SPINAL SURGERY

in Hull and East Yorkshire

GEORGE SPINK FRCS (Neurosurg.) BSc Hons

 

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ARM PAIN - BRACHALGIA

 -      This common condition ('cervical radiculopathy', 'brachalgia', 'trapped nerve') is characterised by pain spreading across the shoulder, into the arm or hand.

-      The pain is usually severe in the early stages and feels like an electric shock in the arm. It may be made worse by coughing or sneezing.

-      It is often associated with altered sensation or 'pins and needles' in the arm or hand.

-      Occasionally there may weakness of the affected arm or hand.

***If you develop severe pain in your arms, associated with progressively worsening weakness or numbness, then you should contact your GP or A+E department as a matter of emergency.***

-      The most common cause of arm pain is referred pain from degenerative disease ('wear and tear') in the shoulder or neck. Spinal surgery does not help the arm pain in these instances.

-      The common cause of true radicular pain in the arm is a bulging disc in the neck or narrowing of the exit route around the nerve - a bit like a blocked pipe.  This may require surgery (see anterior cervical discectomy, or cervical foramenotomy). In some patients it is more appropriate to treat the symptoms with an injection (see nerve root block).

-      In addition to an outpatient assessment and examination you may require an MRI scan if your symptoms persist. (Most patients with a bulging disc will improve without surgery within 2-3 months). An MRI scan uses a powerful magnet to create a picture of your spine. It does not involve any radiation exposure. The scanner itself is a long narrow tunnel, which some patients may find a bit claustrophobic. It is also fairly noisy during the scan.

 

Treatments

-      Gentle exercise, simple analgesic (ibuprofen)

-      Soft cervical collar (for comfort, particularly at night)

-      Nerve root block (highly selective radiology technique)

-      Anterior cervical discectomy (with either fusion or joint replacement)

-      Posterior cervical foramenotomy (minimal invasive surgery)

-      Physiotherapy (gentle exercises manipulation should be used with caution)

 

Outcomes

-      80 - 90% of patients improve following surgery, with the majority seeing complete resolution of their arm pain.

-      A few patients will have a technically successful operation but continue to have symptoms due to irreversible nerve injury.

-      A few patients also go onto develop scar tissue at the site of the operation, causing recurrent symptoms, which can be difficult to manage.