examine or remove lymph nodes and is used in staging breast cancer and in treatment.
• According to a study, 11% of individuals with axillary lymph node dissection suffered damage to the nerve. (Roser Belmonte et al., 2015)

Breast Reconstruction

• In breast reconstruction surgery, the lats can be used as a flap over the implant.
• Depending on the circumstances, the thoracodorsal nerve can be left intact or severed.
• The medical community has not agreed on which method has the best outcomes. (Sung-Tack Kwon et al., 2011)
• There is some evidence that leaving the nerve intact can cause the muscle to contract and dislocate the implant.
• An intact thoracodorsal nerve may also cause atrophy of the muscle, which can lead to shoulder and arm weakness.

Graft Uses

A portion of the thoracodorsal nerve is commonly used in nerve graft reconstruction to restore function after injury, which includes the following:

• Musculocutaneous nerve
• Accessory nerve
• Axillary nerve
• The nerve can also be used to restore nerve function to the triceps muscle in the arm.

Rehabilitation

If the thoracodorsal nerve is injured or damaged, treatments can include:

• Braces or splints.
• Physical therapy to improve range of motion, flexibility, and muscle strength.
• If there is compression, surgery may be required to alleviate the pressure.

Exploring Integrative Medicine

General Disclaimer *

The information herein is not intended to replace a one-on-one relationship with a qualified healthcare professional or licensed physician and is not medical advice. We encourage you to make healthcare decisions based on your research and partnership with a qualified healthcare professional. Our information scope is limited to chiropractic, musculoskeletal, physical medicines, wellness, sensitive health issues, functional medicine articles, topics, and discussions. We provide and present clinical collaboration with specialists from various disciplines. Each specialist is governed by their professional scope of practice and their jurisdiction of licensure. We use functional health & wellness protocols to treat and support care for the injuries or disorders of the musculoskeletal system. Our videos, posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate to and directly or indirectly support our clinical scope of practice.* Our office has reasonably attempted to provide supportive citations and identified the relevant research studies or studies supporting our posts. We provide copies of supporting research studies available to regulatory boards and the public upon request.

We understand that we cover matters that require an additional explanation of how it may assist in a particular care plan or treatment protocol; therefore, to discuss the subject matter above further, please contact Dr. Alex Jimenez or contact us at 915-850-0900.

Dr. Alex Jimenez DC, MSACP, CCST, IFMCP*, CIFM*, ATN*

email: coach@elpasofunctionalmedicine.com

Licensed in: Texas & New Mexico*

References

Chu B, Bordoni B. Anatomy, Thorax, Thoracodorsal Nerves. [Updated 2023 Jul 24]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK539761/

Al Maksoud, A. M., Barsoum, A. K., & Moneer, M. M. (2015). Langer's arch: a rare anomaly affects axillary lymphadenectomy. Journal of surgical case reports, 2015(12), rjv159. https://doi.org/10.1093/jscr/rjv159

Britannica, The Editors of Encyclopaedia. "latissimus dorsi". Encyclopedia Britannica, 30 Nov. 2023, https://www.britannica.com/science/latissimus-dorsi. Accessed 2 January 2024.

U.S. National Library of Medicine: MedlinePlus. Peripheral neuropathy.

Belmonte, R., Monleon, S., Bofill, N., Alvarado, M. L., Espadaler, J., & Royo, I. (2015). Long thoracic nerve injury in breast cancer patients treated with axillary lymph node dissection. Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer, 23(1), 169–175. https://doi.org/10.1007/s00520-014-2338-5

Kwon, S. T., Chang, H., & Oh, M. (2011). Anatomic basis of interfascicular nerve splitting of innervated partial latissimus dorsi muscle flap. Journal of plastic, reconstructive & aesthetic surgery : JPRAS, 64(5), e109–e114. https://doi.org/10.1016/j.bjps.2010.12.008

Optimal nervous system health is the key to maximum body function and overall health. Individuals don’t really think about their nervous system until symptoms from injury, disease, or nerve problems present. The nervous system consists of billions of neurons that connect/network the brain with the rest of the body.

Nervous System Health

All of the body's systems, organs, and tissues have nerves attached to them. The brain engages with this network to control and coordinate bodily functions. Functions include:

• Heart
• Lungs
• Immune system
• Digestive system
• Reproductive system

Every function the body performs requires brain-body communication through the nervous system. The brain communicates with the nervous system to regulate the body to the environment it is in. For example:

• If it’s hot, the body sweats.
• If it’s cold, the body shivers.
• If there is danger, the fight or flight response activates.
• All are directed by the brain transmitting signals and messages through the nervous system.

