111 N. Wabash Ave Suite 2011 • Chicago, IL 60602
Neck and Back Problems, Numb Fingers and Toes
My shoulders have ached for years and
years. I thought it was normal.
—a 45-year-old secretary
I'm numb one day and fine the next. There's
no rhyme or reason.
—a 22-year-old student
After headaches, the most common symptoms of
TMJ are pain and stiffness in the neck and shoulders. They
often occur with headaches, and patients report that pain
begins near the temples, spreads to the front and back of
the head, and down into the neck and shoulders. The pattern
of pain resembles a knight's helmet; the entire head, from
the forehead back, and the neck and shoulders are in pain.
The pain can begin anywhere and spread throughout the area.
The place the pain begins may be the same every time or change
from headache to headache.
Backaches, both in the upper and lower back,
are also frequently reported by patients subsequently diagnosed
as having TMJ. When connected with TMJ problems, numbness
in the extremities is a result of muscle spasms, not neurological
Like headaches, all of these symptoms may be
caused by TMJ, by conditions unrelated to TMJ, or by a combination
of conditions. TMJ may be one part, either major or minor,
of an entire complement of symptoms and conditions. It is
also important to remember that an evaluation of shoulder,
neck, and back pain and muscle spasms should investigate all
the causes of spasms.
Conditions like arthritis can cause neck pain,
and anyone suffering with regular and persistent neck or back
pain should have this condition investigated. Spasms in the
neck muscles may also result from something as simple to remedy
as sleeping in a draft. Occasionally people have to correct
their posture in order to get rid of neck pain. People who
walk with their heads thrust forward can sometimes correct
neck pain simply by consciously training themselves to hold
themselves more erect.
ONE PATIENT WITH NECK PAIN
Michael Maloney didn't seek treatment for his
neck pain. He was referred by another dentist to have extensive
reconstructive work done. However, from the way Mr. Maloney
moved his body and head, it was obvious that he was in considerable
pain. "I have to be careful not to jar my neck,"
he said. "It's been sore for weeks, and my doctor says
I have another pinched nerve."
The routine screening revealed that his neck
muscles and his external pterygoid muscles were in spasm.
In addition, he had a severe tooth-gearing problem, adding
to the evidence that TMJ should be considered. However, Mr.
Maloney said that he rarely had headaches and that when they
did occur, they were quite mild. He also said he didn't have
any of the other common symptoms of TMJ.
Mr. Maloney came seeking a particular dental
treatment, but was told that he had TMJ and that perhaps his
neck pain was related. As with similar patients, it was important
that the TMJ be addressed before his reconstructive work was
started. It was likely that either the work would trigger
other symptoms or the work would need to be altered or destroyed
if Mr. Maloney later sought treatment for the TMJ.
As often happens, Mr. Maloney was skeptical
about these recommendations. He had never heard of TMJ, and
he had been told and was accepting that his pain was caused
by a pinched nerve. He decided to wait to have the dental
work done, however, because he didn't want the additional
discomfort while his neck still bothered him. He couldn't
understand or believe that his pain could be connected with
Mr. Maloney made his next appointment about
a year later. He'd been through several more episodes of neck
pain, and they were becoming more frequent and more severe.
This time he was anxious to begin treatment for TMJ, partly
because of his discomfort, but also because his physician
had become more aware of TMJ and advised him to get help.
This case demonstrates some important issues
in the treatment of pain syndromes. Mr. Maloney's neck pain
was diagnosed as a pinched nerve because, given the description
of the symptoms, it was a logical explanation for the pain,
and other reasons for the pain had been ruled out. This diagnosis
was a descriptive diagnosis rather than an absolute one. Much
pain experienced in the neck, shoulders, and back receives
this kind of descriptive diagnosis rather than a definitive
A descriptive diagnosis has a number of ramifications
for a patient. First, the patient is reassured that the condition
isn't life-threatening. Second, it gives the patient a label
for the pain—a name to put on a condition to explain
it to friends, family, and co-workers. However, for a diagnosis
based on a reasonable explanation of the pain, rather than
the true cause, the only treatment is often pain-relief medication
to help the patient cope through intense periods of discomfort.
When he first came to my office, Mr. Maloney
managed to cope with the level of pain he was experiencing.
But as the year went by, his threshold was lowered, he could
no longer tolerate living with the periods of discomfort,
and he eventually got fed up with the problem. He also had
been given another possible reason for the symptom. He was
then able to re-evaluate his treatment choices. Once aware
of TMJ, he began to be aware of how he clenched his teeth,
and he could even feel the tooth-gearing discrepancy. Furthermore,
he now had another health practitioner tell him that he might
find help elsewhere.
As TMJ becomes more widely known within the
health care community, more patients are likely to be referred
for TMJ evaluation; they will get more than a descriptive
diagnosis. This was advantageous for Mr. Maloney, because
he was pain-free within two weeks of beginning treatment.
