traumatology

cervicobrachialgia

Generality

Cervicobrachialgia is a medical condition caused by the compression of nerve structures connected to the spinal nerves C5, C6, C7 and C8, which mainly causes pain in the neck and pain in one or both upper limbs (including shoulders and hands).

Also known as cervico-brachial syndrome, cervicobrachialgia most frequently affects people who perform manual activities where certain gestures or movements are repeated continuously.

Cervicobrachialgia is not only a cause of pain; in fact, where it causes pain, it is also responsible for: a sense of stiffness, a sense of numbness, tingling, muscle weakness and reduced muscle control.

An accurate diagnosis of cervicobrachialgia requires: physical examination, medical history and a series of instrumental tests, such as chest radiography, nuclear magnetic resonance of the spine and electromyography.

The basic therapy of cervicobrachialgia is conservative and symptomatic.

What is cervicobrachialgia?

Cervicobrachialgia is the medical term indicating a condition responsible for a pain that typically extends from the cervical spine (neck) to the ends of one (more common) or both (less common) the upper limbs, passing through the so-called scapular belt (or shoulder girdle).

Since cervicobrachialgia generally includes, in addition to pain, several other symptoms, this particular condition is also called cervico-brachial syndrome (NB: remember that, in medicine, syndrome means set of symptoms).

What does cervicobrachialgia mean?

The word cervicobrachialgia recalls all the main characteristics of the condition to which it refers; in fact, in medicine:

  • The term "cervico" generally refers to the cervical portion of the spine, the one in which the so-called cervical vertebrae reside;
  • The term "brachi" (from "brachial") refers to the anatomical area of ​​the arm and, more generally, to the upper limb as a whole;
  • The term "algia" means " pain ".

An important aspect of the term cervicobrachialgia must be clarified: while for some experts this word indicates any localized pain between the neck, shoulder and upper limb (therefore it refers to something non-specific), for other experts it refers to a precise syndrome, whose origin is 'is a very specific nervous suffering.

Other synonyms

In addition to cervico-brachial syndrome, another noteworthy synonym for cervicobrachialgia is cervico-brachial neuralgia .

Epidemiology

According to some statistical research, cervicobrachialgia would be more widespread than cervicalgia, which is essentially pain limited to the cervical area of ​​the spine (and therefore to the neck).

It is a fact that cervicobrachialgia mainly affects adults with manual work, during which they are called to continually repeat a certain gesture or certain gestures; examples of such occupations are computer work, writing jobs, jobs where the continuous lifting and continuous movement of heavy objects, etc. are expected.

Causes

Cervicobrachialgia can be the result of a cervical radiculopathy affecting the spinal nerves of the brachial plexus or the consequence of a very particular medical condition, known as thoracic outlet syndrome or thoracic egress syndrome .

Although with different modalities, both these circumstances cause cervicobrachialgia by means of a nerve compression mechanism, which will be discussed in the next chapters.

Cervical radiculopathy and cervicobrachialgia

In medicine, the term radiculopathy refers to a pathological condition that affects, by means of compression, the roots of the spinal nerves and their extensions, altering the motor and sensory functions of these structures just mentioned.

In a cervical radiculopathy on the spinal nerves of the brachial plexus, the roots or the earliest relative extensions of one or more of the cervical spinal nerves C5, C6, C7 or C8 are subjected to compression (NB: the brachial plexus comprises the roots of these 4 spinal nerves plus the thoracic spinal nerve roots T1).

To understand why the cervicobrachialgia may depend on such a cervical radiculopathy, it is necessary to remind readers that the cervical spinal nerves C5, C6, C7 and C8 exit the vertebral canal through the hole delimited by the vertebra of previous number and the corresponding number (therefore the C5 nerve exits between C4 and C5, the C6 nerve between C5 and C6, the C7 nerve between C6 and C7 and the C8 nerve between C7 and T1) and go to make up the complex of nerve structures that controls the muscles and the sensory capacities of shoulder, arm, forearm and hand.

Deepening on the brachial plexus

From the roots of the cervical spinal nerves C5, C6, C7, C8 and T1 derive the 5 terminal branches of the brachial plexus - the so-called musculocutaneous nerve, ulnar nerve, median nerve, radial nerve and axillary nerve - which preside over the control of muscles and sensory capacity of a part of the chest, shoulder, upper limb and hand.

