The most common problem we see in all our clinics is sciatica, which is the general term for neuralgic pain in the legs caused by a spinal problem. When it is felt in the arms it is called “brachalgia”.
Causes of sciatica and brachalgia vary according to age group. Generally, in people under the age of 50 the commonest cause is spinal nerve root compression or irritation due to a herniated intervertebral disc (“slipped” or “ruptured”).
After the age of around 50 the commonest cause of sciatica or brachalgia is nerve root compression due to a combination of loss of height of the intervertebral disc, which reduces the available room for the nerve root to leave the spine, in combination with osteophyte (new bone) formation. In younger people it frequently resolves spontaneously over the course of a few weeks and the sufferer will need to take a combination of painkillers, anti-inflammatories and muscle relaxants during this time. Physiotherapy can help during the acute phase of sciatica but less so with neuralgic pain in the arm.
However, in older patients conservative measures generally do not work as effectively. In either case where conservative measures have failed or where a patient needs rapid treatment and symptomatic relief we plan a series of one to three image guided spinal steroid injections which are generally very effective at alleviating symptoms within a few days. Most patients get a good result from the first treatment, around a third will need a second treatment but generally if patients still have symptoms after a second treatment it is unlikely that they will get good symptomatic relief after a third, but there will be occasions in which we will consider it.
In patients who have problematic symptoms or if they have a significant structural problem as demonstrated on appropriate imaging, which is most likely to be an MRI scan, we may refer a patient on for surgery, but fortunately most patients with sciatica and brachalgia can be managed without surgery. If you think you have sciatica or brachalgia please get in touch with us.