Another manifestation of TMJ that usually is
combined with other symptoms is shoulder pain and stiffness.
Generally this symptom accompanies headaches and neck pain.
We don't know why certain muscles become significantly more
susceptible to painful spasms than others. However, we could
speculate that posture places more physical stress on those
muscles, depending upon the type of work a person does or
the activities he or she engages in.
Mr. Maloney was a carpenter and spent much
of the day leaning over, looking up, kneeling, and lifting.
The muscles in his neck were the most susceptible to stress
from these activities. Other people doing similar work may
complain of shoulder pain and never mention neck discomfort.
Many, if not most, people occasionally have sore shoulders.
They usually attribute it to things like sitting at a desk
too long, playing tennis too hard, or sleeping in an awkward
Shoulder pain is often caused by simple, everyday
activities. In women, one common cause of shoulder pain is
carrying a heavy bag over one shoulder. For many women this
is a daily activity. However, some people with TMJ notice
that after treatment this stops being a significant problem.
Sore shoulders can result from injury to the
shoulder joints, tendons, ligaments, or muscles. Muscle spasms
themselves seldom damage the muscle. Arthritis and bursitis
are also causes of shoulder and joint pain. Any person who
has persistent pain of any kind should see a physician to
have all these causes investigated.
Like headaches, shoulder pain can have more
than one cause, resulting in confusion in diagnosis and treatment.
This was the case with Margaret Adams. Ms. Adams had suffered
with pain in one shoulder for many years. It was diagnosed
as bursitis, and she had been under treatment for many years
for that condition. She logically blamed all her shoulder
pain on her diagnosed bursitis.
However, Ms. Adams also had frequent headaches
and sought treatment for TMJ. She really didn't expect any
resolution of her shoulder pain. During treatment, she noticed
that her shoulder pain was less frequent and less severe.
TMJ treatment eliminated one component of the shoulder problem,
relieving much of her pain, and isolating her additional condition,
thus making it easier to treat.
Back pain can have so many causes that entire
books have been written about it. A person who complains of
regular back pain should have all other possible causes investigated
and eliminated before TMJ is considered. This is especially
true if the person has no headaches or any other common symptoms
Back pain can be caused by structural problems
in the spine and discs. Posture problems can produce back
pain, with or without accompanying TMJ. An infection in the
kidneys or in other internal organs can cause pain in the
back, and even a peptic ulcer can cause this symptom.
Muscle spasms may also be caused by back strain
from heavy lifting or sports injuries. Strain in the legs
or shoulders may be felt as pain in the back because of an
imbalance in the muscles in the whole chain. Even a slight
injury may change the contraction patterns of the other muscles.
Any of these causes of back pain can exist
independently or together with TMJ, and these causes should
be investigated. When seeking a diagnosis, be mindful of the
kind of diagnosis you are getting. Systemic diseases, herniated
discs, and sports injuries that respond to treatment may not
need further investigation. But when the cause of back pain
is given as tension or stress, then TMJ should be investigated,
bearing in mind that people with TMJ rarely experience back
pain independently of other TMJ symptoms.
NUMB FINGERS AND TOES
Numbness in the fingers and toes is a symptom
that alarms many patients. It is associated with neurological
disorders, and patients often fear that they have suffered
a stroke. Indeed, a physician should evaluate this symptom
to rule out neurological disorders. A definitive diagnosis
of TMJ shouldn't be made until all neurological causes have
been ruled out. Remember, symptoms may have more than one
When TMJ is the cause of extremity numbness,
the symptom is related to muscle spasms. When a muscle is
in spasm, it is contracting, and in the contraction it gets
fatter. The increased "belly" of the muscle may
press on the actual nerves as they exit from the spinal column
and travel to the extremities.
Because muscle spasms come and go, numbness
comes and goes. Variations in intensity appear to have less
to do with the concept of dipping and rising of the threshold
to pain. Numbness may occur with other painful symptoms or
without it. It is one symptom that seems to have a time schedule
and manifestation schedule that isn't predictably related
to a patient's discomfort.
Occasionally a patient will report that his
or her extremities become cold and may even change color,
becoming very pale or even bluish. This is caused by the pinching
of nerves of the tiny muscles around the blood vessels. Pinching
or squeezing these nerves can change blood flow and affect
the extremities. As with all the other symptoms of TMJ, coldness
of the extremities and changes in skin color may be caused
by other disorders. Raynaud's disease is a common cause of
this symptom and should be investigated and ruled out before
TMJ is considered.
As with headaches, while TMJ may cause the
symptoms mentioned here, any manifestation of them should
be considered a medical problem. If a physician rules out
medical causes, the dental profession can be called in to
investigate TMJ. Descriptive diagnoses—ones that only
re-describe the symptoms without giving a logical reason for
them—are not necessarily definitive and should be questioned.