الفهرس 
AnatomyOnly 14 pages are availabe for public view
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Abstract
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SUMMARY
Brachialgia is the radiating pain to the upper extremity or occipital
area of the skull and is referred to one or more dermatome with.or
without tenderness in the muscle of the involved nerve root, there is
aparaesthesia, numbness, sensory loss, disturbance of reflexes.of upper
extremity..
It is caused by many disorders of the cervical vertebrae and the
thoracic outlet through compression of the brachial plexus and blood
vessels.
The most common causes of brachialgia are cervical spondylosis,
cervical prolapsed disc, cervical spondylotic myelopathy, thoracic outlet . - ..
syndrome, carpal tunnel syndrome and syringomyelia.· The diagnostic
techniques compasses Radio and electrodiagnosis.
The Radiodiagnosis includes X-ray, plain myelogram, CT, CTM,
MRI &11dradionuclear bone scan, x-ray is, done routinely for cervical
spine and chest to detect the cervical rib, long C7 transverse process, first
rib anomalies, fracture calvicle callus, tumour involving the thoracic
outlet, narrowed cervical disc, degenerative cervical arthritis, osteophytes
and narrowed intervertebral foramena.
Other diagnostic imaging studies with an ability to visualize neural
tissue or intervertebral disc are used to assess nerve root compression;
these modalities include myelography, CT, CTM and MRI. CT can allow
direct visualization of the neural compressing structures, in contrast to
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myelography which detects neural compression indirectly by changes in
the contour of contrast filled, CT with contrast can effectively
demonstrate extradural, intradual or intramedullary lesions but this
information can be obtained more safely and w.ithout radiation by. MRI.
MR.Iand CTM have been used extensively in evaluation of patients
who present with cervical radiculopathy where as myelography is
generally considered the least sensitive and specific study after the plain
film, the choice between MRI and CTM has been controversal. where as
radionuclear bone scan is of value where there are a multiple areas of
skeletal involvement as in malignancy.
The electrophysiological study make it possible to confirm the
nerve root suffering, to determine the site, the degree and the type of the
lesion, to make prognosis and to follow up the reinnervation process. The
. electrodiagnostic techniques includes electromyography, direct nerve root
stimulation, NeV, percutaneous electrical and magnetic cervical
stimulation and SEP’s study.
Non operative treatment can be helpful in the early period which
may be characterized by episodes of pain in the neck and upper
extremities, modalities of non operative treatment includes
immobilization with a firm collar, intermittent bed rest, medications such
as non steroidal antiinflammatory agents and muscle relaxants, trigger
point injection, epidural injection and physical therapy.:
Surgical treatment is indicated in’ patients who have severe,
longstanding symptoms and who have tried some treatment modalities
without much success and those who have obvious objective neurologic
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signs or arterial or venous compression. Cervical spine operations
includes cervical laminectomy, cervical fusion and cervical spine
stabilization. Surgical treatment of toes, includes transaxillary first rib
resectionand cervical scalenectomy.