Brachialgia is a painful complaint of the arm, joints or shoulder. It is a pain that results from, for example, mechanical irritation or another condition. The intensity of brachialgia varies.
What is brachialgia?
Brachialgia refers to pain in the arms, joints, or shoulder. It results from compression of the nerve roots. In the corresponding dermatome of the spinal cord nerves, there is radiating pain with a varying degree of severity. Likewise, paresthesias occur with and without sensorimotor failure. They are manifested by tingling, numbness or a falling asleep of the arm. Certain movements of the cervical spine can influence the pain and relieve it. The more severe the compression on the nerve root, the more extensive are the symptoms and deficits in the patient. Damage most commonly occurs to the C6 and C7 cervical nerve roots followed by C8 and C5. All are located in the upper third of the cervical spine, at the level of the shoulder girdle to the scapula. Brachialgia can be caused by external influences such as mechanical irritation, or it can be caused by internal processes such as a tumor. Brachialgia is medically divided into several forms due to the different manifestations as well as causes.
Causes
The causes of brachialgia are varied. A rough distinction is made between mechanical irritation and pathological causes. In mechanical irritation, the patient subjects the nerve to excessive stress. The irritation causes pain in the arm or shoulder. Pathological causes include a tumor, a general inflammatory process, or shoulder amyotrophy. In addition, brachialgia may occur in women who have had their breasts amputated. Another cause is concomitant with radiation therapy. Shoulder amyotrophy is a rarely occurring inflammation of the brachial plexus. Suddenly, severe pain and paralysis of the shoulder and arm muscles occur. The inflammation of the brachial plexus is classified as acute. If brachialgia occurs in women after breast removal, the surgical procedure often includes removal of the axillary lymph nodes. This causes a lymphatic drainage disorder associated with lymphatic congestion and compression of the nerves. As a result, pain may occur in the arm and shoulder. Irradiation can cause it interference or damage to the nerves. These occur above the collarbone as well as the armpit.
Symptoms, complaints, and signs
Symptoms of brachialgia include uncomfortable pain in the arms, fingers, or shoulder. In addition, the joints may ache. The intensity of the pain is variable among patients and can range to acute pain. There are additional sensorimotor complaints of various degrees. Mostly, these are symptoms such as numbness, tingling or a falling asleep of the affected region. The complaints are individual and can radiate from the shoulder to the little finger. There are disturbances of sensation or failures of the musculature.
Diagnosis
In making the diagnosis, the first step is to determine whether mechanical irritation is present. This involves stretching the arms and shoulders or making circular movements. If they relieve the pain, irritation is likely. If it persists, there may be a pathological cause. For this, further checks are made via the blood count or X-ray. A pathological cause is also indicated if the pain occurs either spontaneously or intensifies over a longer period of time. Via the anamnesis, it is checked whether the failure symptoms increased steadily.
Complications
Brachialgia may result in limited use of the affected arm. This is not only the case with paralysis (paresis) – sensory disturbances and paresthesias can also indirectly affect motor function. Depending on the treatment, further complications may appear. When taking painkillers, which have addictive potential, physical dependence is possible. This manifests itself in the same dose of the painkiller being less effective.Nevertheless, in order to effectively combat the pain caused by brachialgia, the dose of the painkiller is often increased. To avoid dependence, many physicians prefer to prescribe painkillers that are not physically addictive or have only a low potential for addiction. Painkillers that are obtained illegally or taken at one’s own discretion are particularly problematic, as there is no monitoring of these drugs. As a result, long-term physical damage is also possible, for example in the form of kidney or liver disorders. In addition, taking painkillers can be psychologically addictive. This risk exists above all if the person concerned has a corresponding predisposition and suffers from increased psychological stress. If addiction occurs as a result of taking medication, additional psychotherapeutic or psychiatric treatment may be required
When should you see a doctor?
Since the causative conditions of brachialgia, apart from simple “muscle soreness,” all belong in medical treatment, be it root irritation or a herniated disc of the cervical spine; pulling up from below, carpal tunnel syndrome; or even starting from the chest, a heart attack, it is always indicated to take severe and persistent pain in the arm seriously. Taking painkillers on one’s own is widespread, but can lead to the causes of the pain not being treated for longer than necessary. Pain relief leads the patient to believe that he can treat his condition himself, but in most cases this is not possible, as the causes of the pain in the arm are manifold. Only if the affected person had to perform heavy physical work the day before or knows that he has exerted himself too much as an untrained person, it may be right to refrain from visiting the doctor for the time being. However, since pain in the arm can always be based on serious diseases, even then it is not wrong to seek out the doctor to be on the safe side and let him clarify whether the causes are harmless or a longer-term therapy is necessary.
