Brachialgia (cervical radiculopathy)

, due to crushing or irritation of a spinal nerve in the neck.

Causes
Brachialgia is a characteristic or secondary symptom of numerous disorders and diseases, such as: degenerative changes in the intervertebral joints, cervical arthrosis, herniated discs, osteophytes, progressive disc degeneration, spondylosis, spinal stenosis and tumors of the spine.

Symptoms
In addition to the cervical pain that radiates down the arm, the patient with brachialgia complains: scapular and neck pain, weakening and loss of muscle strength in the arm, tingling and perception of electric shocks in the hand and arm.

Diagnosis
In case of brachialgia, the patient is invited to undergo a series of diagnostic tests, useful for tracing the cause of the disorder: medical history, medical observation, imaging tests (CT, magnetic resonance), electromyography.

Therapy

The choice of one treatment over another depends on the cause responsible for brachialgia; therapeutic options include: discectomy, foraminotomy, laminectomy and replacement of the compromised cervical disc. In mild cases, brachialgia can be relieved simply by taking pain relieving and anti-inflammatory drugs.

cervical they are synonyms used in the medical field to identify any painful condition, at the level of the arm, due to crushing or irritation of a spinal nerve in the neck. The nerve roots most commonly affected by brachialgia originate from the C7 (60% of cases) and C6 (25%) vertebrae.
Among young people, brachialgia is often the result of a "herniated cervical disc. In older patients, however, neuropathic pain in the arm is generally caused by a narrowing of the foraminal and spinal canal (ducts in the spinal column where the roots run). of the spinal nerves and the spinal cord itself).

Cervical disc herniation (most common cause of brachialgia among young people)

Degenerative diseases of the cervical discs

Osteophytes (bone spurs): these are bone growths located on the same surface of the bone. The disorder - typical of the joints - is due to an exaggerated accumulation of calcium on the articular cartilage.

Progressive disc degeneration, often caused by the "inexorable process of" aging

Intervertebral prolapse

Spondylosis

Spinal stenosis

Spinal tumors

It is not uncommon for two or more pathological conditions just listed to occur simultaneously.
A patient is more exposed to the risk of brachialgia during recurrent spinal infections, heavy work, power sports (weight lifting) and smoking.

To keep the cervical muscle bundles and the spine in general in good condition, it is essential to always assume a correct posture. The alterations of the cervical spine and brachialgia are not only caused by violent movements and heavy work: even being in front of the computer many hours a day does not help the spine. Incorrect postures, especially when maintained for a long time, can promote muscle spasms in the cervical area of ​​the spine, inevitably causing more or less marked suffering in the intervertebral discs.

muscular. Brachialgia can also alter the sensitivity of the skin of the arm in correspondence with the compromised nerve: the patient perceives a reduction in sensitivity to mechanical skin stimuli, up to complete cervicobrachialgia (muscle weakness of the arm associated with persistent cervical pain).

continuous, spread along the arm, must be subjected to diagnostic investigations, useful for shedding light on the cause of brachialgia. In fact, only after having isolated and identified the origin of the pain is it possible to proceed with a targeted and specific treatment. The investigative examination consists of a series of tests, such as:

• Medical history, observation and palpation: the patient with brachialgia tends to tilt the head to the side of the nerve injury and to keep the neck stiff.
• Cervical spine imaging test:
  • Radiography (X-rays): Provides a general view of the bones and tissues of the neck
  • TC (Computerized Tomography): detects any structural-bony alterations of the cervical spine (e.g. acute fractures / herniated discs) responsible for brachialgia
  • CT + myelography: this combination of analytical tests is able to assess the severity of a "possible injury to the cervical spine, also identifying the precise location of the spinal cord compression
  • MRI (Magnetic Resonance Imaging): first choice investigative test to detect possible pathologies affecting the soft tissues (e.g. herniated disc)
• Electromyography: patients who complain of brachialgia can also undergo electromyography, a test useful for identifying nerve root abnormalities and excluding other possible neurological causes

painkillers reduces and temporarily masks pain: for this purpose, NSAIDs, opioids and sometimes anticonvulsants are the most used in therapy.
When the pain is fierce and severely compromises the normal work-social activities of the victim, the doctor may suggest the injection of anesthetic substances directly into the nerve involved in the disorder; this inoculation of drugs is performed under the radiological guidance of a CT scan. procedure, patients often declare themselves enthusiastic because the pain deriving from brachialgia tends to decrease significantly; the only disadvantage of this therapy is that the anesthetic effect disappears after a few days, and the pain occurs in equal intensity.

For further information: Drugs to Treat Brachialgia

Surgery

Parallel to the pharmacological treatment, the patient suffering from brachialgia can derive relief from an "adequate physical-conservative therapy, which can include physiotherapy, targeted massages, acupuncture and osteopathy.
Where the therapies described above are not sufficient to alleviate and ward off brachialgia, generally the patient undergoes surgery, subordinated to the triggering cause:

• Discectomy: indicated when brachialgia depends on a "herniated cervical disc." The operation consists in the removal of the herniated disc through an incision in the neck. Subsequently, the disc is replaced with a small bone fragment taken from the patient's own pelvis.
• Foraminotomy: surgery indicated to relieve the pressure exerted on the compressed nerves inside the intervertebral foramen
• Laminectomy with or without fusion: surgical removal of the lamina of one or more vertebrae involved in the injury. In this way an "opening of the vertebral canal is obtained which allows to correct any malformative / traumatic pathologies responsible for brachialgia.
• Replacement of the compromised cervical disc with a prosthesis

It is the duty of the neurosurgeon to direct the patient with brachialgia to the most suitable surgical treatment.