Cervical Brachial Neuralgia

Cervical and brachial neuralgia is a complex syndrome, characterized by cervical pain irradiated on the upper limb, with interest in a cervical nervous root. Doctor Patrascu Mrs. Georgiana, specialist in Reumatology, Recovery, Physical Medicine and Balneology at Gral Medical Clinic explains the symptoms, diagnosis and treatment of cervical-brachial neuralgia (NCB). Cervical and Brachial Neuralgia (NCB) Symptoms and Evolution Diagnosis of Cervical Brachial Neuralgia (NCB). Radical (cervical nerve root) compression in the spinal canal via intervertebral disc herniation or the presence of a posterior osteophyte. 2.

Nerve compression through cervical degenerative processes (without disc herniation): antero-posterior vertebral osteophytes, hypertrophic joints. Symptoms and Evolution The onset of neuralgia may be acute (through cervical disc herniation) in which the disc migrated to the spinal canal or a slow onset (when the disc did not migrate) and occurs after exposure to cold when the column is maintained . The pain is localized to the cervical lobe, to the affected upper limb or to the median line, and has several aspects: it can be of constant intensity, being permanent, with shoulder irradiation, upper limb, elbow, to the fingers, according to the dermatome . Irritative stage, characterized by cervicalgia 2. Compressive stage: pain accompanied by paraesthesia and abolition or reduction of osteo-tendon reflexes.

Paresthesias follow dermatomal topography, so in many cases the affected cervical intervertebral disc can be identified. 3. Paroxysmal stage: all of the above symptoms are present, associating motor deficiency (feeling weak / muscular fatigue by decreasing muscle strength, hypothyroidism and hypotonia at the level of the affected muscular groups of the affected nerve root). The motor deficiency can be located at the hand, forearm, very rarely on the arm. The clinical examination may reveal static changes of the cervical spine (scoliosis, certain antalgic postures such as head inclination to the painful shoulder, anterior projection of the head) and changes in dynamics (limiting the mobility of the cervical spine).

Musculo-ligamental syndrome refers to the contra-muscular contracture, its appearance being within a reflex, pain-defending mechanism and localized latero-cervical, superior to the shoulder (trapezoid muscle) and upper thoracic paravertebral. NCB may be less likely to associate with myelopathy, a situation where neurological signs that may extend to lower limbs. Another possible association is with vascular disorders due to compression of the vertebral artery, which is manifested by acute cerebral ischemia phenomena, sudden movements of rotation / extension of the cervical spine. NCB evolution may last for 5-6 months after the first 4 weeks (acute phase), symptoms being partially attenuated, going to the subacute stage in the next 2-3 months. Though the trend is tremendous, short spell-release periods of pain may also occur.

Top Diagnosis of Cervical Brachial Neuralgia (NCB) Positive diagnosis is based on symptomatology (irradiated cervicalgia, paraesthesia, motor deficit, positive root elongation test) and imaging investigations (radiographs, nuclear magnetic resonance, computed tomography, myelography). The radiological examination reveals degenerative changes, which may be involved in the patella / stenosis of one or more cervical intervertebral spaces. MRI and CT provide accurate information on the location of disco-radicular damage, cervical nerve root and spinal cord at that level. Laboratory analyzes are useful for the differential diagnosis of cervical and brachial neuralgia in some situations when it is more difficult to perform. Differential diagnosis is made with diseases that mimic irradiated pain on the upper limb: shoulder-to-hand syndrome, scapular-humeral periarthritis, carpal tunnel syndrome, epicondylitis, breast cancer, leukoevrraxitis, spondylodiscity, intramedullary tumors, metastases, cervical coastal syndrome,.

Pancoast-Tobias (with C8-T1 root affection). Top Treatment of cervical and brachial neuralgia Treatment of cervical and brachial neuralgia is based on long-term medical therapies or neurosurgical intervention, indicating the degree of disease. 1 - In the acute phase (the first 3-4 weeks), the treatment objectives are: fighting pain, inflammation and muscle contraction. It is recommended to immobilize the cervical spine in the orthosis (minerva) to alleviate the pain and avoid the movements that can aggravate the hernial disc. The orthosis should be applied correctly and worn 24 hours a day, both in the acute and subacute phases, being allowed to be removed only for personal hygiene.

Also the upper limb can be supported in a scarf to avoid straining the affected strings. Drug therapy is based on the use of anti-algic, steroidal / non-steroidal anti-inflammatory drugs, myorelaxants, vasodilators, neurotropes (group B vitamins, antioxidants). Physical therapy in this phase has as main objectives the achievement of muscle relaxation and blockage of nerve conduction, which can be achieved by means of ice cube massage. Electrotherapy should be used with caution in this phase. 2 - In the subacute phase (at ap.

2-3 months after onset), the treatment objectives are, in addition to continuing measures to combat pain, muscle contraction and inflammation, motor deficit recovery and static and cervical dynamics. In addition to medical treatment, physical therapy plays an important role in this phase. The massage is of two types: decontractant sedative at the cervical-brachial level and thoracal paravertebral or trophic / tonic in the frustrated forms of motor deficit of the upper limb. Electrotherapy consists of the application of low frequency currents (diadinamics, TENS, Trabert, galvanic), medium frequency (interferential), high frequency (diathermy, ultrasound). A series of physical procedures last for an average of 10 days, with a daily frequency, favorable effects on local pain and inflammation, visible after the first 4-5 sessions, so continuity in treatment is important.

General hydrothermotherapy consists of making hot baths at apx. 37 ̊ C for 20 minutes to induce general relaxation and combat local muscle contractions. Physical therapy has as objectives: 1. Correction of static disorders of the cervical spine 2. Rebalancing the tonus of flexing muscle groups and cervical paravertebral extensions.

3. Restoring cervical column mobility Besides the passive mobilizations of the cervical spine (with the patient in dorsal decubitus, the movements being performed slowly in rotation, lateral inclination, flexion-extension), the cervical cervical muscles have an important role to play in cervical cervical muscles . Traction can also be done mechanically, with the patient in a horizontal / sitting position, using special traction devices or pulley assembly. 3 - In the chronic phase, the treatment objectives are the same as those in the subacute phase, placing greater emphasis on the rehabilitation of the cervical spine dynamics and the loco-regional muscular balance. All the above-mentioned therapies are indicated, with a decontractant massage (cervico-thoracic paravertebral and scapular belt), cervical axial tractions, physical therapy exercises and vertebral manipulations (passive mobilizations) performed by kinetotherapists.

Physical-kinetic treatment is contraindicated in certain situations, so it is very important to make a differential diagnosis of cervical glands, physical therapy being avoided in all the following cases: cervical glands caused by obvious direct trauma to patients with rheumatoid arthritis, to which . Prognosis is much better in young people, only 15-20% of them having surgical indication, while elderly not responding to apx. A month of conservative treatment, were treated in the neurosurgery service in a proportion of 30-35%. Postoperative recovery is also very important in these patients. Upper cervical column kinetoprophylaxis: Avoid exposure to cold.

Control / awareness of the cervical spine posture and its correction, regardless of the position of the patient (orthostatism, sitting, decubitus). Observing correct cervical column posts during sleep will avoid the use of high cushions; . Lifting weights greater than 4-5 kg ​​in one hand should be avoided; . Avoiding prolonged monotonous jobs imposed by professional activity (office / computer work); . 2 hours should be interrupted and mobilization of the cervical spine in all respects the constant repetition of the exercise program learned at kinesitherapy sessions in order to maintain optimal muscular tone in the cervical spine periodic exercise of balneal cures, the advantage of which being the natural factors of .

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