Body Function

Optimal body function means that all bodily functions are normal, active, and healthy. Everything is working as it should. When the body functions at less than 100%, it can develop into more serious problems little by little. Like a vehicle that starts making a little sound that seems like nothing, then after a few days, weeks, months, it becomes a massive popping, grinding, starting, stopping, emergency, when vital information that regulates function gets lost in transmission from the brain to the body, health declines.

Flowing Spinal Highway

The vital information/communication between the brain and the body flow through the spinal column. The super information highway/spinal cord travels down the spinal column. Branching off the spinal cord are spinal nerve roots that go to every system, organ, and tissue in the body. The spinal bones are lined up like an electrical conduit channel for the spinal cord. The vertebrae should be lined up and move properly, allowing optimal blood and nerve circulation without any obstruction or interference.

When the spine shifts out of place, creating misalignment, moving properly becomes hindered, causing discomfort and pain, along with the vital communication needed to regulate maximum function not able to get through. This leads to malfunction within the body and decreases health and well-being. Spinal misalignment that interferes with nerve message transmission is called a vertebral subluxation. Chiropractic healthcare professionals are trained to detect and correct spinal subluxations. They realign the spine's bones to restore nervous system health and internal communication for proper body function.

Body Composition

Prebiotics Can Help With

Inflammation

Inflammation is a normal function of the immune system; however, chronic inflammation can cause damage to the body. Chronic inflammation is associated with:

• Obesity
• Heart disease
• Cancer
• Other diseases and conditions.

Having a balance of healthy gut microbiota helps decrease chronic inflammation and the risk of disease.

Gastrointestinal Diseases and Conditions

Prebiotics also ferment in the colon producing short-chain fatty acids. These provide energy for the colon’s epithelial cells that line and protect the colon. Prebiotics increase the protection provided by the epithelial cells, reducing the risk for gastrointestinal conditions like:

• Irritable Bowel Syndrome - IBS
• Crohn’s disease
• Cancer.
• Prebiotics can also reduce symptoms of gastrointestinal conditions.

Neurological System

The central nervous system is also known as the brain and spinal cord. However, many do not know about the enteric nervous system, which includes the gastrointestinal tract. The link between the enteric and central nervous systems involves cognitive and emotional functions. Prebiotics increase and promote healthy gut microbiota to help manage:

• Mood
• Learning
• Memory
• Certain psychological disorders

General Disclaimer *

The information herein is not intended to replace a one-on-one relationship with a qualified health care professional, licensed physician, and is not medical advice. We encourage you to make your own health care decisions based on your research and partnership with a qualified health care professional. Our information scope is limited to chiropractic, musculoskeletal, physical medicines, wellness, sensitive health issues, functional medicine articles, topics, and discussions. We provide and present clinical collaboration with specialists from a wide array of disciplines. Each specialist is governed by their professional scope of practice and their jurisdiction of licensure. We use functional health & wellness protocols to treat and support care for the injuries or disorders of the musculoskeletal system. Our videos, posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate to and support, directly or indirectly, our clinical scope of practice.* Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We provide copies of supporting research studies available to regulatory boards and the public upon request.

We understand that we cover matters that require an additional explanation of how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900.

Dr. Alex Jimenez DC, MSACP, CCST, IFMCP*, CIFM*, ATN*

email: coach@elpasofunctionalmedicine.com

Licensed in: Texas & New Mexico*

References

Cerdó, Tomás et al. “Probiotic, Prebiotic, and Brain Development.” Nutrients vol. 9,11 1247. 14 Nov. 2017, doi:10.3390/nu9111247

Chu, Eric Chun Pu, and Michelle Ng. “Long-term relief from tension-type headache and major depression following chiropractic treatment.” Journal of family medicine and primary care vol. 7,3 (2018): 629-631. doi:10.4103/jfmpc.jfmpc_68_18

Kiani, Aysha Karim et al. “Neurobiological basis of chiropractic manipulative treatment of the spine in the care of major depression.” Acta bio-medica : Atenei Parmensis vol. 91,13-S e2020006. 9 Nov. 2020, doi:10.23750/abm.v91i13-S.10536

Maltese, Paolo Enrico et al. “Molecular foundations of chiropractic therapy.” Acta bio-medica : Atenei Parmensis vol. 90,10-S 93-102. 30 Sep. 2019, doi:10.23750/abm.v90i10-S.8768

Wirth, Brigitte et al. “Neurophysiological Effects of High Velocity and Low Amplitude Spinal Manipulation in Symptomatic and Asymptomatic Humans: A Systematic Literature Review.” Spine vol. 44,15 (2019): E914-E926. doi:10.1097/BRS.0000000000003013

A pinched, compressed, overly stretched, twisted, and entangled nerve can happen throughout the body. The most common locations are the neck, shoulder, upper back, upper chest, arm, elbow, hand, wrist, low back, legs, and feet. This disrupts the nerve's ability to function properly. Each nerve stimulates muscles and detects sensations in specific areas of the skin or internal organs so they work properly. Common symptoms are tingling, numbness, pain, weakness, and musculoskeletal problems. The average pinched nerve duration can last a few days to as long as 4 to 6 weeks or, in some cases, longer, in which case individuals should see a doctor or neurologist. Injury Medical Chiropractic and Functional Medicine Clinic can relieve, release, and restore nerve health.

