Brachial plexopathy: everything you need to know

Brachial neuralgia is a severe form of nerve impulse conduction disorder that occurs against the background of degenerative, dystrophic, traumatic, inflammatory or compression injuries. The disease can occur acutely and suddenly, for example, with compression, or develop gradually over several months (this often happens with degenerative processes in the area of ​​intervertebral discs.

You need to know the main clinical symptoms of shoulder neuralgia in order to begin treatment in a timely manner. Only early therapy and rapid elimination of the potential cause of neuralgia can lead to complete recovery and restoration of lost motor and sensory function of the affected upper limb.

The brachial plexus is formed by branches of five radicular nerves (C5, C6, C7, C8 and T1). These branches intertwine at the level of the shoulder and further branch into the subclavian and supraclavicular branches. They are responsible for the innervation of the entire shoulder girdle and upper limb. The supraclavicular branch leaves through the lateral triangle in the neck. The subclavian branch is initially based in the axilla and branches further from here. Therefore, when wearing tight clothing that puts pressure in the armpits, compression brachial plexitis may develop. The disease can also be triggered by enlarged and inflamed lymph nodes of the axillary group.

Three branches are formed in the axillary fossa: median, superior and inferior, which then pass into the medial, lateral and frontal bundles. They are located along the axillary artery and pass with it through the soft tissue.

Subsequently, the bundles break up into short and long branches, which are responsible for the innervation of different muscle groups. The short types of nerve fibers in the shoulder area include seven main nerves:

• the dorsal scapula provides innervation to the muscle responsible for lifting the scapula, the rhomboid muscles;
• the long pectoral ensures the performance of the serratus anterior muscle;
• the subclavian innervates the muscle of the same name;
• suprascapular ensures the functioning of the infraspinatus and supraspinatus muscles;
• subscapularis teres major and subscapularis muscles;
• axillary activates the teres minor and deltoid muscles.

The long branches of the brachial plexus are responsible for innervation of the entire upper limb. They are divided into the following types of nerves:

1. musculocutaneous, formed from the lateral bundle, passes to the elbow joint and subsequently provides innervation to the skin of the forearm and part of the hand;
2. the median is responsible for the performance and sensitivity of the first four fingers of the hand and wrist joint, partially innervates the elbow joint;
3. the ulnar is responsible for flexion of the hand, innervation of the little finger and part of the ring finger;
4. cutaneous medial provides the function of skin sensitivity;
5. The radial one is responsible for the extension of the hand and forearm, fingers.

With neuralgia of the shoulder, both individual branches and bundles and the entire plexus at the level of its formation by radicular branches can be affected. Depending on the level of damage, the clinical picture may include pain over the entire surface of the upper limb and shoulder or localized to a specific area. An experienced neurologist will be able to immediately determine at what level the pathology is developing and what part of the brachial nerve plexus is affected by tendon reflexes, pain on palpation, and a decrease in the level of skin sensitivity. The success of future treatment largely depends on the correctness of the diagnosis. Therefore, try to contact competent and experienced doctors at an early stage of the disease.

In Moscow, you can make an appointment for a free appointment with a neurologist at our manual therapy clinic. Here you will be provided with individual advice. During the initial appointment, the doctor will conduct an examination and manual examination, as well as functional diagnostic tests. Based on the results, a preliminary diagnosis will be made, examination and treatment will be recommended.

Causes of pain in the shoulder joints

There are many reasons for the appearance of painful sensations. Pain in one or both shoulders can be a consequence of inflammation of the tendons, microtrauma of the articular cartilage, inflammatory-degenerative pathologies of the joints and cervicothoracic spine. The discomfort can be either minor or so intense that you cannot move your arm.

Among the causes that cause sharp or aching pain in the shoulder are:

• one-sided intense load for a long time;
• scoliosis, lordosis and other deviations in the normal position of the spine;
• physical inactivity.

In addition, pain can occur due to infections, inflammatory processes, hereditary predisposition, diseases of internal organs, and tumors.

In cases where the right shoulder hurts, the following pathologies may be present:

• Tendonitis is inflammation of tendons and soft tissues due to significant physical activity.
• Myositis - when the muscles of the shoulder joint are involved in the inflammatory process.
• Arthrosis is the destruction of articular cartilage.
• Arthritis is an inflammatory process in a joint due to infection, allergic reaction or autoimmune diseases.
• Osteochondrosis of the cervical spine.
• Bursitis is an inflammation of the joint capsule.
• Capsulitis is a pathological change affecting the joint capsule and synovium.
• Brachial nerve neuritis.
• Tuberculous lesion of the joint on the right.
• Humeroscapular periarthritis.
• Metastasis from a nearby tumor.
• Chondrosarcoma.
• Right-sided pneumonia.

