Cervicobrachial neuralgia
Cervical radiculopathy — The "sciatica of the arm"
What is cervicobrachial neuralgia?
Cervicobrachial neuralgia (CBN) is arm pain of cervical origin, caused by the compression or irritation of a nerve root in the neck. It is commonly known as the "sciatica of the arm" because the mechanism is identical: a nerve is compressed as it exits the spine.
The most common causes are cervical disc herniation and cervical arthritis (uncovertebral osteophytes) that narrow the foramen — the small channel through which the nerve leaves the spinal column. The C6 and C7 roots are the most frequently affected, which explains why the pain typically radiates into the shoulder, arm and certain fingers.
How it develops
Nerve root compression can result from several phenomena:
• Cervical disc herniation: a disc fragment protrudes and directly compresses the nerve — the most common cause in younger patients
• Uncovertebral arthritis: bony "parrot beak" spurs (osteophytes) that form with arthritis progressively narrow the nerve foramen — the most common cause after 50
• Foraminal stenosis: a combination of arthritis, disc bulging and ligament thickening that "strangles" the nerve in its passage
• Inflammation: the mechanical compression is accompanied by a local inflammatory reaction that amplifies the pain
Symptoms & Clinical signs
The clinical picture is often highly characteristic:
• Cervicobrachial pain: pain starting in the neck and radiating into the shoulder, arm, forearm and sometimes the fingers — often described as a "burning" sensation or an "electric current"
• Dermatomal pattern: the pain follows a precise path depending on the root involved — C6 (thumb and index), C7 (middle finger), C8 (ring and little finger)
• Night pain: a hallmark of CBN, the pain wakes the patient and forces them to change position or get up
• Tingling and numbness: in the territory of the compressed nerve
• Weakness: reduced grip strength, difficulty squeezing the hand or lifting objects — a sign of motor involvement to watch carefully
• Neck pain: pain and stiffness of the neck often associated, though sometimes absent
Diagnosis
• Clinical examination: Spurling's test (axial compression + lateral tilt of the neck) reproduces the arm pain; search for sensory or motor deficit
• Cervical MRI (gold standard): visualises the cause of the compression (herniation, arthritis) and the degree of nerve involvement
• Cervical CT scan: details bony structures (osteophytes, foraminal stenosis) with great precision
• EMG: useful in doubtful cases to confirm nerve suffering and locate the affected root
Treatment
The vast majority of cervicobrachial neuralgias improve without surgery:
Conservative treatment (first line)
• Relative rest, soft cervical collar if needed for a short period
• Painkillers and anti-inflammatory drugs (occasionally oral corticosteroids for very painful forms)
• Gentle physiotherapy: manual cervical traction, mobilisation, cervical muscle strengthening
• Foraminal injections: CT-guided corticosteroid injection directly around the compressed nerve — often highly effective
Surgical treatment
• Indications: failure of medical treatment after 6 to 8 weeks, persistent sleep-disturbing pain, or neurological deficit (weakness)
• Technique: anterior cervical discectomy (removal of the disc or osteophyte from the front of the neck) followed by fusion or disc replacement
• Outcome: arm pain relief in over 90% of cases
Key figures
80–90%
Of CBN cases resolve without surgery with well-managed medical treatment
C6 – C7
Most frequently affected nerve roots
4–6 weeks
Typical timeframe for significant improvement under conservative treatment
Recovery after surgery
After anterior cervical discectomy (with cage fusion or disc replacement), arm pain relief is often immediate or near-immediate. The hospital stay is typically 1 to 2 days. The small anterior incision (3 to 4 cm) sits in a natural neck crease and leaves a discreet scar. A cervical collar is not always necessary — Dr Dimitriu adapts this on a case-by-case basis.
Walking is resumed immediately. Driving is possible from week 2. Swallowing may feel slightly uncomfortable for a few days (a "lump in the throat" sensation) due to the surgical approach — this is normal and temporary. Return to work occurs between 3 and 6 weeks depending on the type of activity. Residual tingling and numbness fade gradually over the weeks following surgery as the nerve recovers.
Consultation with Dr Dimitriu
Dr Christian Dimitriu, a neurosurgeon specialising in cervical spine surgery, manages cervicobrachial neuralgias that have not responded to medical treatment. During the consultation, he performs a precise neurological examination: Spurling's test, assessment of sensory or motor deficit, grip strength evaluation and tendon reflex testing.
Analysis of the cervical MRI allows precise identification of the compressed root and the cause of compression (soft disc herniation, osteophyte, foraminal stenosis). Dr Dimitriu always favours conservative treatment first and only proposes surgery when medical management has failed or a neurological deficit is present. If surgery is indicated, he discusses the choice between a fusion cage and a disc replacement, based on the patient's age, the level involved and the condition of the adjacent discs.
Prevention and ergonomics
Preventing CBN relies on adopting good cervical hygiene in daily life. Workplace ergonomics are essential: screen positioned at eye level, arms resting on armrests, keyboard and mouse placed to avoid shoulder elevation. Regular breaks every 30 to 45 minutes allow the cervical muscles to relax.
Strengthening the cervical muscles and shoulder girdle (trapezius, rhomboids) improves neck stability and protects the nerve roots. Daily gentle cervical mobility exercises (rotations, lateral tilts, trapezius stretches) prevent stiffness. It is important to avoid prolonged head-down positions (smartphone, tablet), which significantly increase the load on the cervical spine — a phenomenon known as "text neck".
Consultations in Île-de-France
Dr Dimitriu practises at 4 facilities in the Paris region (Île-de-France), easily accessible from central Paris: Clinique de l'Yvette (Longjumeau), Hôpital Privé d'Antony, Clinique du Mont-Louis (Les Lilas) and Hôpital Privé de l'Ouest Parisien (Saint-Cloud). See addresses and book an appointment.
Frequently asked questions
Most cases of CBN improve significantly within 4 to 6 weeks with appropriate medical treatment. Some forms may persist for 2 to 3 months before resolving completely. If the pain remains disabling beyond 6 to 8 weeks despite treatment, a neurosurgical consultation is recommended to assess whether an operation is needed.
Yes, CT-guided foraminal injections are often highly effective. They involve injecting corticosteroid directly around the compressed nerve root. Relief can be rapid and long-lasting. They are a first-choice treatment before considering surgery and sometimes make an operation unnecessary.
Surgery is considered after failure of medical treatment for 6 to 8 weeks, persistent sleep-disturbing pain despite injections, or neurological deficit (loss of strength in the hand or arm). In cases of sudden motor weakness, surgery may be offered sooner. The success rate of surgery exceeds 90% for arm pain relief.
Yes, but with ergonomic adjustments: screen at eye level, arms resting on armrests, regular breaks every 30 to 45 minutes to move the neck and shoulders. A document holder at screen height and an ergonomic keyboard can also relieve cervical tension. Sick leave is not always necessary.
Sources: SFCR · Spine (Radhakrishnan et al., 1994) · HAS · European Spine Journal.