Cervicobrachialgia and herniated disc of the cervical spine

Cervicobrachialgia is pain that originates in the neck  and radiates to the fingers, following the course of the brachial plexus , the nerves that connect the spinal cord and arm.


Causes of cervicobrachialgia

Causes include:

  1. Nerve compression from a thickened or tight muscle, such as the scalene or pectoralis minor.
  2. Pinched nerves due to the position of the clavicle, which is lower and closer to the first rib.
  3. The connective tissue can cause pain that travels down the arm and into the hand; adhesions may form, trapping the nerve endings and causing referred pain.

herniated disc is a common but not the only cause of these symptoms; the gelatinous core (nucleus pulposus) emerges from the fibrous cartilage ring of the intervertebral disc (anulus fibrosus); if the vertebra has an outward displacement (osteophyte) that contributes to compression of the spinal cord, this is called a hard disc herniation and can lead to damage to the spinal cord (myelopathy). If, on the other hand, only the intervertebral disc is affected, this is referred to as a soft herniated disc. There are usually no vertebral fractures .

protrusion of the disc that presses on the spinal cord or the roots of the spinal nerves is the cause of neck and low back pain (lombalgia), although most patients who are diagnosed with a herniated disc do not complain of back pain, cervicobrachialgia and lumboischialgia .
The spinal nerves of the brachial plexus originate in the cervical spine and run through the upper limb to the fingers.

When the gelatinous core comes out of its anatomical seat and compresses the nerve roots, it can cause excruciating and constant pain, numbness, burning , paraesthesia (sensory disturbances), muscle weakness and tingling .

Rarely do patients complain of bilateral cervicobrachialgia, but some experience heaviness and weakness in both upper limbs.

What are the symptoms of cervicobrachialgia?

Magnetic resonance of the cervical spine with disc herniation C5-C6, one can clearly see the dark “spot” behind the lower vertebrae, while the posterior ligament can be seen above and below.

The main symptom of cervicobrachialgia is intense, unbearable pain; if it is caused by pinching the nerve roots, the arm, shoulder and upper part of the scapula hurt, in this case it is called cervicobrachialgia, ie pain in the neck and in the area supplied by the brachial plexus, the plexus of nerves in the arm, the neck , shoulder , scapula , upper arm , forearm and hand .
The neck is often stiff when turning, and the shoulder and arm can also experience significant movement restrictions.
Patients often complain of cold and  swollen hands .
But you only have the feeling that the hand is swollen, it is not really; at night they often feel an unpleasant tingling sensation that wakes them up.

The patient does not know how to sleep, he turns in bed all night looking for a position that could give him relief and so the night spent in bed becomes a torment. In this case, in addition to magnetic
resonance , a Electromyography can be carried out, ie a diagnostic examination in which muscle activity is analyzed at rest and during spontaneous activity. If dizziness and headaches occur, this cannot be caused by a herniated disc in the cervical spine, since these symptoms originate in the C1-C2 vertebrae, between which there is no disc that compresses the nerve. Damage to the intervertebral discs in the cervical spine occurs mainly in the intervertebral discs C4 – C5 and C6 – C7, i.e. at the base of the neck.

Many of my patients report feeling the beads in the back of their neck and believe they are enlarged lymph nodes causing the arm symptoms, but there is no connection between these disorders.

Diagnosis of cervicobrachialgia

The doctor in charge is a specialist in neurosurgery.
During the examination, strength, reflexes and range of motion of the arm must be checked.
If the pain along the arm is caused by a herniated or protruding disc, neck compression and nerve stretch will increase the pain, allowing the doctor to identify the source of the symptoms.
An important test method is the Jackson test, which involves compression with the neck rotated sideways.

The exact localization of the symptoms can provide information about which nerve is causing the symptoms:

  • Cervicobrachialgia C5, ie the nerve arising between the vertebrae C4 and C5, the pain occurs at the level of the biceps.
  • Cervicobrachialgia C6, the pain area is in the lateral upper and lower arm and extends to the thumb.
  • Cervicobrachialgia C7, the symptoms occur in the back of the upper and lower arm and extend to the middle finger.

In the case of a right disc herniation, only the right arm is affected, but the left side if the nerve is compressed on the left side. In the case of a severe central herniated disc, the symptoms can appear simultaneously in the arms and legs , but this is only very rarely the case.

