NERVOUS SYSTEM – Brachial neuralgia
Fear of disease is more worrisome than suffering with the disease itself. This condition is often seen in brachial neuralgia, since it mimics referred pain of heart attack i.e. pain radiating to
shoulder. So, shoulder pain or arm pain, even if it is simple, should be brought to the notice of the doctor to lead a life peacefully without any ‘psychological’ heart complaints.
Brachium means arm i.e., from shoulder to elbow. Thus, the neuralgic pain in the arm is medically termed as brachial neuralgia. This brachial neuralgia seems to occur in people who lead a sedentary life. Like sciatica in legs, brachial neuralgia attacks the upper limb. It is otherwise called cervicobrachial neuralgia or thoracic outlet syndrome where brachial plexus (group of nerves supplying arm) is irritated or inflamed or compressed or pinched to cause symptoms in shoulder, arm, forearm or in hand.
It is a painful nerve disorder where pain radiates to the arm in the particular pathway of the affected nerve(s). It comes after the inflammation / irritation / compression of the particular nerve(s) (i.e., neuritis). Its intolerable intensity, persisting character or recurrent attacks make every sufferer worried. The pain of brachial neuralgia may be constant, sharp, stabbing, burning, shooting, radiating, annoying, debilitating and sometimes it comes and goes just like flashes one afraid of it.
Incidences – Brachial neuralgia is rare, especially in those under 20. Sufferers are mostly sedentary workers (computer professionals) and long distance travellers / drivers. They will be weak and get trapped due to occasional strain. It occurs mainly due to development of friction loss / osteoporosis / degeneration. Also it is commonly noted after strenuous exercise, spinal injury, lifting heavy objects improperly, prolonged sitting, after watching TV / movies continuously, etc.
Pathology – In general, cervical or neck vertebras are 7 in numbers, namely, C1, C2, C3, C4, C5, C6 & C7. Spinal nerves emerging from these vertebrae form the brachial plexus (collection of nerve roots) and supply the entire upper limb i.e., shoulder, arm, forearm and hand. Among all cervical vertebrae, C5, C6 & C7 are the more vulnerable vertebra to degeneration
or friction loss with movement. So brachial plexus of these roots often get inflamed. This inflammation is medically called as ‘brachial neuritis’ and the symptom following this inflammation is called as ‘brachial neuralgia’.
Causes – Brachial neuralgia can be caused by innumerable factors. It can originate from neck or shoulder or arm or forearm or hand.
Neck – Due to losing normal curvature of spines with friction loss, degeneration, distortion, herniation of disc, tumours, arthritis, extra bone growth, (i.e., cervical spondylitis / Ankylosing spondylosis / cervical spondylosis / spinal tumours or abscess / disc prolapse / cervical rib), fracture, improper posture, strains, violent exercises, bursitis, tendonitis, herpes, etc.
Arm – Due to injections, injury, herpes, etc
Forearm – Due to tennis elbow, carpal tunnel syndrome, fractures / tendonitis, etc.
Shoulder – Due to arthritis / periarthritis / frozen shoulder / bursitis
Other than these, nervous diseases / disorders, diabetes, hypertension, SLE, etc., can cause this type of neuralgia.
usually vary from person to person in type, intensity and suffering period depending
upon the involved nerve fibres and nature of the complaint or disease. The site of the pain depends on the condition that causes it and the place of injury or infection or inflammation in the specific supplying nerve(s). The complaints commonly get aggravated with change of position and range of movements. Sometimes it is felt more at night after falling asleep which generally wakes up the person in the middle of sleep. It may be compression created due to lying posture or exerted pressure over diaphragm / heart. The common symptoms are:
- Tightness & stiffness of shoulder, arm, forearm, etc.
- Difficulty in lifting / stretching / extending the arm
- Violent sharp lightning / shooting down / electric flickering- type pain
in shoulder or upper arm or lower arm or in all parts
- Pain usually travels / radiates down to the hand
- Altered sensation or numbness or tingling sensation (feeling of pricking pins) with weakness in the parts involved
- Restlessness and fear due to pain
- Sleep in a straight position, spreading arms sideward
- Have a small pillow i.e. not more than 3-4 inches thickness
- Sit erect and use neck in erect posture while doing any job
- Maintain good posture while reading or working with computers
- Check for bike shock absorbers often and use smooth roads
- Lifting heavy objects / strenuous exercises
- Putting hands under the head while sleeping
- Sitting and keeping neck in one position continuously for prolonged period
- Massaging violently with analgesics, since it can aggravate the complaint
- Avoid exposure to cold weather and cold bath
Diagnosis and investigation – It is essential to do clinical examination with detailed case taking i.e., for analysing history of complaints to plan for treatment, since they often provide a clue to the point of disease / complaint origin. For example:
- Pain in thumb and index finger indicates compression of nerves of C5 and C6
- Pain in little finger and ring finger indicates compression of nerves C7-T1
Examination of spines and checking for the force and ability to lift the hand in front, backwards, sidewards and rotation of the hand should be done before starting treatment. The weakness, loss of sensation, stiffness and radiation of pain should also be analysed with respect to specific spines or specific nerve roots or change of positions or range of movements.
