Para saber en qué consiste la cervicalgia y cervicobraquialgia debemos conocer bien de lo que hablamos. La región cervical está compuesta por 7 vértebras de las cuales las dos primeras tienen nombres propios por tener características diferentes (Atlas y Axis), las restantes son similares entre sí.  Es el segmento con mayor movilidad en la columna vertebral. La anatomía funcional de la columna cervical es extraordinariamente compleja y está integrada por una gran cantidad de elementos anatómicos: cápsulas articulares, ligamentos, tendones, músculos y filetes nerviosos. Todos ellos posibles generadores de dolor, sea por patología, como por causas ajenas a su estructura (esfuerzos laborales extremos, posiciones anti fisiológicas en el trabajo, falta de descanso durante el sueño).

La Cervicalgia es una de las causas más frecuentes de consulta en atención primaria. Se calcula que el 10% de la población presentará dolor cervical, y en un 25% de los casos de forma crónica (mayor a 3 meses) y/o recidivante.

Además, es origen de numerosas bajas laborales, estimándose que hasta entre un 11–14% de los trabajadores ven limitada su actividad por dolor cervical. El 1% desarrolla déficits neurológicos. La mayor parte de los dolores cervicales están causados por patología mecánica (90%), siendo frecuente la cervicalgia postraumática secundaria a un accidente de tráfico (latigazo cervical). La Cervicalgia es el dolor localizado en el cuello que generalmente se acompaña de impotencia funcional para los movimientos de flexo-extensión, rotación y/o lateralización, y que puede irradiarse a los hombros y espalda.

Hablamos de Cervicobraquialgia cuando el dolor cervical se irradia a una de las extremidades superiores a través del territorio correspondiente a una raíz nerviosa cervical baja (C5, C6, C7 y C8). Las raíces más frecuentemente afectadas son C7 y C6, por este orden.

Se produce un proceso global de forma súbita por una estructura neural en compromiso o por la suma de pequeños “atrapamientos” del nervio a lo largo del trayecto que sigue desde su salida a nivel cervical (PLEXO BRAQUIAL) hasta la mano.

Causas de la Cervicalgia

  • Origen traumático.- Es la causa más frecuente de una Cervicalgia, debido a movimientos bruscos del cuello que conllevan pequeños desgarros a nivel músculo-ligamentario. Es lo que se conoce como esguince o “latigazo” cervical y el mecanismo más frecuente es la flexo-extensión brusca del cuello por aceleración/desaceleración en accidentes de tráfico. El dolor puede iniciarse a las horas del traumatismo y se acompaña generalmente de contractura muscular.
  • Patologías artrosis-degenerativa, presentes en la región cervical.
  • Las posturas inadecuadas y la sobrecarga muscular en determinadas profesiones, el stress y cuadros de carácter psico-orgánico.

Causas de la Cervicobraquial

  • Compresión de una raíz nerviosa cervical baja a nivel de su emergencia radicular. En pacientes jóvenes la compresión es más aguda y suele estar causada por una hernia discal a ese nivel. La patología discal es más frecuentemente degenerativa aunque también puede ser de origen traumático.
  • En pacientes con edad avanzada con  espondiloartrosis (osteofitos a nivel del agujero de conjunción).
  • Otras causas menos frecuentes de cervicobraquialgia son procesos tumorales (neurinomas) e infecciosos (empiemas cervicales).

Síntomas de la Cervicalgia

  • Dolor: Es el síntoma de mayor predominio, incluso se puede presentar en momentos donde el paciente se encuentre en inactividad.
  • Cefaleas.
  • Vértigos.
  • Rigidez articular en la región cervical.
  • Contractura muscular en los paravertebrales cervicales.

Síntomas de la Cervicobraquialgia

  • Dolor en la región cervical con irradiación hacia los miembros superiores.
  • Sensaciones parestésicas (hormigueo, entumecimiento) en la extremidad superior afectada, que aumentan con la actividad y pueden estar presente en reposo.
  • Debilidad muscular en el miembro superior afectado.
  • Limitación funcional.

Diagnóstico

En ambas patologías la evaluación física y los síntomas que refiere el paciente, son puntos primordiales para dar con el diagnóstico exacto.

Realizar un RX de columna cervical servirá de inicio para observa que elementos anatómicos están fuera de orden y causando problemas.

De persistir los síntomas es necesario realizar una Resonancia Magnética y así poder descartar si la lesión se encuentra en las partes blandas.

Tratamiento

Para dar solución a la Cervicalgia y Cervicobraquialgia, el tratamiento de base suele ser conservador, trabajando con un equipo multidisciplinario; es decir, médico/fisioterapeuta. El médico tratante indica tratamiento con medicamentos antiinflamatorios no esteroideos, para aliviar el dolor, y junto con ello se debe combinar la rehabilitación física para obtener mejores resultados.

En algunos casos los pacientes con Cervicalgia requieren el uso de un Collarín Blando por un mínimo de 10 días; esto es en dado caso que el dolor se encuentre en una etapa ya crónica. Si no se hallan los resultados con éxitos con el tratamiento conservador,  se realizan estudios más exhaustivos y el médico podrá recomendar una cirugía.

Tratamiento Fisioterapéutico.

La Fisioterapia estará basada en disminuir el dolor, la inflamación y restablecer los movimientos anatómicos del paciente, para ello el terapeuta utiliza los siguientes métodos:

  • Compresas húmedas calientes o Crioterapia.
  • Electroanalgesia.
  • Ultrasonido terapéutico.
  • Ejercicios de estiramiento y fortalecimiento.
  • Movilizaciones pasivas.
  • Terapia Manual.
  • Reeducación postural.

Recomendaciones

  • Implementar la práctica de las pausas activas mínimo 2 veces al día durante las actividades laborales.
  • Realizar  estiramientos del cuello antes y después de conducir.
  • Adaptar la altura de la mesa de trabajo para no estar en posición inclinada. Es mejor (si posible) utilizar una mesa con plano inclinado que horizontal.
  • También es muy importante la elección de la almohada (entre 15 y 18 cm).
  • El paciente debe aprender y practicar los ejercicios que no le producen dolor, evitar la postura del cuello en flexión y así irá reduciendo las hipertonías cervicales y la rigidez, lo que ayuda a evitar las cefaleas y mareos (síntomas molestos de la cervicalgia).
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