Neuralgia refers to a severe sharp pain occurring along the course of a nerve. The middle radicular group refers to the 7th cervical root which consists of motor and sensory pathways. This middle group is one of three trunks forming the brachial plexus.

In some cases, the cause of neuralgia may be unknown. Causative factors may include: injury or irritation to the nerve; nerve root compression by a blood vessel; degenerative bone changes; tumors; or trauma such as penetrating missile injury. Other causes may include: shoulder injury; overextension of a joint; brachial neuritis; carrying heavy objects supported at the shoulder; viral infections; and chronic degenerative diseases such as multiple sclerosis. Damage to the nerves may result from factors including: poor nutrition to the nerve; toxins; inflammation; infections; iatrogenic injection injuries; metabolic injury; nerve entrapment; or fractures.

Signs and symptoms may occur at irregular intervals and be characterized by attacks of unilateral, sharp, stabbing, or constant burning pain. Other manifestations include: anesthesia over the shoulder; inability to raise the arm at the shoulder; decreased reflexes; metabolic neuropathies; demyelination; moderate to severe muscle weakness; muscle atrophy; and edema of the injured limb. Other possible occurrences include: paralysis of forearm flexion, and of abduction and of internal rotation and external rotation of the arm. Distal paresthesias may occur. Evidence of an inability to use a normal functioning hand or complete paralysis may be present. Depending on involvement of neighboring nerves, there may be other signs and symptoms.

Diagnostic measures may include a complete history; physical and neurological examinations; motor, sensory and reflex tests; blood studies; spinal tap; evoked responses; electromyography (EMG); x-ray; computed tomography (CT) scan; and magnetic resonance imaging (MRI).

Treatment may depend on the underlying cause. Additional measures may include anti-inflammatory or pain medications; peripheral nerve blocks if pain medication fails; and transcutaneous electrical nerve stimulation (TENS). Physical therapy may be useful for certain types of neuralgia. Surgical resection may be necessary when medical therapy fails.

Regeneration of the nerve may depend on the degree and site of injury. The closer the injury is to the central nervous system (CNS), regeneration of a severely damaged nerve is less likely to occur. Frequency of attacks may vary with periods of long remissions. However, remission periods may decrease with age. Continuous bouts may be incapacitating and may alter activities of daily living (ADL) and employment. These changes may require counseling intervention. There may be a need for long-term pain management. Medications may warrant ongoing liver and blood studies. The potential for paralysis of the nerve exists.