From the Guidelines
Hand and arm pain after a C5 cervical fracture with spinal cord contusion and incomplete spinal cord injury is most likely caused by neuropathic pain resulting from nerve damage at the C5 level and surrounding areas. This type of pain typically affects sensation and motor function in the shoulders, upper arms, and parts of the forearm. According to the American College of Radiology, MRI is preferred to CT myelography for assessing neurologic injury in the setting of spine trauma, which can help diagnose the extent of nerve damage 1.
Key factors contributing to this condition include:
- Injury to the nerve roots at the C5 level
- Damage to surrounding nerves and spinal cord
- Abnormal signals sent to the brain due to nerve damage
- Resulting symptoms such as burning, shooting, or electric-like sensations, numbness, tingling, or weakness in the affected areas
Treatment options for neuropathic pain in this context may include:
- Medications like gabapentin, pregabalin, or amitriptyline to manage pain
- Physical therapy to maintain range of motion and strengthen muscles
- Regular follow-up with a neurologist or pain specialist to adjust treatment as needed and address complications during the healing process. The use of CT angiography and MR angiography for assessing cervical vascular injury, as mentioned in the study 1, may also be relevant in some cases to rule out vascular complications.
From the Research
Causes of Hand and Arm Pain
- Hand and arm pain after a C5 cervical fracture with spinal cord contusion and incomplete spinal cord injury can be caused by various factors, including nerve injuries and spinal cord damage 2, 3.
- The C5 nerve palsy is a common post-operative neural disorder that can occur after cervical spine procedures, presenting with deltoid and/or biceps weakness, and may present immediately or several days after surgery 2.
- Parsonage-Turner syndrome is an idiopathic plexopathy that can present with severe neuropathic pain in the shoulder, neck, and arms, followed by neurological deficits involving the upper brachial plexus 2.
- Incomplete spinal cord injuries, such as those occurring at the C5 level, can result in variable recovery, with some individuals experiencing significant motor and sensory deficits, while others may recover some degree of walking capacity and upper limb function 3, 4.
Spinal Cord Injury and Recovery
- The prognosis for spinal cord injury recovery is influenced by the severity of the injury, with incomplete injuries tend to have better outcomes than complete injuries 3, 4.
- Early diagnosis, prompt treatment, and multidisciplinary care, including surgery, mechanical ventilation, and rehabilitation, can improve outcomes and promote recovery in individuals with spinal cord injuries 5, 4.
- The presence of cervical spinal canal stenosis can affect outcomes and prognostic factors in patients with traumatic spinal cord injuries, with higher American Spinal Injury Association Impairment Scale (AIS) grades and presence of certain clinical syndromes, such as Brown-Sequard plus syndrome or central cord syndrome, associated with favorable functional outcomes 6, 4.
Clinical Presentation and Management
- Patients with traumatic cervical central spinal cord injuries typically present with greater motor deficits in the upper vs. lower extremities, accompanied by patchy sensory loss, and may exhibit unique neuroradiographic features, such as hyperintense T2 intramedullary signals on magnetic resonance imaging (MRI) 6.
- Management strategies for spinal cord injuries, including surgical and conservative approaches, depend on the specific characteristics of the injury, such as the presence of instability, stenosis, or ligamentous injury, and the individual's overall clinical condition 2, 6, 4.