Cervicobrachialgia or radiating neck pain: What is it, what does it affect, and how can we treat it?

What is cervicobrachialgia?

Cervicobrachialgia involves compression of a nerve root in the brachial plexus originating in the cervical spine, most commonly at the C6 and C7 levels, causing motor, sensory, or both types of symptoms. This condition affects the cervical region ( neck) and radiates down the arm and sometimes even to the hand.

Why does cervicobrachialgia originate?

It is an injury caused by inflammation of the nerve at its exit in the cervical or at another level of its route to the shoulder and can be produced by:

Herniated disc

The disc protrudes from its normal position and compresses the nerve, causing irritation.

Spinal canal stenosis

It consists of a decrease in the space through which the medulla passes. Having less space, we find many compacted structures, causing inflammation of the nerve root.

Nerve compression

It may be caused by a muscle or bone structure:

• Scalenes: They are 3 muscles that we find in the anterior and lateral aspect of the neck. Between them passes the brachial plexus that comes out of the cervical and if we find tension in these muscles can compress the nerve.
• First rib: This bone, together with the anterior scalene, subclavian, and prevertebral muscles, forms a space through which the brachial plexus passes, along with other structures such as arteries and veins. The volume of this space changes with any activity of these muscles or even with breathing. Therefore, if we identify compression of the plexus by these structures within this space, we are dealing with what is known as thoracic outlet syndrome. The patient experiences pain, numbness in the arm, and tingling that can extend all the way to the fingers.
• Pectoralis minor: The distal portion of the brachial plexus passes between this muscle and the ribs. Therefore, if we find tension in this muscle, inflammation, etc., it can cause compression of the plexus at this level, producing the same symptoms mentioned earlier.

What are the symptoms?

Cervicobrachialgia is characterized by severe pain in the neck and upper back, radiating in this case to one or both arms.

This pain can even wake a person up at night. The patient reports a feeling of fatigue in the arm, cramps, or tingling that can even extend to the fingers.

In turn, these symptoms cause pathologies at the shoulder level such as bursitis, irritation of the capsule, tendinopathies, etc., since there is an alteration of the movement of the arm causing the muscles not to act normally.

What are the treatments for cervicobrachialgia?

The treatment of this pathology is aimed at reducing pain and improving the functional capacity of the affected arm, thus improving the patient’s quality of life:

Conservative Treatment

It consists of resting for 2-3 weeks with the intake of analgesics, anti-inflammatory drugs and application of local heat (cervical area).

Physical Therapy Treatment

Within which we can find a more conventional treatment and a more innovative one.

Conventional Treatment

In this treatment we can apply Ultrasound and/or laser therapy in order to reduce the inflammation of the cervical area.

We can also apply microwaves, which consists of deep local heat to relax the muscles in the event that they are causing pain due to tension.

Magnet therapy that causes changes in the area of the injury, allowing the area to regenerate.

And finally, Manual Therapy with the objective of relaxing and normalizing all those structures (muscles, nerves, vertebrae, etc.) that need it.

Innovative Treatment

Within this treatment we can find the application of different techniques:

• Indiba: This treatment involves a machine that delivers heat to damaged tissues in order to reduce inflammation, nourish damaged cells, increase blood flow to the area, and promote the elimination of toxins, among other effects.

In this pathology we aim to reduce pain, eliminate tension and muscle spasms and facilitate the range of motion of the affected shoulder.

• Intratissue Percutaneous Electrolysis (IPE): This procedure involves using acupuncture needles and an ultrasound machine—to ensure 100% accuracy in the injection site—to apply an electrical current directly to the damaged tissue, with the goal of intentionally inducing inflammation so that the cells responsible for tissue regeneration and anti-inflammatory cells can act on that tissue to regenerate it.

The patient will feel a slight warmth in the area, which we will increase or decrease depending on the patient’s tolerance and/or the severity of the condition, whether acute or chronic.

• Percutaneous Neuromodulation (PNM): This procedure involves the application of a different type of electrical current using acupuncture needles under ultrasound guidance, but this time targeting the nerves that supply the injured areas.

In this way, by applying currents to these needles at a certain intensity, we will act on the pain, with the objective that these nerves stop sending pain signals to the brain and therefore the damaged structures stop hurting.

• Medical Therapies: These therapies include injections and nerve blocks, in cases of spinal damage (inflammation) or damage to the affected shoulder (tendinopathy, bursitis, inflammation of the joint capsule, etc.). All of these therapies will be performed under ultrasound guidance to ensure 100% accuracy in targeting the damaged tissue.

With the infiltration we will achieve a significant decrease in inflammation of the damaged area by applying corticosteroids. Once the structure has been infiltrated, this decrease in inflammation will cause a decrease in pain and an increase in the movement of the shoulder.

• The nerve block consists of searching for the nerve that is causing the pain in the neck and/or shoulder area and performing a clamp in order to stop the nerve from sending pain signals to the affected structures.

It is important to know that this type of therapy must always be accompanied by physiotherapeutic treatment.

Surgical Treatment

In general it is usually the last step, having previously exhausted conservative treatments, physiotherapeutic and medical therapies. There are several options for such treatment:

If the pain is caused by a herniated disc, the protruding portion is removed. If that portion was pressing on a nerve and causing pain, removing it will completely eliminate the pain; however, if the nerve was permanently damaged while the disc was pressing on it, the pain may persist, and we would need to treat the nerve.

Another option is that there is little space in the holes where the cervical nerves exit. In this case, the intervention would consist of opening these spaces so that when the nerve passes through, it is not compressed.

It is important to be aware of the risks associated with this type of procedure, such as infections, loss of sensation, and loss of mobility—in cases where the surgeon deems it necessary to stabilize a vertebra with a screw—among many others. Ultimately, it is up to the patient to decide whether or not to undergo the procedure.