Cervicobrachial syndrome: diagnostic and treatment algorithms

Abstract

Neck and shoulder disorders often occur side by side and reinforce each other in their clinical manifestations. Differential diagnosis of neck and shoulder pain can be challenging due to the close anatomical proximity, innervation of neck and shoulder structures, similarity of symptoms and groups of patients suffering from these conditions. Identifying the anatomical source of pain is the most important clinical task when choosing treatment for patients, which is reflected in two clinical observations. In the first clinical case the main complaint was pain in the shoulder; a neuro-orthopedic examination revealed evidence of radicular involvement in the form of a decrease in tendon reflex, pain provocation in Spurling and tension tests, with no evidence of involvement or pain in the joint structures of the shoulder. MRI of the cervical spine revealed signs of CVI discoradicular conflict consistent with the clinical symptoms. In the second observation, the main complaint was pain in the cervical spine and right shoulder, initially considered as radiculopathy; MRI revealed degenerative changes in the spine with possible compression of the CVI root. Neuro-orthopedic examination revealed no signs of radicular lesions; the main anatomical source of pain was coraco-acromial joint involvement, which was confirmed by diagnostic blockade of this joint. Both non-drug methods (kinesiotherapy, manual therapy, ergonomic measures) and medications (non-steroidal anti-inflammatory drugs — Airtal; muscle relaxants — Mydocalm) were used; therapeutic blockades targeting the main source of pain were performed. The cases presented show that it is impossible to determine the main anatomical source of pain based on the pain pattern. It can be determined by a thorough analysis of medical history and a detailed neuro-orthopedic examination. Neuroimaging methods should only be interpreted in the context of the clinical picture. In controversial cases, diagnostic blockades with local anesthetics can be performed to confirm the diagnosis.