Pain in the left shoulder joint is much less common, especially if the person is right-handed. Still, the load on the left hand is significantly less compared to the right. When your left shoulder hurts, the reasons may be the following:

• sprain;
• biceps tendinitis;
• intervertebral hernia in the cervical spine;
• calcification in the tendon;
• angina pectoris or myocardial infarction.

There are cases when the shoulder hurts when raising your arm. Here we can talk about pathologies such as:

• joint injuries;
• rheumatic lesion;
• rotator cuff tendinitis;
• tenosynovitis;
• tendobursitis and bursitis;
• myositis;
• hernia of the cervical spine.

The appearance of pain in the shoulder when trying to move the arm back indicates the presence of bursitis, radiculitis, tendinitis, spinal overload, arthrosis-arthritic joint damage, myocardial infarction.

Indications for injection

Pain blockade by injection is not performed on every patient. Initially, doctors try standard, conservative treatment methods and only after them resort to relief. But the situation changes radically if there are indications for injection:

• the substance is introduced into the glenohumeral joint in the presence of spondyloarthrosis, capsulitis, rupture or degeneration of the rotator cuff;
• pain relief with Lidocaine is prescribed to those patients whose pain has become chronic or intensifies with any body movement;
• with bicipital tendinitis, the presence of degenerative processes in the muscle structure, destruction of cartilage tissue.

It is impossible to immediately begin treatment by blocking the pain syndrome; this may prevent the further development of symptoms. If this happens, the doctor will not be able to diagnose the cause of the problem and eliminate it. Pain can be relieved only after all diagnostic procedures have been completed, conservative treatment methods have been tried and drug therapy has been administered.

Symptoms of the disease

Shoulder pain manifests itself in different ways depending on the cause. Acute is typical in case of injury. When a bruise, dislocation or sprain occurs, the patient experiences discomfort that increases when moving the upper limb. When a fracture occurs, it becomes impossible to move the arm.

Unbearable pain radiating to the neck and upper back is observed with capsulitis. In addition to pain, there is an inability to move the arm back or raise it. Severe pain also occurs with brachial neuritis and arthritis. The first is characterized by the absence of signs of inflammation in the joint; in the second case, swelling of the soft tissues and limited range of motion are noticeable.

Aching pain in the shoulder may be a sign of osteochondrosis of the cervicothoracic spine. Often the symptom is accompanied by numbness of the hand, burning and tingling sensation in the fingers. Aching pain is also observed with deforming arthrosis, but in this case, along with discomfort, a person notes stiffness of movement and swelling in the shoulder joint in the morning, crunching and clicking when bending/extending the arm. With the gradual destruction of cartilage, lifting heavy objects or active movement provokes increased pain.

Constant pain for several weeks is characteristic of bursitis, when the inflammatory process develops in the periarticular bursa. The disease is accompanied by the formation of a compaction, upon pressing on which a fluid transfusion is felt.

Causes

These nerves can be damaged by stretching, pressure, or cutting. A strain can occur when the head and neck are forced away from the shoulder, such as during a fall from a motorcycle or sometimes a car accident. In more severe cases, the nerves may become torn from the spinal cord. Pressure can occur when the brachial plexus between the collarbone and the first rib is damaged, which can occur during a fracture or dislocation. Swelling in the area from excessive bleeding or damaged soft tissue can also lead to injury.

Diagnosis of pathology

Naturally, when there is discomfort, the question inevitably arises: what to do if your shoulder hurts? Don't wait for the symptoms to go away on their own. It is imperative to consult a doctor, whose specialization will depend on the cause of the disease and the general condition of the patient.

If the pain appears after a fall or bruise, then contact a traumatologist. Osteochondrosis and neuritis are treated by a neurologist, a surgeon and a rheumatologist eliminate the consequences of arthrosis, arthritis and tendonitis.

When painful sensations are accompanied by a general deterioration in well-being, it is recommended to consult a therapist, oncologist, cardiologist or gastroenterologist. Indeed, sometimes pain is reflected when there is a discrepancy between the localization of discomfort and the location of damaged organs or tissues. It is very important to diagnose in time, because shoulder pain can appear due to myocardial infarction, pneumonia, pleurisy, pancreatitis, cholecystitis, and neoplasms in the chest.