Pinched Nerve

A pinched nerve is caused by pressure from surrounding tissues that place added stress on it. Muscles, bones, cartilage, and tendons can all press, pull, or entangle a nerve. This can result in a loss of function, which can then lead to symptoms including:

• Tingling
• Numbness
• Muscle weakness
• Various types of pain - sharp, electrical, throbbing, aching, and radiating/spreading out to other areas.
• Burning sensation
• A pinched nerve can become serious, cause chronic pain conditions and lead to permanent nerve damage.
• More severe cases may require surgery.

Pinched Nerve Duration

Pinched nerve duration depends on the injury, which can happen suddenly or gradually. A temporary case with an acute cause, such as injury or poor posture, can last several days. Cases related to chronic conditions, like arthritis, may last longer. Treatment, as well as recovery, also vary based on the location of the injury and what’s causing the pressure.

Body Locations

Neck

A pinched nerve in the neck can cause tingling sensations and pain, which can travel to the shoulders and arms. This type can be caused by:

• Sleeping position
• Repetitive movements
• Injuries
• The pain will usually ease within several days unless a chronic health condition is the cause of the pinching.

Lower back

A pinched nerve in the lower back is often brought on by herniated discs that compress nerve roots.

• It may also be caused by arthritis or injuries.
• Individuals may feel a sharp pain in the lower back, as well as in the buttocks and back of the leg.
• Sciatica may be a symptom.
• Lower back pain may be acute, lasting only a few days.
• If the injury doesn’t resolve, it may cause chronic back pain that can last 12 weeks or more.

Leg

• The legs can develop pinched nerves from herniated discs or injuries.
• If left untreated can lead to peripheral neuropathy.
• This can develop over several weeks or years.

Hip

A pinched nerve in the hip can last a few days if related to an injury. If the pain lasts longer than a few days, consult a doctor. Possible causes of chronic hip pain may include:

• Obesity
• Bone spurs
• Arthritis

Shoulder

Shoulder pain brought on by a pinched nerve usually starts in the upper spine and is caused by:

• Injury
• Tendinitis
• Arthritis
• To tell if the pain symptoms are from a pinched nerve and not a muscle strain, the pain tends to occur in one shoulder, and there is a sharpness to the aches.
• Left untreated, arthritis or tendinitis can lead to chronic pain that can come and go for several weeks, months, or years.

Wrist

Repetitive overuse is commonly linked to pinched nerves in the wrist.

• Pinched nerves can lead to carpal tunnel syndrome - pain and numbness extending through the arm, hand, and fingers.
• Pain lasting over two months could indicate other underlying conditions, like arthritis.

Chiropractic Relief

Chiropractic adjustments identify the impacted nerve/s and use various therapies to remove the compression, relieving symptoms and the injury or issue. A personalized treatment plan can include the following:

• Different types of massage.
• Multiple adjustments.
• Non-surgical decompression therapy.
• Muscle Energy Technique - MET
• Targeted stretches and exercises.
• Posture training.
• Anti-inflammatory nutritional recommendations.

Sciatica During Pregnancy

General Disclaimer *

The information herein is not intended to replace a one-on-one relationship with a qualified healthcare professional or licensed physician and is not medical advice. We encourage you to make healthcare decisions based on your research and partnership with a qualified healthcare professional. Our information scope is limited to chiropractic, musculoskeletal, physical medicines, wellness, sensitive health issues, functional medicine articles, topics, and discussions. We provide and present clinical collaboration with specialists from various disciplines. Each specialist is governed by their professional scope of practice and their jurisdiction of licensure. We use functional health & wellness protocols to treat and support care for the injuries or disorders of the musculoskeletal system. Our videos, posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate to and directly or indirectly support our clinical scope of practice.* Our office has reasonably attempted to provide supportive citations and identified the relevant research study or studies supporting our posts. We provide copies of supporting research studies available to regulatory boards and the public upon request.

We understand that we cover matters that require an additional explanation of how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, don't hesitate to get in touch with Dr. Alex Jimenez or contact us at 915-850-0900.

