Brachialgia, which means pain in the arm, is a symptom complex. It can be produced by any one of a number of lesions affecting the sensory tracts supplying the arm. The site of the lesion can be traced by following the distribution and the quent location for the nerve irritation is in the intervertebral foramen, and anatomical and physiological considerations clarify the relative ease with which sensory disturbances can be produced here. Affections of the intervertebral foramina are usually associated with clinical evidences of pathology in the cervical spine. Treatment must be directed to the primary etiological factor, but hyperextension of the spine will tend to reduce the compression of the nerves within the intervertebral foramina.
What is brachialgia?
Brachialgia is a technical term for arm pain. It is generally 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.
How does brachialgia occur?
The spinal canal and intervertebral foraminae are bony tunnels in the spine through which run the spinal cord and spinal nerves (nerve roots) respectively. When the size of these tunnels is reduced, there is less room for the spinal nerves and/or spinal cord, the consequence of which may be pressure on these structures.
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 brachialgia treated?
There are a number of treatment options fro brachilagia, and these will depend upon your specific situation:
Pain medications. A number of medications may be useful for pain. These include the standard opioid and non-opioid analgesic agents, membrane stabilising agents and anticonvulsants, as well as Pregabalin. Special medical treatments such as Ketamine infusions may be appropriate in some situations.
Nerve sheath injections. Local anaesthetic may be injected through the skin of the neck, under CT scan guidance, around the compressed nerve. This is also known as a ‘foraminal block’. Patients frequently obtain 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.
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.