What is Brachalgia and Arm Pain?
Arm pain again is very common and like leg pain and sciatica, is usually caused by a disc herniation pressing on a nerve. The medical term for arm pain associated with nerve root compression is “brachalgia”, but this is less commonly used, compared to the medical term “sciatica”.
Arm pain may or may not be associated with neck pain. Pain, which has been present for 6 weeks or more, may need further investigation with an MRI scan. The reason, why I say 6 weeks or more is because the natural history (what happens if you do nothing and let nature run its course) is for it to get better by itself.
It is important to remember that 80% of disc herniations get better by themselves in 6 weeks. This occurs by the body recognizing the disc material as being in the wrong place and sending special cells to the area of the disc herniation to “eat” it up. This is known as disc resorption, in that the disc is resorbed. During this time it will be extremely painful and unfortunately there is no evidence that any form of therapy will speed up the rate at which the disc is resorbed.
During this time it is important to take anti-inflammatories regularly as well as codeine based preparations with Paracetamol. If the pain is very severe you may need morphine based medication.
Having Acupuncture or using a TENS machine may help but it is important to remember that in 8 out if 10 cases the disc will be eaten away by the body’s natural defences in 6 weeks irrespective of what you do and anything you do is to control the symptoms.
It is for this very same reason that I would not consider surgical intervention before this.
The only real exception to this is if the patient has neurological compromise or evolving neurology. By this I mean worsening motor function or weakness with associated pain.
The arm pain is usually sharp and shoots down the arm but it also can present with a constant aching in the arm, which is worse on movement or on lifting the arm. It can be made worse by driving or using a computer mouse for example. Pins and needles (paraesthesia) and numbness can also occur with the pain.
When to operate?
Being a surgeon, like all surgeons, I enjoy operating, however it is much more important skill to know when not to operate.
It is the “decision rather than the incision” that is most important.
Unfortunately with severe arm pain secondary to a disc herniation I find that most patients cannot tolerate symptoms for longer than 3 months and it is at about this time that I recommend a cervical nerve root block of the relevant nerve. In the majority of cases by doing this surgery can be avoided and as always surgery is the last resort.