Brachial neuralgia denotes pain in the nerves of the brachial plexus.  If prolonged it may progress to brachial neuritis.

Causes of Brachial Neuralgia
Brachial neuralgia may be caused by posture, a hyperkyphotic curve of the thoracic spine, a lowered shoulder girdle or shoulder compression.

Signs & Symptoms
Intermittent pain, often described a lancinating ‘zing’ along the nerve pathways.  There may be muscle hypotonicity, spasm and possible twitching. Brachial neuralgia may also present with parasthesia, especially of the fingers.

Orthopedic Assessment
Some of the typical orthopedic assessment techniques a massage therapist may use are:

• Active and passive range of motion testing of the neck, arm, elbow, wrist and fingers.
• Sensation may be tested with two-point discrimination or deep and light touch.

Massage Treatment Goals
Therapeutic massage is used to help eliminate the cause, correcting postural dysfunction including hyperkyphosis (if functional in nature) and/or shoulder compression. Massage Therapy aides in reducing muscle spasm, helping strengthen and improve muscle tone in the shoulders, especially the upper and middle trapezius and the rhomboid muscles, which in turn helps raise the levels at which the shoulders are normally carried.  In addition therapeutic massage is used to help relieve pain by reducing the sympathetic nervous system firing, decreasing pressure over the brachial plexus, preventing further compression, treating the compensatory structures and preventing further compensations by helping improve circulation and maintaining tissue health.

Typical Massage Treatment
During the acute stage of brachial neuralgia the patient is positioned for comfort and General Swedish massage techniques may be used along with vibration and stroking. Diaphragmatic breathing may be encouraged, and gentle passive range of motion of the neck and shoulders may be performed.

During the chronic stage of brachial neuralgia Myofascial and General Swedish massage techniques may be used and trigger points may be addressed in the neck, shoulder, anterior chest and thoracic spine muscles.  Attachment release may be used in these areas as well. Diaphragmatic breathing may be encouraged with passive and active stretching of the neck and chest. Stimulatory techniques may be performed on the rhomboids and lower/middle trapezius muscles.

Massage Contraindications & Precautions
The more prolonged brachial neuralgia persists the more likely it is to develop into brachial neuritis a more serious, pathological condition that includes inflammation if the neural tissues.  A patient suffering brachial neuralgia may be taking strong pain medications and may also present with sensory impairment due to the condition itself. Caution must be taken as to massage pressure so that the tissues are not damaged. During acute stages, rhythmic mobilizations and local massage is contraindicated as aggressive massage over the brachial plexus will aggravate the condition.  In addition, full stretches of the cervical spine (neck) or the glenohumeral (shoulder) joint may cause aggravation and should be avoided.

Typical Suggested Homecare
During the acute stage the patient may be asked to perform passive relaxed range of motion within the pain-free ranges.  This may progress with a chronic condition to active range of motion exercises with or without isometric resistance.  Relaxation and respiratory exercises including diaphragmatic breathing may be encouraged. Postural awareness correction and exercises to raise the shoulder girdle, like shoulder shrugs may be taught.  Ice or mild heat may help reduce pain, and contrast washes or baths help increase circulation and maintain tissue health.