Treatment and therapy
The treatment and therapy of brachialgia depends on the cause. Analgesics can be used for all of them. If a mechanically triggered irritation is present, the patient often reacts automatically in advance by sparing the affected parts of the body. Medically, relief is provided by specific movements of the cervical spine. Specific exercises on the symptomatic side, such as extension, lateral flexion or rotation, often minimize pain and are usually trained in physiotherapy. Additionally, supportive anti-inflammatory drugs may be given. If inflammation is present, it is treated with medication. Anti-inflammatory drugs or a blockage of the brachial plexus leads to an elimination of the symptoms after a few months. In the case of a tumor, this is removed by means of a surgical procedure. Further therapeutic measures such as radiation, the administration of medication or targeted physical exercises are then decided on an individual basis. If brachialgia occurs as a result of radiation, the treatment must be coordinated with measures already taking place. Here, the risks of inflammation as well as nerve blockage are increased. If brachialgia occurs in women after breast removal, there is often a lymphatic drainage disorder. The lymphatic congestion is treated by lymphatic drainage. In addition, the patient is given diuretics to promote lymphatic drainage. Furthermore, pain is relieved by a plexus block.
Outlook and prognosis
The prognosis is influenced by consistent therapy and the patient’s own behavior in everyday life. Regular use of antirheumatic drugs improves symptoms. Because mechanical stimuli are among the triggers of brachialgia, the sensitive region of the shoulder girdle can be relieved by specific movement exercises. Physical therapy treatments reduce pain and increase arm and shoulder mobility. Good posture also has a pain-relieving effect. Monotonous and stereotypical movements should be avoided, especially in everyday work. Reviewing and adjusting sitting posture helps improve symptoms and relieves pain. Physical activities in everyday life are better managed by using relieving forms of movement.If the cause of brachialgia lies in a pathological process, the effectiveness of medicinal preventive measures is limited. Training of relieving body movements is also useful in this case. Motor deficits of the musculature regress within a few months. The healing process is favored by chiropractic treatments such as a stretching of the connective tissue. Special physiotherapeutic exercises can be used to correct a deformity that is clearly detectable in the X-ray image. Brusque movements as well as extreme rotations such as forward and backward bends should be avoided. A scarf made of wool or silk can be used to keep the shoulders and cervical spine warm.
Prevention
Preventive measures can be taken, especially in cases of mechanical irritation. These include relieving movements and good posture for the shoulders and arms. Monotonous and repetitive movements should be avoided. Sitting posture can be reviewed and the performance of physical activities should be changed to relieving forms of movement. If the causes are pathological, few preventive measures can be taken. Relieving body movements are also recommended here. Nevertheless, success here is highly dependent on the cause of the complaint.
This is what you can do yourself
The quality of life in everyday life can be correspondingly limited in brachialgia due to the painful discomfort in the shoulder, arm or joints. Self-help in everyday life also always depends on the underlying causes in the case of brachialgia. Restrictions in everyday life also result from the intensity of the symptoms. The course of the disease is determined on the one hand by the correct therapy, and on the other hand by one’s own behavior in everyday life. Most brachialgia is triggered by mechanical irritation. Therefore, movements for everyday life should be trained to relieve the sensitive region of the shoulder girdle so that these complaints, which tend to become chronic, do not constantly occur. Optimal self-help against brachialgia also includes good posture for the arms and shoulders. This is often neglected in everyday activities, but can be trained in such a way that it becomes automatic. Particularly in everyday working life, patients with brachialgia should avoid repetitive and monotonous movements. Pain relief can often be achieved by adjusting the way the patient sits. Those who have to perform physical activities despite brachialgia should use relieving forms of movement. Correspondingly alternative movement patterns are useful from a physiotherapeutic point of view and can effectively prevent new complaints. However, if brachialgia is caused by an underlying pathological event, the possibilities for self-help or prevention in everyday life are very limited. However, adapted relieving body movements are recommended even in these cases.