Dr. Alex Jimenez DC, MSACP, CCST, IFMCP*, CIFM*, ATN*

email: coach@elpasofunctionalmedicine.com

Licensed in: Texas & New Mexico*

References

Cornwall, R, and T E Radomisli. “Nerve injury in traumatic dislocation of the hip.” Clinical orthopedics and related research, 377 (2000): 84-91. doi:10.1097/00003086-200008000-00012

Dmytriv, Mariya, et al. “PT or cervical collar for cervical radiculopathy?.” The Journal of family practice vol. 59,5 (2010): 269-72.

Hochman, Mary G, and Jeffrey L Zilberfarb. “Nerves in a pinch: imaging of nerve compression syndromes.” Radiologic clinics of North America vol. 42,1 (2004): 221-45. doi:10.1016/S0033-8389(03)00162-3

Lopez-Ben, Robert. “Imaging of nerve entrapment in the foot and ankle.” Foot and ankle clinics vol. 16,2 (2011): 213-24. doi:10.1016/j.fcl.2011.04.001

Needham, C W. “Pinched nerves and signature signs.” Connecticut Medicine vol. 57,1 (1993): 3-7.

Siccoli, Alessandro, et al. “Tandem Disc Herniation of the Lumbar and Cervical Spine: Case Series and Review of the Epidemiological, Pathophysiological and Genetic Literature.” Cureus vol. 11,2 e4081. 16 Feb. 2019, doi:10.7759/cureus.4081

The body's functionality, circulation, and communication are significantly affected by the health of the nervous system. The brain, spinal cord, and nerve roots connect every part of the body into a massive communication highway. If circulation and communication are interrupted, interfered with, or completely blocked then the body's health begins to breakdown. Chiropractic treatment and spinal alignment will clear the pathways and get the nerve energy flowing restoring overall health.

Nervous System Operations

The nervous system regulates all areas of the body in communication, coordination, and it functions in the control of all major bodily functions. This includes:

• Basic cellular function
• Organ processes
• Higher-level brain functions that include

1. Learning
2. Thinking
3. Memory

The nerves within the nervous system communicate via chemical and electrical messages. Nerve cells primarily communicate through quick electronic pathways and signals.

Nerve Energy Compromised

The signals that pass between the brain, spinal cord, nerves, and rest of the body maintain connectivity, coordination, and proper organ function. The electrical energy necessary to keep the circulation/signals flowing smoothly happens with optimal nerve strength. Causes that can affect nerve integrity include:

• Chronic inflammation
• Injury
• Mental health factor
• Spinal misalignment

If the circulation/communication highway in the nervous system is compromised, it can rapidly turn into misinterpreted, crossed, false, or no signals being sent. Ultimately, the signals can turn into total confusion, making the body fall into a state of total dysfunction. The lines of communication need to remain clear and uninhibited. This allows the body to function with ease as all systems cooperate.

Spinal Misalignment Affects Nerve Energy

With all the signals traveling through the spinal cord, any misalignment will affect circulation. Common causes of misalignment include:

• Poor posture
• Sedentary lifestyle
• Poor body mechanics
• Injuries
• Weight factors

Misalignment can be addressed with professional chiropractic adjustments. A chiropractor will pinpoint any subtle changes, address them, and restore the nerves' circulation, as well as restore the body's balance.

Restore and Maximize Nerve Circulation

Chiropractic is a research-based systematic approach to whole-body care and is designed to yield optimal results non-invasively. Contact Injury Medical Chiropractic to see what they can offer in helping to achieve health goals.

The Body's Composition

Stress is hard enough to handle, but chronic stress can have complex, detrimental effects on emotional health. Over time, stress can wear away at both mental and physical health. And it does not take weeks or months to start seeing the effects.

It can take as little as four days to notice a significant impact on energy, fatigue, and soreness levels. Remember that achieving healthy body composition is more than just building muscle and losing fat. Maintaining a proper diet and getting enough sleep is necessary to make consistent progress.

Dr. Alex Jimenez’s Blog Post Disclaimer

The scope of our information is limited to chiropractic, musculoskeletal, physical medicines, wellness, and sensitive health issues and/or functional medicine articles, topics, and discussions. We use functional health & wellness protocols to treat and support care for injuries or disorders of the musculoskeletal system. Our posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate and support directly or indirectly our clinical scope of practice.*

Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We also make copies of supporting research studies available to the board and or the public upon request. We understand that we cover matters that require an additional explanation as to how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900. The provider(s) Licensed in Texas& New Mexico*

References

Lorei, M P, and E B Hershman. “Peripheral nerve injuries in athletes. Treatment and prevention.” Sports medicine (Auckland, N.Z.) vol. 16,2 (1993): 130-47. doi:10.2165/00007256-199316020-00005