Cervicobrachialgia or cervical radiculopathy

What is the difference between cervicobrachialgia and radiculopathy?

In both injuries, there is pain felt in the neck that then radiates into the arm, or vice versa.

The symptoms are often the same. We will say it is radiculopathy if we determine that one or more nerves in the neck are irritated or compressed.

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What are the symptoms of cervicobrachialgia or radiculopathy?

There is often (but not always) pain or stiffness in the neck or in the shoulder blade and shoulder area. The pain also radiates into one or two arms and can manifest as:

• Electric shocks
• Tingling/prickling
• Needles
• Burning sensations

In general, neck movements and certain arm movements trigger the pain. Some people may also feel other symptoms such as:

• A loss of sensation in the arm or certain fingers
• A loss of strength in the arm
• Having the sensation of having a dead or very heavy arm

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What are the serious symptoms of cervicobrachialgia or radiculopathy to watch out for?

The presence of certain signs and symptoms should prompt you to seek immediate medical attention at the emergency room or from a doctor. These include:

• Severe weakness or paralysis in one or both arms
• Significant or even complete loss of sensation in one or both arms
• Recent loss of balance when walking
• New incoordination of the arms or hands
• New difficulties with bladder or bowel control
• Loss of sensation in the genital area or when wiping after a bowel movement

Serious symptoms are only present in less than 1% of cases. Most of the time, although the pain can be very unpleasant, the condition resolves well.

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What are the causes of cervicobrachialgia or radiculopathy?

The pain is caused by irritation or compression of one or more nerves in the neck. Nerve irritation or compression can be caused by:

• Progressive wear and tear of the neck joints (such as osteoarthritis)
• A herniated disc (quite rare and mostly in young adults). See the section cervical disc herniation
• Irritation of the joints, muscles or nerves of the neck following an overload (this is the most common cause)

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This injury can develop gradually over several months or years, but it can also be triggered suddenly following:

• Significant strain
• Neck or head trauma (car accident, fall, impact)

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How is cervicobrachialgia or radiculopathy diagnosed?

Diagnosis is made based on a review of your symptoms and a clinical examination.

In rare cases, radiological exams (X-rays, MRI, EMG) may be necessary to determine the extent of the nerve injury. These tests are not required if there are no serious symptoms.

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When should you see a physiotherapist for cervicobrachialgia or radiculopathy?

You should consult a physiotherapist if you have symptoms as described above or if your doctor has already ruled out any other cause that may be responsible for your pain.

You do not need to see a doctor before consulting a physiotherapist. If your condition requires you to see a doctor, your physiotherapist will be able to tell you.

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What physiotherapy treatments are available for cervicobrachialgia or radiculopathy?

Your physiotherapist will perform an assessment to determine the cause of your nerve irritation. To do this, they will evaluate the following elements:

• Your joint mobility
• The gliding of your nerves
• Your postural habits
• The quality of your movements
• Your strength and stability

Based on the assessment results, your physiotherapist will:

• Mobilize the joints and nerves in your neck and arms to reduce pain and improve movement.
• Give you specific exercises to do at home to address the cause of the problem and relieve pain
• Teach you how to properly manage your daily activities and hobbies to optimize healing
• Give you advice for your postural habits and movements

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What can you do at home for cervicobrachialgia or radiculopathy?

Temporarily stop doing movements that cause too much pain, and then gradually start doing them again.

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Here are some other tips that may help at home:

• Move your neck in the movements that don't cause any pain at all
• Support your shoulders and shoulder blades
  
  • With a cushion under your armpit
  • With the armrests of a chair or sofa
  • By putting your hand in your pants pocket while standing
• Limit the time spent in the same position (computer, television, reading). Get up regularly for a few minutes to move your neck and shoulders a little.
• Make sure your neck is well supported while sleeping with a pillow that fills the curve of your neck. Sleeping on your stomach should be avoided, especially if you have stiffness or pain in the morning or during the night.

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If you don't see any improvement after 10 days, you should consult a physiotherapist.

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Sources

• McCartney S, Baskerville R, Blagg S, McCartney D. Cervical radiculopathy and cervical myelopathy: diagnosis and management in primary care. British Journal of General Practice. 2018 Jan 1;68(666):44-6.
• Kuijper B, Tans JT, Schimsheimer RJ, Van Der Kallen BF, Beelen A, Nollet F, De Visser M. Degenerative cervical radiculopathy: diagnosis and conservative treatment. A review. European Journal of Neurology. 2009 Jan;16(1):15-20.

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