Cervical Disc Herniation, Brachialgia and Cervical Radiculopathy Information
Introduction
Nerve pain in the arm or hand is called brachialgia. Brachialgia is often caused compression of a nerve in the neck or cervical spine. The pain can be like an electric shock going down the arm and can involve one or both arms. Sometimes the nerve pain can be a constant, dull aching pain that is worse with different positions of the neck or when lifting your arms above your head. It is often associated with neck pain.
Brachialgia is most commonly due to a disc herniation or prolapse compressing a nerve in the cervical spine. Alternatively the pain may be due to aging, or “wear and tear,” in the cervical spine. This process is called cervical degeneration. Cervical spine degeneration can lead to what is called cervical spondylosis and cervical foraminal stenosis. Rarely brachialgia can be due to a more serious condition such as infection, trauma or cancer in the neck, however, routine imaging can easily rule these conditions out.
For more information about brachialgia and cervical radiculopathy watch the video below.
Video about cervical radiculopathy and brachialgia
Cervical spondylosis describes degenerative changes (arthritic changes) in the cervical spine and includes the following changes:
These changes combine to cause narrowing of the spaces (foramen) for the nerves to pass through on their way to your arms. This narrowing is termed foraminal stenosis. Sometimes the spinal cord can also be compressed, a process termed cervical myelopathy (CSM). The degenerative changes in the spine also cause altered biomechanics and can make the spine stiffer or unstable, both of which can cause neck pain.
Disc degeneration is thought to be the precipitating factor in cervical spondylosis. See our disc degeneration page for more information about intervertebral disc degeneration.
In addition to pain, compression of a nerve travelling to your arm can cause other problems in the area that the nerve supplies. This is called radiculopathy. Radiculopathy relates to dysfunction of a nerve causing:
Cervical disc prolapse, cervical spondylosis and brachialgia are very common in the general population. Although it is rare to see in younger adults it does occur. It more commonly occurs in the middle aged and older population groups.
The pain can be severe and disabling, however, it is a common problem and easily managed by an experience neurosurgeon or spine surgeon.
Symptoms
Cervical spondylosis is a major cause of neck pain. Neck pain comes from abnormal or degenerate structures in the cervical spine which include:
In addition to neck pain, cervcial spondylosis and disc prolapse is associated with symptoms of nerve compression which include:
The symptoms of cervical spondylosis are usually progressive and get worse with time. However, with appropriate management the degree of progression can be slowed or even halted.
Sometimes compression of the spinal cord can cause symptoms of cervcial myelopathy.
Investigations
Following the initial clinical assessment it is usual for some type of radiological investigation to be organised to look in more detail for the cause of the pain and discomfort and the degree of nerve compression.
Dr Oehme will arrange all of the necessary tests for you.
Management Options
Unless you have severe pain or significant neurological deficits, such as arm weakness, the initial treatments for brachialgia and cervical spondylosis are conservative non-operative therapies. These treatments include:
Following exhaustion of non-operative measures or when the degree of nerve compression is severe, surgery is often indicated for brachialgia and cervical spondylosis. Where symptoms of nerve compression predominate, the goal of intervention is to decompress the nerves, relieving the pressure on them. Relieving the pressure on the nerves reliably improves the symptoms of pain in the arm.
Surgery generally involves a procedure such as anterior cervical discectomy and fusion (ACDF) or cervical laminectomy. Dr Oehme will advise you which procedure is most appropriate.
- Ligament overgrowth (hypertrophy) and buckling (infolding). This particularly occurs in the ligamentum flavum at the back of the spinal canal.
- Facet joint overgrowth (hypertrophy), arthritis and degeneration
- Osteophyte formation, or bony overgrowth, at the back of the disc space.
- Intervertebral disc bulging, prolapse and collapse.
- Slipping of one vertebral body on another (spondylolisthesis)
- Spinal instability
These changes combine to cause narrowing of the spaces (foramen) for the nerves to pass through on their way to your arms. This narrowing is termed foraminal stenosis. Sometimes the spinal cord can also be compressed, a process termed cervical myelopathy (CSM). The degenerative changes in the spine also cause altered biomechanics and can make the spine stiffer or unstable, both of which can cause neck pain.
