Arm Pain- Brachialgia

 

What is brachialgia?

Brachialgia is a sciatic-like symptom  the patient experiences in the arm. The pain starts in the shoulder region and radiates all the way towards the arm, forearm, and to certain part of the fingers.

Does all brachialgic pains goes to the fingers?

There are 8 exciting nerve roots that comes out of the cervical spine, depending on the  nerve root is involved, the pain travels to various aspects of arm, forearm and fingers.

What are the other associated symptoms in addition to pain in brachialgia?

The associated symptoms can be pins and needles in the arm, numbness in the fingers, weakness in the fingers, dropping of objects. Because of the neck problem the patient can present with bilateral shoulder region pain, occipital or frontal headaches and rarely upper and mid back pain.

What is the cause of brachialgia?

The common causes of brachialgia are disc prolapse in the neck leading onto pressure effect on the nerves, arthritis of the facet joint, posterior discal bars from the posterior margin of the vertebra putting pressure effect on the space that is available for the nerves that are coming out.

There might be other causes of nerve root compression like tumour, infection and other miscellaneous causes.

What are the investigations available for the brachialgic symptoms?

The investigations available are baseline investigation in the form of x-ray. The other investigations are MRI scan in order to reveal the level of the pathology and also the cause of the pathology. In case of multilevel problems EMG nerve conduction test will be of benefit in order to identify and isolate the level that causes the symptoms of the patient. In many cases the symptoms might be complex because of 2 or 3 level problems.

I am experiencing shoulder pain. Is the shoulder pain because of the shoulder problem or is it because of the neck problem?

Many patients’ presenting with neck and the shoulder pathology have got both shoulder and also neck problems. The most common cause of the shoulder pathology will be a wear and tear condition of the acromioclavicular joint alongwith impingement syndrome. In this particular event, the patient might not be able to lift the arm completely sideways. A thorough clinical examination along with investigations would be of benefit in order to identify and differentiate this condition. Surgical intervention should not be carried unless otherwise shoulder problems have been ruled out prior to cervical spine pathology where the predominant manifestation of the patient’s symptoms is in the shoulder region.

What are the relative indications of surgery in brachialgia?

  1. Chronic pain persisting for more than 6 months.
  2. Acute pain with severe relentless pain.
  3. Neurological involvement in the form of numbness, weakness, dropping objects or any evidence of upper motor neuron signs or symptoms.

What are the treatment options available for brachialgia?

The treatment options available are

  1. Conservative in the form of pain killers, heat treatment, etc. Most brachialgic symptoms spontaneously resolve over a period of 6 – 9 months. The acute pain settles over a period of 1 to 2 months following the onset of the brachialgic symptom. As the common cause of brachialgic symptom is acute disc prolapse once the disc dehydrates and shrinks in size the pressure effect on the nerve automatically goes away leading onto resolution of brachialgic symptoms.
  2. Physiotherapy and exercise programs.
  3. Lifestyle modification with appropriate ergonomic arrangements.
  4. Pain management pathway in a way towards symptomatically trying and control the pain.
  5. CT scan guided foraminal nerve root injection can be done by interventional radiologist.
  6. In case of recurrent and refractory pain associated with neurological symptoms surgical intervention can be patronized.

What is the prognosis for brachialgic symptoms?

Left as it is, by the natural history of the disease most brachialgic symptoms spontaneously resolves over a period of 6 – 9 months since the time of onset. The acute pain settles down in many cases in majority of the cases over a period of 1 – 2 months. With surgical intervention the brachialgic symptoms success rate is around 80 – 85%. The surgery is predominantly done for the pain rather than the neurological symptoms in the form of numbness or weakness.

Can acute disc prolapse be dangerous in neck?

Severe disc prolapse leading onto pressure effect on the spinal cord can lead to myelopathic features. Provided myelopathy is established the patient can develop weakness in all the 4 limbs. The patient can end up with paralysis neck down.

What is ACDF?

ACDF is an abbreviation for anterior cervical discectomy and fusion. This is the most commonly performed procedure in the neck where the disc that is the cause of the problem is excised and a cage is put between 2 vertebras for the adjacent vertebra to fuse. This may or may not be secured with the plate fixation.

What is cervical disc replacement?

In younger patients with adjacent level degeneration of the disc, cervical disc replacement has been tried.  Long term results are still not available. The patient will undergo a discectomy and instead of fusion in the form of cage and bone grafting a prosthetic metal with ceramic is secured in between the vertebras where the motion segment is preserved.

Are there any other treatment options available for brachialgia?

Neurosurgical procedures in the form of posterior cervical foraminal decompression can be performed. This is predominantly done by neurosurgeons.

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