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Overview of a Pinched Nerve

There are over 100 billion nerves in your body. Together, they form a complex “wiring harness” that your brain uses to communicate with and control body parts. For this system to work properly, individual nerves (wires) need to transmit signals without interference. A nerve traveling through a body part can get pinched (compressed) by surrounding tissues, such as bones, joints, or muscles. When this happens, signals may not get transmitted properly, like a wire that short-circuits, resulting in pain, numbness, tingling, or even weakness.

Pinched nerves can occur anywhere in the body. When a nerve in the lower back gets pinched, by a herniated disc for example, this may result in leg pain in the area that the nerve travels (e.g. sciatica is pain radiating down the sciatic nerve in your leg). A pinched nerve at the wrist can cause carpal tunnel syndrome. A pinched nerve in the neck can cause pain into the arm and hand (i.e. radiculopathy).

Symptoms can vary from mild to severe. It is important to address symptoms sooner than later to avoid permanent damage. Fortunately, most cases of pinched nerve will get better without surgery.

Symptoms

Signs and symptoms of pinched nerves include:

  • Electric or burning pain in the arms or legs.
  • Numbness or tingling sensation (“pins and needles”).
  • Sensitivity to a light touch.
  • Muscle weakness (may be noticed while gripping, raising arms, walking overall or while, going up/downstairs, or prolonged activity.

Causes

A nerve can get pinched by bone, a herniated disk, tendons, muscles, ligaments, scar tissue, and/or narrowing of the tunnel/space (i.e. stenosis) the nerve travels through. Inflammation of the nerve and/or tissues surrounding the nerve can also increase compression. The compression may be due to postural deficits, static positions (i.e. computer use, bent elbows when sleeping, prolonged sitting/standing, repetitive movements, or a traumatic impact/injury). It can also be associated with arthritis, obesity, or pregnancy.

Diagnosis

Most cases of pinched nerves can be diagnosed after a thorough history and physical exam is performed by your medical doctor. However, diagnostic testing may be necessary to localize where the nerve is getting pinched (compressed), or to measure the severity of damage. Diagnostic tests may include:

  • Nerve conduction study. The speed and strength of nerve impulses are measured by sending small electric currents via electrodes placed on the skin to determine nerve performance.
  • Electromyography (EMG). An EMG measures the activity of the muscles at rest and during contraction, determining the communication of the nerve to the muscle. In an EMG test a needle is used in addition to electrodes.
  • Magnetic resonance imaging (MRI). An MRI provides a clear picture of a body part (e.g. lumbar or cervical spine) to visualize exactly where the nerve is being compressed and what is causing the compression.
  • High-resolution ultrasound. Images are produced with high-frequency sound waves sent through the body. These are typically useful with more superficial areas of compression, such as carpal tunnel syndrome.

Treatment of a Pinched Nerve

Initial treatment of mild symptoms include rest and avoiding activities that increase your symptoms. If symptoms do not resolve within a few days, increase in severity, or involve weakness, you should seek medical attention immediately. Treatments may include:

  • Medication: Over the counter medications such as Advil or Tylenol may be used to treat your pain if symptoms are mild or moderate. Oral corticosteroids many also be prescribed to reduce inflammation.
  • Physical therapy: Exercises, manual (i.e. massage) therapy and modalities (e.g. heat, ice, electric stimulation) can be used to decompress the site of compression and treat the swelling and pain in order to promote tissue healing and reduce pain. Education can be provided to modify activities to avoid strain to the effected nerve.
  • Injections: Steroids can also be injected directly to the area of inflammation to reduce swelling closer to the nerve root. A physician may perform an image guided injection near the nerve root thought to be the source of the patient’s pain or a direct injection around the affected area. While corticosteroids do not fix spinal stenosis, they do help decrease the inflammation surrounding the neural tissue.
  • Splint: In certain circumstances you may benefit from immobilization to allow appropriate rest of the tissues involved.
  • Surgery: If the above treatments do not improve your symptoms, surgery may be required. Surgery would involve decompressing the nerve by removing /cleaning out the bone, disk, scar tissue, tendon, or soft tissue that is compressing the nerve.

Summary

Pinched nerves can happen anywhere in the body. A nerve traveling through a body part can become pinched (compressed) by surrounding tissues, such as bones, joints, or muscles. When this happens, signals may not be transmitted properly, like a wire that short-circuits, resulting in pain, numbness, tingling, or even weakness. When symptoms cannot be managed conservatively or are causing worsening disability and quality of life, surgical intervention may be an option. If you notice increasing pain, numbness, tingling, or weakness you should seek medical attention immediately. You do not have to live in pain.

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