Could I Have a Pinched Nerve?

For today’s discussion I’m going to use as an example nerves that might get pinched in the cervical area (neck). Each cervical vertebra sits on top of each other much like building blocks. In between each vertebra is a disc. This acts as a shock absorber between the spine bones. It has a thick, rubbery outside and is filled with thick jello. In between each vertebra is a small, bony foramen (hole). The nerves exit from the spinal cord through this hole and then along the arms towards the fingers. Nerves commonly are “pinched” in one of the following areas: (1) When a disc “protrudes” (or herniates) it “pooches out” and pushes on the exiting nerve. (2) Due to arthritic wear and tear, the foramen, or hole, that the nerve exits from can be narrower than usual and can pinch the nerve at that level. (3) The facet joint where rotation or twisting in the neck occurs can be “twisted out of position” or “jammed” and catch the nerve as it runs right next to it. (4) Lastly, the nerve can be pinched in the soft tissue or muscle. This can occur from a muscle tear with swelling or, if the injury is chronic, scar tissue. All of these injuries will produce similar symptoms. At the site of the “pinching”, patients will describe pain or numbness and tingling, which will then travel along the nerve all the way to the portion of the skin (called a dermatome) where the nerve ends. A very careful history will almost always tell which nerve is pinched. A very careful exam will on many occasions tell us which of the above four mechanisms are causing the “pinching”. Taking the history and doing the exam require significant skill. An MRI scan is often required to make a definitive diagnosis and to document for legal cases. A nerve conduction study can also be performed to confirm that the nerve is “pinched”.

Treatment will depend on which of the above four injuries are causing the pinching. If it is a disc injury, cervical traction(a home unit that attaches to your bed and gently stretches the spine) will be recommended. If that is not effective, cervical epidurals (steroid injection into the spine) or surgery may even be required. The facet joints can normally be “maneuvered” back into their normal position, and this will often “release the nerve”. Wear and tear causing narrowing of the neural foramen will usually respond to traction but sometimes injection therapy and even surgery may be required to “open up the hole so the nerve isn’t pinched”. Trapping of the nerve in the soft tissue requires highly skilled nerve-release techniques that at the present time are only performed by a limited number of physical therapists in the country.

In summary, a detailed history, careful clinical exam, and additional sophisticated testing may be required to make the diagnosis. Treatment is almost always possible, but occasionally requires invasive techniques such as surgery.

A Better Way to Get Better,
Adrian Lewis
Adrian Lewis, MD