Disc degeneration is thought to be the precipitating factor in cervical spondylosis. See our disc degeneration page for more information about intervertebral disc degeneration.
In addition to pain, compression of a nerve travelling to your arm can cause other problems in the area that the nerve supplies. This is called radiculopathy. Radiculopathy relates to dysfunction of a nerve causing:
- Neurogenic pain (brachialgia)
- Weakness of the shoulder, arm or hand
- Reflex changes - such as loss of elbow jerk
- Sensory abnormalities - loss of feeling, numbness or tingling in the arm and hand.
- Headache
- Neck pain
- Interscapular pain
Cervical disc prolapse, cervical spondylosis and brachialgia are very common in the general population. Although it is rare to see in younger adults it does occur. It more commonly occurs in the middle aged and older population groups.
The pain can be severe and disabling, however, it is a common problem and easily managed by an experience neurosurgeon or spine surgeon.
Symptoms
Cervical spondylosis is a major cause of neck pain. Neck pain comes from abnormal or degenerate structures in the cervical spine which include:
- Intervertebral discs
- Periosteum/bone
- Ligaments
- Paraspinal musculature and fascia
- Nerve roots
- Psychological causes
In addition to neck pain, cervcial spondylosis and disc prolapse is associated with symptoms of nerve compression which include:
- Arm pain (brachialgia)
- Loss of feeling in the arms (numbness or parasthesias)
- Shoulder, arm or hand weakness (for example difficulty writing)
- Reflex changes - such as loss of elbow jerk
- Headaches
The symptoms of cervical spondylosis are usually progressive and get worse with time. However, with appropriate management the degree of progression can be slowed or even halted.
Sometimes compression of the spinal cord can cause symptoms of cervcial myelopathy.
Investigations
Following the initial clinical assessment it is usual for some type of radiological investigation to be organised to look in more detail for the cause of the pain and discomfort and the degree of nerve compression.
- MRI scan (this is the best test to assess cervical spondylosis, disc prolapse and brachialgia)
- CT scan
- X-ray
- Dynamic x-ray (flexion and extension x-ray to look for instability)
- Bone scan including SPECT CT - to look for active facet joint arthritis and active disc degeneration
- Nerve conduction studies and EMG (Electromyography)
Dr Oehme will arrange all of the necessary tests for you.
Management Options
Unless you have severe pain or significant neurological deficits, such as arm weakness, the initial treatments for brachialgia and cervical spondylosis are conservative non-operative therapies. These treatments include:
- Analgesics (pain medications)
- Non-steroidal anti-inflammatory drugs (NSAIDs)
- Physiotherapy
- Steroid injection therapies - such as a nerve root injection or facet joint injection
- Behaviour modification - e.g. avoiding heavy lifting
- Cervical collar application
- Pilates
- Hydrotherapy
- Swimming
- Weight loss is also important as extra weight places more stress on the spine contributing to back pain.
- Strengthening exercises to strengthen core and paraspinal muscles will help provide extra stability to the spine reducing pain.
- Pain management
Following exhaustion of non-operative measures or when the degree of nerve compression is severe, surgery is often indicated for brachialgia and cervical spondylosis. Where symptoms of nerve compression predominate, the goal of intervention is to decompress the nerves, relieving the pressure on them. Relieving the pressure on the nerves reliably improves the symptoms of pain in the arm.
Surgery generally involves a procedure such as anterior cervical discectomy and fusion (ACDF) or cervical laminectomy. Dr Oehme will advise you which procedure is most appropriate.
Anterior Cervical Discectomy and Fusion (ACDF) Video
This surgery removes a herniated or diseased disc and relieves neck and radiating arm pain caused by parts of the disc pressing on nerve roots.
Cervical Laminectomy Video
This procedure removes a section of bone from the rear of one or more vertebrae to relieve the painful and disabling pressure of stenosis.