Synonyms
Cervical brachialgia, neck pain, radiculopathy, nerve root pain, back pain, low back pain, lumbar syndrome, root irritation syndrome, compression syndrome, herniated disc, facet syndrome, vertebral joint pain, myofascial syndrome, tendomyosis, spondylogenic reflex syndrome, spine, cervical spine
Definition Cervicobrachialgia
Cervicobrachialgia is not a diagnosis of disease, but rather the description of a decisive and groundbreaking sign of the disease, the cervical spine pain that continues into the arm. Cervicobrachialgia is most frequently the expression of a herniated disc of the cervical spine (cervical spine).
Conceptuality
Cervicobrachialgia is composed of the terms cervicalgia = cervical spine pain and brachialgia = arm pain transmitted via the nerve roots and arm nerves.
Causes of cervicobrachialgia
Cervicobrachialgia can have several underlying causes. By far the most common cause of the disease is a slipped disc in the cervical spine (cervical spine). The disc tissue prolapsing in the direction of the spinal cord leads to chemical and mechanical irritation of the nerve roots.
This causes nerve root pain (radiculopathy), which continues along the affected body nerve (peripheral nerve) into the body. Depending on which nerve root/arm nerve is affected by the damage, the pain band along the arm can differ (see above dermatome distribution). There is a correlation between the intensity of nerve root irritation and the extent of the pain in the arm.
The stronger and more sudden the irritation (stimulus) of the nerve root, the further the pain is transmitted along the affected body nerve into the arm. Accordingly, very strong nerve root irritation leads to arm pain all the way into the hand, while less strong and slowly developing nerve root irritation leads to arm pain, which can break off in the upper or lower arm. Typically, cervical arm pain caused by a herniated disc is experienced by the patient more in the arm than in the cervical spine.
More rare causes of cervical brachialgia are wear-related narrowing of the nerve exit holes in the spinal column (degenerative spinal disease), vertebral joint cysts or inflammation of the body nerves themselves (neuritis/plexus neuritis). Pseudoradicular pain is a distinct distinction from cervicobrachialgia. This is a fake nerve root pain that can be caused by various diseases (e.g. cervical spine syndrome). Pseudoradicular cervical spine pain also radiates into the arm or neck area, but never reaches the hands and cannot be attributed to a nerve root. The following diseases can cause pseudoradicular cervical spine pain:
- Facet syndrome /spondylarthrosis
- Uncarthrosis (form of cervical spine arthrosis)
- “Blockages” of the cervical spine joints
- Muscular tension (myogeloses)
Symptoms
Complaints caused by cervicobrachialgia are usually based on a constant or epochal pressure on the nerves of the cervical spine. The nerves running along the cervical spine move to the area of the arms. Depending on the severity of the pain, it can take the form of severe headaches that radiate into the cervical spine.
These can be of a pulling or dull, knocking character. They can sometimes be triggered by manual pressure on the cervical spine and become worse. They are usually not permanent, but can increase in strength, especially during long periods of lying down or after getting up in the morning.
Severe headaches in this area can also occur after long car journeys. Apart from the headaches and the sometimes very strong neck tensions, pain in one or both arms is usually described in parallel. These pains are described as pulling and extremely unpleasant.
A feeling of numbness can also be felt in places, with a correspondingly severe course. Severe headaches are the most common symptom of cervicobrachialgia. Since the nerves of the cervical spine are irritated by constant pressure, the pain spreads from the head to the neck and arms.
The pain is particularly felt after phases of inactivity, for example after getting up in the morning or staying in a sitting or lying position for a long time. The pain is often described as pulling and throbbing and has approximately the character of a migraine-like pain. In addition, the pain is described more in the back of the head, which is more likely to indicate damage to the upper cervical spine.
In the therapy of cervicobrachialgia, pain is also reduced, mainly by the so-called “NSAIDs”, for example ASS, ibuprofen and diclofenac. The complaints described by the patient and the physical examination are groundbreaking. Typical for cervicobrachialgia is the radiation of pain along a dermatome (see above).
The most frequent nerve root irritation of the cervical spine caused by a herniated disc affects nerve roots C6 and C7. The intervertebral disc, or a herniated disc C5/C6 with the development of cervicobrachialgia C6/C7, accounts for 36% of most herniated discs. The sensitive supply area of the skin of the affected nerve root C6 (dermatome of C6) extends over the thumb-side upper and lower arm to the thumb itself.
Sensory disturbances and pulling pain in this area are clearly assigned to this nerve root. In the full expression of C6 syndrome, the biceps reflex and radial periosteal reflex is weakened or extinguished. There is also a loss of strength in active forearm flexion.
The herniated disc C6/C7 is in second place in its frequency with 35% almost equally. The dermatome of the C7-root extends over the shoulder and upper arm to the stretched middle forearm and into fingers 2-4 (especially middle finger). Signs of the disease can be a disturbance of sensation in this area as well as muscular weakness of the upper arm extensor muscles (triceps) with loss of the tricep reflex.
A further sign is atrophied thumb ball musculature, which in turn must be distinguished from carpal tunnel syndrome. If the root pain is to be proven in imaging procedures, magnetic resonance imaging (MRI) of the cervical spine is the most suitable method. It can be used to visualise the nerve roots of the spinal cord and any herniated discs.
