What is a Pinched Nerve?
THERE ARE OVER 100 BILLION NERVES in the human body. Together, they form a complex “wiring harness” which the brain uses to communicate and control the body. At Centers for Neurosurgery Spine & Orthopedics, our dedicated team of specialists understands how each individual nerve needs to transmit signals without interference for the body to function properly. A nerve traveling through a body part can get pinched or compressed by surrounding tissues, such as bones, joints, or muscles. When this happens, similar to when a live wire gets short-circuited, nerve signals are not transmitted properly, resulting in pain, paresthesia, numbness, tingling, or even weakness.
Pinched nerves can occur anywhere in the body but it most commonly occurs in the nerve roots of the spine. When a nerve in the lower back gets pinched by a herniated disc, it will result in leg pain on the same side of the body as the pinched nerve that travels from the spine down the leg supplying sensation on movement signals to the leg. An example is sciatica which is a term used for pain radiating down the back of the leg stemming from the sciatic nerve that travels down the posterior part of the leg. The sciatic nerve originates out of the spinal cord at the lumbar level of the spine. A more complicated example is when someone has symptoms similar to carpal tunnel syndrome with symptoms experienced in the hand.
Carpal tunnel syndrome is when the nerve is pinched in the wrist but if the nerve is actually pinched in the cervical spine instead of the wrist, it can cause pain or paresthesias in the hand (i.e. radiculopathy) too and be mistaken for carpal tunnel syndrome. A neurosurgeon and an MRI of the neck is needed to confirm the diagnosis.
Symptoms can vary from mild to severe. It is important to address symptoms sooner than later to avoid permanent damage. Fortunately, most cases of a pinched nerve can be treated conservatively and will resolve without surgery.
Symptoms can vary from mild to severe. It is important to address symptoms sooner than later to avoid permanent damage.
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.
A nerve can get pinched by bone, a herniated disc, tendons, muscles, ligaments, scar tissue, and/or narrowing of the tunnel/space (i.e. stenosis) the nerve travels through. An irritated nerve becomes inflamed and swells. Inflammation of the nerve and/or tissues surrounding the nerve can also increase compression of the nerve. 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.
The diagnosis of a pinched nerve may be suspected after a thorough history and physical exam is performed by a physiatrist, a pain management doctor, neurosurgeon, or orthopedic spine doctor. Diagnostic testing, however, may be necessary to localize what is compressing the nerve or whether the nerve itself is misfunctioning. 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.
- Magnetic resonance imaging (MRI): An MRI provides a clear picture of the nerves and spinal cord (i.e. cervical, thoracic, or lumbar 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 reflected off targeted anatomical structures. An ultrasound image is useful for superficially located areas of compression, such as the median nerve of the wrist which, if pinched, causes carpal tunnel syndrome.
Treatment of a Pinched Nerve
Initial treatment of mild symptoms may only require rest and avoiding activities that increase your symptoms. If symptoms do not resolve within a few days schedule an appointment with CNSO. Medical attention should immediately be sought if there is an increase in severity arm or leg weakness, loss of balance, inner thigh numbness, or incontinence. Mild to moderate symptoms can be treated conservatively as listed below with surgery being reserved for severe cases:
- Medication: Over-the-counter medications such as Advil or Tylenol may be used to decrease pain and inflammation of the irritated pinched nerve. Oral corticosteroids may also be prescribed to reduce inflammation.
- Physical therapy: Exercises, manual (i.e. medical massage) therapy, and modalities (e.g. heat, ice, electric stimulation) can be used to decrease muscle spasms that form near the site of nerve compression. Proper pressure and stretching applied to the affected area helps reduce the associated muscle tension, swelling, and pain. At CNSO, education is provided to help the patient continue home exercises and how to modify activities to avoid reinjuring the affected nerve.
- Steroid Injections: After a thorough evaluation that identifies the location of the pinched nerve, pain management doctor can perform an image guided injection of steroids near the affected nerve root that is the source of the patient’s pain. While corticosteroids do not fix any structure causing the pinched nerve, they do help decrease the inflammation that causes the swelling of the nerve. Ultimately, the reduction in swelling decreases the neuronal agitation.
- Splint: In certain circumstances, immobilization of the affected limb to allow the complete rest of the tissues involved may be beneficial.
- Surgery: If an anatomic structure that correlates with your symptoms has been identified and the above treatments do not improve your symptoms, surgery may be required to remove the offending anatomical structure. Surgery would decompress the nerve allowing it to function free from obstruction and irritation.
Let Centers for Neurosurgery, Spine, & Orthopedics Help
Pinched nerves can happen anywhere in the body. The dedicated team at Centers for Neurosurgery, Spine, and Orthopedics (CNSO) understands how to diagnose a pinched nerve versus any other nerve, brain or musculoskeletal causes of pain and paresthesias. Our team of recognized board-certified neurosurgeons, pain management doctors, physiatrists, rehabilitation specialists, and certified physical therapists provide every patient with comprehensive and coordinated care and treatment. CNSO offers multiple convenient locations in Northern NJ. Contact CNSO today to schedule an appointment.