Radicular arm pain

Cervical radiculopathy is a neurological condition caused by dysfunction or compression of a cervical nerve root. Patients often report unilateral neck pain with radiation to the ipsilateral arm, often with sensory changes in a dermatomal distribution. Weakness and reflex changes are also commonly found and can be very troubling for patients. Careful history and examination is important to identify any more concerning features such as progressive symptoms and features of myelopathy, which could prompt surgical management. Although the majority of patients will see an improvement in their symptoms over time with conservative management, surgery is indicated in patients with debilitating pain, progressive neurology, significant weakness, instability or myelopathy. Advancements in surgical techniques offer a range of potential operations that should be considered carefully for each patient. This article outlines the clinical approach to presentation, pathophysiology, diagnosis and management.

US-guided transforaminal cervical nerve root block: a novel lateral in-plane approach

Objective The aim of the present study was to investigate the effectiveness and safety of a novel lateral in-plane approach for US-guided transforaminal cervical nerve root block (US-guided TF-CNRB) in the treatment of cervical radiculopathic pain. Design The design of the present study consisted of an institutional, retrospective case series. Setting The present study was conducted at a university hospital. Subjects Thirty-two patients with cervical radiculopathy who were resistant to conservative therapies and regular US-guided CNRB were included as participants. Methods The included patients were treated with US-guided TF-CNRB. During the treatments, using real-time fluoroscopy, we monitored the spreading patterns of a contrast medium, and double confirmed the positions of needle tips. Pain numeric rating scales (NRS) and symptom relief grades were determined via telephone interviews at 1, 4, and 12 weeks after the procedures. Results US-guided TF-CNRB was performed at the C5 level in 6 patients, the C6 level in 18 patients, and the C7 level in 8 patients. Comparing to NRS at baseline, pain scores decreased throughout the observation period. Symptom relief rates of US-guided TF-CNRB at 1, 4, and 12 weeks were 72%, 69%, and 63%, respectively. Venous blood was aspirated during the procedures in two patients, and the needle tips were corrected. No intravascular injections or neurologic injuries were observed. Conclusion US-guided TF-CNRB produced circumferential spreading around the involved cervical nerve root, and showed significant clinical effectiveness in patients resistant to regular US-guided CNRB.

Results of repeat manipulation under ultrasound-guided cervical nerve root block with corticosteroid and local anaesthetic injection for recurrence of frozen shoulder

Background This study aimed to evaluate the clinical results of a repeat manipulation under ultrasound-guided cervical nerve root block (MUC) with corticosteroid and local anaesthetic injection for recurrence of idiopathic frozen shoulder after MUC. Methods A consecutive series of 42 shoulders in 39 patients with idiopathic frozen shoulder underwent MUC. All patients were assessed according to the American Shoulder Elbow Surgeon (ASES) score and shoulder range of motion (ROM) both before MUC and at 1 year thereafter. If patients continued to have pain and limited ROM at 3 months after the procedure, they were offered a repeat MUC. Such patients were also assessed before the procedure and at 3 months and 1 year thereafter. Results The initial MUC was successful in 31 shoulders (single group). Repeat MUC was required in 11 shoulders (repeat group). Patients in the single group showed significant improvement in ROM and ASES score at 1 year after the procedure (p < 0.001); similarly, patients in the repeat group had significant improvement in ROM and ASES score at 3 months and 1 year after the procedure (p < 0.001). Patients in the repeat group had had significantly more severely limited ROM (p < 0.01) and decreased ASES score (p < 0.001) before the procedure compared with those in the single group. Conclusions A repeat MUC with corticosteroid and local anaesthetic injection is a valuable option before proceeding to surgery for recurrence of idiopathic frozen shoulder. When there is severely limited ROM and decreased ASES score before the MUC, a repeat MUC may be necessary, which would require the patient’s informed consent. Trial registration Retrospectively registered