Tenderness over the muscle or spine or nerve indicates infection or inflammation on that spot. Spasm / stiffness indicates persisting infection either in muscles, nerves, ligaments, etc.
Routine blood test and mantoux test (for diagnosing tuberculosis) is essential in case of suspicion of tumours of spines. The most essential investigations are X-rays and CT or MRI for analysing neck and thoracic spines and shoulder to arrive at final clear diagnosis. Further, to root out cardiac origin of complaints, one can go for ECG, Echocardiogram, treadmill test, etc., and to root out diaphragm origin or liver origin or gall bladder origin, it is essential to do ultrasound scan of abdomen.
General treatment – Brachial neuralgia, if left untreated / maltreated, usually lasts for several months and sometimes even for many years. So, one needs to start right line of treatment at the earliest. Unless otherwise the cause is found out and treated given accordingly or appropriately, the result will not be satisfactory. Since brachial neuralgia has numerous causative factors, finding the exact cause on of a sudden is difficult and thus difficulty arises in starting the apt treatment immediately. So, in general, in Allopathy, one will be kept in wait-and-watch mode with all sorts of investigations to find out the cause. Meanwhile, the patient will be provided anti-inflammatory drugs, pain-killers, analgesic ointments / gels / sprays and short wave diathermy for pain reduction. Further, one will be advised bed rest, supplements like calcium, magnesium and essential fatty acids with mild physiotherapy. Sufferers will also often try their own way with oil application, massage and hot bath.
Treatment options usually vary depending upon the causes and intensity of the complaints i.e., traction for cervical spondylitis, surgery for cervical rib, calcium supplements for periarthritis of shoulder, surgical release of nerves in case of entrapment as in cervical spondylosis and carpal tunnel syndrome, etc. In extreme cases, seizure medicines or steroidal medicines or anti-depressants will also be prescribed to manage the excruciating pain temporarily. As a last resort, neurosurgery for surgical dissection or desensitisation of nerves with steroidal injections will be opted.
Any type of neuralgia should not be treated just with anti-inflammatory drugs and pain-killers, since the situation will often get worse with time to lead to disappointment. Also, one should be aware that “Instantly killing pain with a pain-killer tablet is just like putting out the light when you don’t want to see the things around. Surely the day will come when / where you cannot switch off the pain”. Here pleasure with pain-killers is nothing else but intermission of pain.
If the causative factor is finely tracked and the patient is well-analysed constitutionally, Homeopathy can root out all the sufferings at the earliest with the apt drug. Also, sometimes, the causative factors cannot be found even with all sorts of investigations, and complaints will be brought to the doctor just as a subjective pain. Even then, by giving importance to the feelings / sensations, aggravating factors, constitution of the patient with detailed case taking, Homeopathy can provide miraculous relief from this nervous pain without any side-effects by controlling the inflammation and infection of the nerves.
Homeopathic medicines commonly used in cases of brachial neuralgia are Acid phos, Apis mel, Arnica, Belladonna, Bryonia, Calc carb, Calc phos, Causticum, Colocynthis, Kalmia, Kali bich, Kali phos, Lachesis, Ledum, Lycopodium, Mag phos, Medorrhinum, Natrum mur, Nux vom, Phytolacco, Plumbum met, Pulsatilla, Rhus tox, Ruta, Sangunaria, Spigelia, Strychinum, Sulphur, Tarentula, Viscum alb, Xanthoxylum, Zinc met, etc. These Medicines should be taken under the advice and diagnosis of a qualified Homeopath.
Dr. S. Chidambaranathan, BHMS, MD (Homeo)
24 E. New Mahalipatti Road
Tel: +91-452-233-8833 | +91-984-319-1011 (Mob)
(Disclaimer - The contents of this column are for informational purpose only. The content is not intended to be a substitute for professional healthcare advice, diagnosis, or treatment. Always seek the advice of healthcare professional for any health problem or medical condition.)