Vertebrogenic pain syndrome - what is it? Let's explain in simple words

Brachialgia is a medical term that is used by neurologists to clarify the diagnosis of dorsopathy. Indicates a state of severe pain in the upper limb on the side of the affected nerve fiber. For example, an intervertebral disc herniation located in the area of ​​the right foraminal opening is highly likely to provoke right-sided brachialgia

What brachialgia is and how to treat such a condition is described in detail in the article presented to your attention. Here you can read about potential causes, clinical symptoms, differential diagnosis, types of pathology and methods of pain relief.

If you have pain in the upper limb, you should see a neurologist as soon as possible. This may be a manifestation of numerous pathologies that can be successfully treated only in the early stages of development. For example, vertebrogenic brachialgia can be successfully treated only in conjunction with the underlying pathology. Those. The doctor will treat osteochondrosis, protrusion or herniated disc. And the earlier these diseases are diagnosed, the higher the chances of success.

What happens if vertebrogenic brachialgia is not treated? First, let's figure out what causes pain.

The spinal column is conventionally divided into cervical, thoracic, lumbar, sacral and coccyx. Each of them contains inside the spinal cord section of the same name. The radicular nerves depart from it through the foraminal lateral openings in the vertebral bodies. They branch out and are responsible for the innervation of certain areas of the body. The lower branches of the radicular nerves located in the 5th, 6th, 7th vertebrae of the cervical spine form the so-called brachial nerve plexus. It is responsible for the innervation of the upper limb and shoulder girdle.

The spinal column consists of vertebral bodies with spinous and arcuate processes. This structure forms the spinal canal, inside which the dural membrane and the spinal cord with cerebrospinal fluid are located. With the help of this fluid, nerve impulses are transmitted to the structures of the brain and back.

Between the vertebral bodies there is an intervertebral disc. This is a dense membrane in the form of a fibrous ring and a gelatinous body located inside it, which is responsible for the shock-absorbing distribution of physical load that occurs during various human movements. The annulus fibrosus does not have its own vascular network. It can receive fluid and nutrients dissolved in it only through diffuse exchange with the vertebral endplates and the surrounding muscles of the back frame, collar zone and neck.

If diffuse nutrition is disturbed, for example, due to a sedentary lifestyle, gradual dehydration of the tissue of the fibrous ring occurs. It cracks and begins to take fluid from the nucleus pulposus located inside it. The second compresses and loses its ability to distribute the shock-absorbing load. The decrease in the height of the intervertebral disc is called the protrusion stage. This condition causes the radicular nerves to be periodically pinched by adjacent vertebral bodies. Constant pressure is exerted on them from the intervertebral disc, which, as the height decreases, increases in the horizontal plane and extends beyond the boundaries of the vertebral body.

The second factor that provokes vertebrogenic brachialgia is prolapse of the hernia - in this case, the structure of the nucleus pulposus irritates the nerve fiber. Secondary inflammation begins, which entails a rapid spread of the reaction to the fingertips on the affected side.

If you have signs of vertebrogenic brachialgia, immediately consult a neurologist. In Moscow, you can sign up for a free consultation with a vertebrologist and neurologist at our manual therapy clinic. An experienced doctor will conduct a full examination, make a preliminary diagnosis, and tell you how to correctly and effectively carry out complex treatment of spinal disease and concomitant brachialgia.

Causes of vertebrogenic brachialgia

Brachial syndrome is pain in the arm caused by damage to the nerve fiber. Some doctors call it lower cervical syndrome. It may also present with paresthesia, muscle weakness, cramps, numbness, impaired skin sensitivity, etc. A characteristic feature is the gradual downward spread of all unpleasant sensations. First, the patient experiences pain in the neck or collar area. The pain then spreads to the shoulder, forearm, hand and fingers.

The leading cause of brachial syndrome is the destruction of the cartilage tissue of the intervertebral discs. Risk factors that can trigger this disease include:

• maintaining a sedentary lifestyle with predominantly sedentary work;
• poor posture in any part of the spine;
• incorrect foot placement when walking and running, which leads to uneven distribution of the shock-absorbing load;
• drinking alcoholic beverages and smoking;
• lack of physical education;
• wearing tight clothes and poorly fitting shoes;
• rheumatic diseases of the spine (Bechterew's disease, systemic lupus erythematosus, scleroderma, etc.);
• conditions after surgical operations;
• traumatic effects on the spinal column and paravertebral tissues (bruises, cracks, fractures, sprains and ruptures of ligament and tendon tissue).

When excluding cervical radiculopathy during differential diagnosis, the doctor must exclude the presence of myotomas (muscle tumors) and dermatomas (neoplasms in the thickness of the epidermis).