Which research methods are best?

TC and magnetic resonance are good methods of investigation to detect this compression because they also analyze the soft tissues, while an X-ray only shows the bones, ie one could only see a narrowing of the intervertebral space.
Response shows paramedian or external disc herniation on side presenting with symptoms; if the compression were central, the symptoms would not be unilateral.
In some cases, the herniated disc can also affect the vagus nerve and cause symptoms in the organs it innervates: respiratory tract, heart, lungs, stomach and intestines; it can nausea, difficulty swallowing and anxiety.

herniated disc should not be confused with brachialgia, which is irritation of the brachial plexus, although both have the same symptoms and often occur together.
Some patients complain of shoulder pain originating from the cervical spine area. Sometimes they come   to the practice with their forearms held overhead because in this position the roots of the fifth and sixth cervical nerves are relieved and the stabbing pain subsides.

Some wear their arm in a sling like someone with a dislocated shoulder; in this way the root of the seventh cervical nerve is relieved.
Another pathology may present symptoms similar to stenosis of spinal canal or vertebral foramina through which spinal cord and nerve roots pass; when these openings become narrower than the nerves passing through them, a condition very similar to nerve compression from a herniated disc results.

What can you do? Which form of treatment is most suitable?

The protrusion of the intervertebral disc is not temporary, the protruded part does not retract on its own.
Often the symptoms of acute cervicobrachialgia disappear within 8 months as the protruding gelatinous core is absorbed, but in other cases the disease becomes chronic.

Pharmacological treatment

The doctor may prescribe corticosteroids in the acute phase , but once the pain subsides, nonsteroidal anti-inflammatory drugs such as diclofenac (Voltaren) and possibly muscle relaxants such as MuscoRil, which do not have the side effects of cortisone , are possible .
Doctors often recommend pregabalin (trade name Lyrica) for neuralgia.

Physiotherapy and natural remedies

Physical therapy with McKenzie’s exercises “pushes” the nucleus back to its original location, thereby relieving pressure on the spinal nerve root.

The disc will not be the same again, but the symptoms can be eliminated. Performing muscle-strengthening exercises
for the muscles of the spine is important for the treatment of cervicobrachialgia , as relaxation of the ligaments and muscle weakness lead to instability of the spine. A herniated disc does not automatically cause pain; these, on the other hand, can be caused by brachialgia, which can also be treated with heat therapies such as: laser, patient massage and Tecar ®.

Osteopathy is one of the manual therapies and can relieve tension, joint blockages and nerve compression; therefore it can have a great effect here.

Cervical traction is a treatment that provides relief, but there is no scientific research on the effectiveness of the therapy for disc protrusion.

Wearing a cervical collar to immobilize the joint is not helpful; on the contrary, it is counterproductive as it adds stiffness to the other symptoms. Rest is sufficient to avoid aggravating the symptoms.
hot shower or hot water bottle can relieve symptoms and loosen tight muscles; no ice pack should be placed on the neck or arm.

Swimming is also one of the sports to avoid because the crawl requires frequent neck rotation; arm movement can also increase symptoms.

The best sleeping position is on your back with your sore hand behind your head because nerve stretch is reduced that way.

When the pain subsides or is gone, all daily activities can be resumed; Postural exercises can help prevent relapses.

When is an operation necessary? Surgical intervention for cervicobrachialgia

In severe cases, which fortunately are very rare, surgery may be considered if cervicobrachialgia has not resolved within a few months.
The surgical procedure is performed by a neurosurgeon.
There are three different techniques. The most recent of these envisages the insertion of an artificial intervertebral disc (Brian’s cervical prosthesis) and has the advantage that the mobility of the cervical spine is not restricted.

Another option is microdisectomy , in which part of the damaged disc is removed, which is only possible if it has not degenerated.
It is also possible to combine the vertebrae; however, this type of surgery has significant repercussions because the spine loses some of its mobility.

How long are the healing times? Prognosis

A herniated disc can only rarely be healed in a short time with anti-inflammatory or cortisone-containing agents .
If left untreated, healing can take several months; in more severe cases, surgery is necessary, but fortunately this is not common.
If the disc protrudes or bulges slightly, a few McKenzie therapy sessions can solve the problem.
If the symptoms are of muscular or connective tissue origin, the patient can recover completely within a few weeks with appropriate treatment.

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