Brachialgia (Cervical Radiculopathy)

WHAT IS BRACHIALGIA?

Brachialgia is a technical term for arm pain. It is used when the pain is thought to be due to a problem with the nerves, most frequently a compressed or pinched nerve in the neck.

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How does brachialgia occur?

The spinal canal and intervertebral foraminae are bony tunnels in the spine.  The spinal cord and spinal nerves (nerve roots) run through these. When the size of these tunnels is reduced, there is less room for the spinal nerves and/or spinal cord. As a result, pressure may be placed on these structures.

Symptoms

Symptoms of neural (nerve or spinal cord) compression include pain in the neck, shoulder blade or arm. Numbness, tingling sensations, and weakness are often associated with brachialgia.

Disorders that can cause nerve root compression and brachilagia include spinal stenosis, degenerative disc disease, a bulging or prolapsed intervertebral disc, bony spurs (osteophytes), or spondylosis (osteoarthritis of the spine). Commonly, two or more of these conditions are seen together.

How is brachilagia treated?

There are a number of treatment options for brachilagia, and these will depend upon your specific situation:

PAIN MEDICATIONS

A number of medications may be useful for this type of pain. These include analgesics, membrane stabilising agents, anticonvulsants, and Pregabalin. Special medical treatments such as Ketamine infusions may be useful in some situations.
 

NERVE SHEATH INJECTIONS

Local anaesthetic may be injected through the skin of the neck, under CT scan or X-ray guidance, around the compressed nerve. This is also known as a ‘foraminal block’. Patients frequently achieve a significant benefit from this procedure, and surgery can sometimes be delayed or even avoided. Unfortunately, the benefit obtained from this procedure is usually only temporary, and it tends to wear off after several days, weeks, or sometimes months. This procedure is also an excellent diagnostic tool, especially when the MRI scan suggests that multiple nerves are compressed and your neurosurgeon would like to know exactly which nerve is causing your symptoms. These procedures are best co-ordinated by an interventional pain specialist, as the blocks may be followed by other low risk needle-type procedures such as pulsed radiofrequency neurotomies.

PHYSICAL THERAPIES

These include physiotherapy, osteopathy, hydrotherapy and massage.

ACTIVITY MODIFICATION

Sometimes simply modifying your workplace and recreational activities, to avoid heavy lifting and repetitive neck or arm movements, allows the healing process to occur more quickly.

Surgery

Surgical options include anterior cervical discectomy and fusion, foraminotomy, posterior cervical decompression (laminectomy) with or without fusion, and an artificial disc replacement. You should discuss these alternatives, and their potential risks and benefits, with your neurosurgeon or spinal surgeon at Precision Brain Spine and Pain Centre. 


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