For diagnostic purposes, the doctor may prescribe the following types of examinations:

• X-ray of the shoulder or entire upper limb;
• Ultrasound of the shoulder joint;
• MRI of the joint and/or spine;
• ECG.

In addition, you may need to take a general blood test, as well as biochemistry and sexually transmitted infections. The patient is also prescribed fluorography and fibrogastroduodenoscopy.

Treatment for pain in the shoulder joint

When complaining of pain in the shoulder, the specialist prescribes comprehensive treatment. Therapy includes:

• Local and general anesthesia. Can be achieved using medications or physiotherapeutic methods, acupuncture, etc.
• Eliminating the root cause of pain. Manual therapy, osteopathy, PRP therapy and Kinesitherapy help with this.
• Symptomatic therapy. They use products to relieve swelling of soft tissues, hyperemia of the skin, and reduce temperature.
• Rehabilitation treatment. This includes kinesitherapy.

During the rehabilitation period, physical therapy and physiotherapeutic treatment are widely used to restore joint mobility. In advanced cases and in the absence of effect from conservative therapy, surgical treatment is possible.

The article was reviewed by traumatologist-orthopedist V.Yu. Bogdanov.

Causes of neuralgia of the right and left shoulder

The potential causes of neuralgia in the neck and shoulder are generally similar. The difference in the degree of damage depends on which hand the person has is the “working” one. Right-handed people often develop neuralgia of the right shoulder. While left-handers suffer from neuralgia of the left shoulder due to improper distribution of physical and shock-absorbing load.

Potential causes of the development of shoulder neuralgia include the following pathogenic factors:

• excessive physical activity without prior training and preparation of the musculoskeletal system;
• traumatic impact in the form of shoulder dislocation, sprain or rupture of ligament, tendon and muscle tissue, fracture, crack or injury;
• intoxication with salts of heavy metals, alcohol, nicotine and a number of pharmacological drugs;
• cervical osteochondrosis with radicular syndrome (often pleural neuralgia occurs with protrusion of the fibrous ring or hernial protrusion of the nucleus pulposus of the C6-C7 or C8-T1 intervertebral disc);
• infections with impaired immune function, leading to the development of rheumatic inflammation in areas of cartilage and connective tissue;
• exposure to stress factors leading to excess production of cortisol (this hormone has a destructive effect on cartilage and connective tissue, provokes the formation of scars, which causes compression of the brachial plexus bundles);
• deforming osteoarthritis of the shoulder joint and glenohumeral joint;
• habitual dislocation and excessive stretching of the shoulder joint capsule;
• axillary lymphadenitis with a sharp increase in this group of lymph nodes (can occur against the background of a pulmonary infection or with metastasis of oncological processes);
• endocrine pathologies leading to impaired microcirculation of blood and lymphatic fluid (diabetic angiopathy, thyroid failure, etc.);
• menopause with a sharp change in hormonal levels.

These are the most common causes of brachial neuralgia. Doctors also recommend excluding a deficiency of B vitamins, poor nutrition, poor posture, static tension, leading a sedentary lifestyle and wearing tight clothing that compresses the armpit area.

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Treatment process at the Innovation Center

Our Innovative Clinic has created excellent conditions for the diagnosis and treatment of pain in the shoulder joints of various types and origins. After finding out the causes of the pathology, the doctor will select tactics and methods of treatment. We practice using the following techniques:

• Acupuncture.
• Manual therapy.
• Kinesitherapy.
• Osteopathy.
• Massotherapy.
• Physiotherapy.

We achieve excellent results using shock wave therapy and Hiwamat therapy. The course of treatment is carried out under the supervision of a doctor, whose efforts are aimed not only at relieving unpleasant symptoms, but also at eliminating the cause of discomfort. The professionalism of our specialists and an individual approach will help you completely get rid of the problem, and if this is not possible, then avoid complications and achieve stable remission. This is confirmed by a large number of reviews about the work of our center and doctors both on our website in the Reviews section and on other sites on the Internet.

Treatment

In most cases, treatment takes place on an outpatient basis, in severe situations - in a hospital. For plexopathy, anti-inflammatory therapy is carried out, painkillers, dehydrating drugs are used, and physiotherapeutic procedures are also prescribed. After the pain subsides, special exercises, massage, and a complex of vitamins are prescribed.

In more severe situations, surgical treatment is prescribed to eliminate the compression and restore the functionality of the plexus branches.