Differential diagnostic aspects of cervicobrachialgia

1. Big picture

Cervicobrachialgia means neck pain radiating into the arm. In neurology, the important question is not only “does the patient have neck pain?” but:

Is this a cervical root lesion, spinal cord lesion, plexus lesion, peripheral nerve lesion, shoulder disease, tumor, vascular disease, or referred pain?

For the exam, cervicobrachialgia is mainly a localization and differential diagnosis topic. The examiner wants you to distinguish:

• Cervical radiculopathy: root compression, usually from disc herniation or spondylosis.

• Cervical myelopathy: spinal cord compression, dangerous.

• Brachial plexus lesion: multiple root/nerve territory involvement.

• Peripheral nerve entrapment: median, ulnar, radial nerve lesions.

• Shoulder/periarticular disease: pain with shoulder movement but no dermatomal neurological pattern.

• Pancoast tumor or spinal tumor: progressive pain, systemic signs, Horner syndrome.

• Vascular or inflammatory emergencies: anterior spinal artery syndrome, epidural abscess, dissection, etc.

The lecture specifically lists cervical spondylosis, osteochondrosis, spondylarthrosis and disc herniation as common cervical causes, and names the key differentials: brachial plexus lesion, Pancoast tumor, spinal tumors, periarthritis humeroscapularis, cervical myelopathy, and anterior spinal artery syndrome.