Another common reason is obstruction of the so-called thoracic outlet. A branch of the subclavian artery passes through it, forming the posterior vertebral artery. The subclavian vein and brachial nerve plexus are also located here. If there is a narrowing in the thoracic outlet, then functional compression occurs. In this case, brachialgia is accompanied by signs of cerebral circulatory insufficiency against the background of posterior vertebral artery syndrome.

Pain in the hand can be an occupational disease. It affects people who engage in heavy lifting, perform monotonous painstaking operations with the upper limbs, and are forced to excessively strain the muscles of the upper belt. Painters, builders, seamstresses, hairdressers, programmers, stenographers, office managers, etc. are highly likely to develop brachialgia.

Treatment

Therapy should be aimed at eliminating the underlying disease and symptoms (especially pain).

Drugs

Drug treatment is prescribed by a neurologist.

Typically therapy includes the use of the following groups of drugs:

As for nonvertebrogenic cervicobrachialgia, it usually develops against the background of heart disease. In such cases, patients are prescribed medications containing nitroglycerin .

Surgery

Surgeries for cervicobrachialgia are rarely performed.

The indication for surgical intervention may be:

• the presence of pronounced pain syndrome;
• lack of effect from conservative therapy for 4 months or more;
• presence of spinal tumors;
• development of severe muscle atrophy;
• the appearance of severe neurological deficit due to compression of the spinal cord.

Exercise therapy and massage

Physical therapy for cervicobrachialgia is used to restore mobility of the cervical vertebrae and normal muscle functioning . The program is developed by a physician and usually includes several basic exercises: stretching, bending, lateral bending and rotation.

No less effective is massage, which stimulates metabolic processes in tissues. The main thing is to know exactly the nature of the lesion and its location. It is also worth considering that massage is contraindicated for some pathologies.

Video: “Exercises for cervical osteochondrosis: the doctor talks about his own technique”

Treatment at home

You can reduce unpleasant symptoms using the following recipes::

1. Take 1 tbsp. l. St. John's wort, dandelion and burdock root, add 250 ml of cold water. Put on gas, boil for 5 to 7 minutes, strain. Fold the gauze in several layers, moisten it in the broth, and apply it to the sore area for 10-15 minutes. Remove the compress and wrap the affected area with a warm scarf.
2. Pour 2 tsp. parsley root 450 ml boiling water, leave, cool. Take 1 tbsp. l. once or twice a day (but not more often) for severe pain.
3. Mix 1 tbsp. l. pre-chopped hop cones with 1 tbsp. l. pork fat. Mix thoroughly to obtain a homogeneous mass. Rub the resulting product onto the affected area of ​​the body.
4. Mix 5 tbsp. l. oregano, 2.5 tbsp. l. thyme and 3 tbsp. l. rosehip. Take 2 tbsp. l. the resulting mixture, pour 250 ml of boiling water. Drink 1/3 glass three times a day after meals.

Video: “Gymnastics for the shoulder joints”

Prevention

To prevent cervicobrachialgia, you need to follow some rules. Pay attention to them. You can avoid the appearance of cervicobrachialgia if:

• be regularly examined by a neurologist, consult a doctor if you experience minor pain or discomfort in the neck;
• give preference to healthy foods;
• move a lot, practice adequate physical activity;
• spend a lot of time outdoors;
• swim regularly (in a pool or open water);
• properly organize the office workplace;
• maintain correct posture.

Left-sided and right-sided brachialgia

Brachialgia on the right rarely raises doubts about making a preliminary diagnosis. Right-sided brachialgia appears against the background of cervical osteochondrosis and is its complication. The patient complains of periodic pain in the arm and numbness. All symptoms intensify after prolonged static stress and intense physical activity.

The situation is more complicated with brachialgia on the left, since in order to make an accurate diagnosis in this case, you need at least an electrocardiogram. This examination allows us to exclude the possibility of developing unstable angina, coronary spasm and acute myocardial infarction. The clinical picture is very similar. Left-sided brachialgia causes severe burning pain in the shoulder area. It extends to the little finger. The hand is taken away. Against the background of fear, the patient experiences coldness of the extremities, his skin is covered with cold sticky sweat. The pulse quickens and blood pressure rises. All these clinical signs are characteristic of an attack of angina pectoris, turning into acute myocardial infarction. If such symptoms appear, it is recommended to urgently call an emergency cardiac care team. It is better to be safe than to underestimate the life-threatening danger of coronary vascular insufficiency.

Symptoms

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The main symptom of cervicobrachialgia is pain in the neck and arm. The main symptom of the syndrome is pain in the neck, which can be aching, constant throbbing or shooting.

With cervicobrachialgia, pain radiates to other parts of the body - to one or both arms, the back of the head, shoulders or shoulder blades.