CAUSES OF CERVICAL RADICOLOPATHY

Among the causes and risk factors of cervical radiculopathy (including the form of cervical radiculopathy that can trigger cervicobrachialgia) are:

  • Cervical hernia (or hernia of the cervical disc or cervical disc hernia);
  • Cervical arthrosis;
  • Rheumatoid arthritis;
  • The presence of congenital malformations in the spine;
  • The presence of osteophytes at the cervical level;
  • Traumas affecting the cervical spine;
  • Neoplasms of the spine with seat along the cervical tract.

Thoracic outlet and cervicobrachialgia syndrome

In human anatomy, the thoracic strait is the physiological (hence natural) narrowing delimited by the first rib, the clavicle, the scalene muscles (median and anterior), the subclavian muscle and the pectoralis small muscle, within which the system of blood vessels run subclavian artery-vein and the aforementioned brachial plexus.

In medicine, the set of symptoms and signs deriving from the compression of blood vessels and / or nerve structures passing through the thoracic strait is called thoracic outlet syndrome.

The cervicobrachialgia can be a consequence of the thoracic outlet syndrome when the latter involves the compression of the nerve structures passing through it, ie the brachial plexus.

In this case, the cervicobrachialgia is the result of a nerve compression located further downstream, compared to the situation described above (cervical radiculopathy); it is interesting, however, to point out to the reader that, despite this difference, the outcome is superimposable, including suffering on the neck, the shoulder and along the entire upper limb.

CAUSES OF THE THORACIC STRETCH SYNDROME

The cause / favor of thoracic outlet syndrome (therefore indirectly also cervicobrachialgia) can be: a congenital anatomical defect of the thoracic strait, a strong trauma to the thoracic strait, the assumption of wrong postures, obesity and the repetition of certain activities manuals.

Symptoms and complications

Normally, cervicobrachialgia begins with pain along the cervical spine ( neck pain ); in a short time, therefore, cervical pain is associated with a painful sensation in the shoulder and upper limb, and a series of other symptoms, including:

  • Tingling and numbness in the arm;
  • Tingling in the hand and fingers of the hand;
  • Tingling and numbness in the shoulder and the nearest portion of the chest;
  • Sense of weakness affecting the deltoid muscle and the muscles constituting the so-called rotator cuff;
  • Reduced ability to control the flexor muscles of the fingers of the hand;
  • Difficulty in controlling the extensor muscles of the fingers of the hand;
  • Neck stiffness;
  • Dizziness and dizziness;
  • Headache;
  • Disturbed sleep.

Characteristics of cervical pain?

The painful sensation that characterizes the cervicobrachialgia can be a throbbing pain or a burning pain .

During the day it is subject to variations; for example, it may increase following a physical activity or due to a trivial sneeze.

Seat of compressionMain consequences
Spinal nerve root compression C5Pain in the anterolateral region of the shoulder and arm.

Weakness of the deltoid muscle and the rotator muscles of the shoulder.

Spinal nerve root compression C6Pain in the antero-lateral region of the forearm, thumb and forefinger.

Dysfunction of the flexor muscles of the thumb and forefinger.

Spinal nerve root compression C7Pain in the posterior portion of the arm and forearm, and at the back of the hand.

Dysfunction of the extensor muscles of the fingers.

Spinal nerve root compression C8Armpit pain, on the inside face of the arm and forearm, in the hand, middle finger and ring finger.

What does tingling and numbness depend on?

Tingling and numbness depend on an alteration of the sensory component of the roots or of extensions of the roots belonging to the cervical spinal nerves.

What does muscle weakness depend on?

Muscle weakness is the result of an alteration of the motor component of the roots and of the extension of the roots belonging to the cervical spinal nerves.

Complications

Failure to treat cervicobrachialgia leads to an aggravation of the symptomatology (eg, pain becomes more intense, tingling becomes unbearable, etc.), so that even the simplest manual activities are difficult - if not impossible - clearly with the limb interested superior).

In such circumstances, the inability to perform the most trivial manual tasks can have negative repercussions on the psychological sphere of the patient (discomfort, depression, decreased mood, etc.).

Diagnosis

As a rule, the diagnostic procedure for the detection of cervicobrachialgia includes an accurate medical history, an in-depth physical examination, a neurological examination and a series of instrumental tests .

Within this diagnostic path, the figure of the neurologist plays a fundamental role, that is of a doctor specialized in the diagnosis and treatment of nervous system diseases.

Instrumental tests: what are they?

In the diagnostic pathway leading to the detection of cervicobrachialgia, instrumental tests are very important, because they confirm what was found during the previous investigations and help the doctor to establish the precise pathophysiological mechanism underlying the symptomatology (in other words, they clarify which is the cause of nerve compression).

The instrumental tests useful for the diagnosis of cervicobrachialgia include:

  • Radiography (X-rays) or nuclear magnetic resonance of the thorax. Allow the diagnostic doctor to recognize any abnormalities in the thoracic area.
  • CT or nuclear magnetic resonance of the cervical spine. They allow the diagnostic physician to identify any nerve compression, affecting the roots of the cervical spinal nerves, as well as the cause of this compression (cervical hernia, cervical osteophytosis, cervical spine tumor etc.).
  • Electromyography. It is an instrumental examination that allows you to study the goodness of the nervous control of a muscle or a series of muscles close together.

    In a context of cervicobrachialgia, it serves to understand precisely which nerves are affected by the phenomenon of nerve compression and if it has caused any damage.

Therapy

In treating a condition like cervicobrachialgia, doctors generally adopt the following strategy: based on the triggering causes, they first plan a conservative and symptomatic therapy, and give them the right time to take effect; therefore, once the aforementioned time period has elapsed, they evaluate the results of the treatments adopted and, if and only if these latter have proved to be useless or in any case not very effective, prescribe ad hoc surgical therapy .

Conservative and symptomatic therapy: what are the possible treatments?

Conservative therapy (that is, which does not involve surgery) and symptomatic (ie aimed at alleviating symptoms) of cervicobrachialgia includes various treatments and remedies, including:

  • A period of rest from all those activities that cause or increase pain. In general, rest is a remedy recommended for all patients, especially in the acute phase of symptoms;
  • Taking pain medication . Paracetamol and ibuprofen are among the most commonly used painkillers for cervicobrachialgia. Corticosteroids are rarely used;
  • Intake of muscle relaxants . In particular, these drugs are indicated when, from diagnostic investigations, an involvement of the shoulder, arm and hand muscles emerges;
  • Cryotherapy (cold therapy) alternates with thermotherapy (heat therapy). They provide, respectively, the application of ice on the most painful area and the execution of hot baths with a particular interest for the painful anatomical regions. Their purpose is to reduce painful symptoms;
  • Physiotherapy cycles based on the triggering cause. Physiotherapy for cervicobrachialgia can include stretching exercises, muscle strengthening exercises, postural gymnastics etc.

    Good physiotherapy can have extraordinary beneficial effects.

Surgical therapy: what does it consist of?

Surgical treatment of cervicobrachialgia varies according to the triggering factor.

In any case, however, it consists of an intervention aimed at nervous decompression, that is, in an operation that "frees" a particular nervous structure from its compression, responsible for its altered functioning.

In the presence of cervicobrachialgia, this type of intervention can involve the roots of the cervical spinal nerves, their immediate extensions or their shunts passing through the so-called thoracic narrow.

In the presence of cervicobrachialgia, doctors take into consideration the use of surgical therapy only after a year of ineffective conservative and symptomatic treatments.

Prevention

At the moment, there is no remedy that prevents 100% cervicobrachialgia.

However, there are various precautionary measures that greatly reduce the risk, such as:

  • Use your body properly, while lifting weights, and avoid excessive back torsions. There are numerous online guides that teach how to lift a weight without burdening the spine.
  • Maintain a correct posture, especially in a sitting position, so as not to alter the normal anatomy of the spine.
  • Exercise regularly, because this preserves the spine from cervical hernia (one of the main causes of cervical radiculopathy).

Prognosis

If the diagnosis is accurate and the therapy is appropriate, the prognosis for cervicobrachialgia tends to be benign.