The severity of this symptom increases during coughing, sneezing, and making all kinds of head movements (turning, bending).

Over time, the tension in the neck muscles is accompanied by limited movement (the patient cannot turn his head separately from his body). Prolonged intense pain causes hypotension, which gradually turns into atrophy.

Another symptom is sensory disturbances , which can occur on the right or left. The patient may complain of numbness in the limbs, a crawling sensation, and even cramps in the hands.

Diagnostics

Since cervicobrachialgia occurs against the background of other diseases, the patient’s examination should be comprehensive . Diagnosis begins with a visual examination, during which stoop, asymmetry, and any signs of deformation are revealed.

Then palpation (palpation) and tapping are carried out to determine the location of the pathological process. The doctor also evaluates sensitivity disorders and mobility of the cervical spine.

But the most important diagnostic methods to detect the root cause of the syndrome are the following instrumental studies:

• magnetic resonance imaging – designed to identify protrusions and disc herniations, as well as their localization;
• radiography performed in different planes;
• CT scan;
• biochemical tests of urine and blood to identify or exclude concomitant pathologies.

The most preferred diagnostic method is MRI , which visualizes the structures of the spinal cord and intervertebral discs. As for x-rays, they only show bone tissue.

Clinical symptoms of brachialgia include:

• pain that is acute, shooting in nature, spreads from the cervical spine to the little finger;
• impaired skin sensitivity (for example, the patient cannot evaluate a cold or hot object by touch);
• tingling in soft tissues associated with a secondary complex of insufficiency of blood microcirculation in the capillary network;
• impairment of motor functions (impossibility to clench your hand into a fist, take something, bend at the elbow, lift up, etc.);
• paresthesia, convulsions.

Vertebrogenic brachialgia with cephalgic syndrome is a characteristic condition for compression of the nerve fiber in the area of ​​the thoracic outlet. It manifests itself in the fact that in addition to pain in the arm, there is a sharp pain in the scalp in the back of the head.

Cervicothoraco brachialgia is a condition in which the functionality of the hand is impaired, and there is a feeling of a thick glove being put on the hand. In this case, the patient periodically experiences paroxysmal headaches that are not associated with organic brain damage and an increase in blood pressure.

Transient brachialgia is characterized by periods of pain and numbness. But in general, the patient notes the well-being of his health. In case of transient (passing) attacks, it is recommended to urgently undergo examination by a neurologist. This may be a sign of a so-called “sliding” herniated disc. These types of protrusions of the nucleus pulposus often lead to sequestration (rupture) of the nucleus pulposus. Only emergency surgery can help in such a situation.

Epicondylosis

Sometimes pathological impulses are aimed at the areas of the epicondyles of the shoulder. With healthy tissues in this zone, the degenerative peripheral process may not be realized in this zone. Nevertheless, in the practice of treating cervical vertebrogenic syndromes, it occurs quite often, since in the area of ​​the external epicondyle of the shoulder there are relatively vulnerable osteo-fibrous tissues. They are both bradytrophic and very, very overloaded, especially with repeated jerky movements of pro- and supination. Trophism is more quickly disrupted at the site of attachment to bony protrusions. Of course, they are the most vulnerable.

The clinical picture of epicondylosis is poor in local symptoms. The main symptom is pain and tenderness in the area of ​​the epicondyle, most often the external one, but not itself, but the more distal zone of attachment of the brachioradialis muscle to it; spontaneous cerebral pain is very intense, often with a burning tinge. They intensify with jerking movements in the elbow or hand, with rotation of the forearm, especially with an outstretched arm, for example when fencing, playing tennis, while preparing chops, when working with a hammer or sledgehammer. Characteristic muscle weakness is detected by the following techniques. Thompsen's sign: when trying to hold a clenched fist in a position of dorsiflexion, the hand quickly drops.

Welsh's sign: simultaneous extension and supination of the forearms on the affected side is delayed. Dynamometry reveals weakness on the affected side. The pain intensifies when you place your hand behind your lower back.

So, epicondylosis in cervical vertebrogenic pathology is part of a wide range of neurodystrophic phenomena in the places of attachment of fibrous tissue to bone protrusions. These phenomena occur under the influence of impulses from the affected spine or (less often) other lesions of nearby tissues. The formation of one or another pathological syndrome is determined by the background state of the periphery, where the substrate was prepared. And this is created by local micro- and macrotraumas, proprioimpulses during jerking movements and overexertion. The experience of sports medicine clearly indicates the significance of the corresponding overloads (“tennis elbow”, “fencing epicondylosis”). All overloads are asymptomatic until the “attraction” of pathological impulses from the altered receptors of the spine occurs in a given dominant focus.