Pinched nerve

by Nathan Wei, MD, FACP, FACR

Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.

Click here: Second Opinion Arthritis Treatment Kit

The term "pinched nerve" describes damage or injury to a nerve or set of nerves.

A nerve is a microscopic cell. Interestingly, its fibers may run several feet in length. A nerve cell that originates in the brain or in the spinal cord is called a central nerve, and a nerve that leaves the spine to go into the arms or legs is called a peripheral nerve. These peripheral nerves are actually bundles of millions of nerve fibers that branch out to target organs such as skin, muscle, and so forth.

The injury may be due to compression, constriction, or stretching. Symptoms include numbness, "pins and needles" or burning sensations, and pain radiating from the injured area. The extent of injuries may vary from minor, temporary damage to a more permanent condition. Early diagnosis is important to prevent further damage or complications.

A nerve can be pinched as it leaves the spine by a herniated disc or by bone spurs that form from spinal arthritis. Some examples include:

• Pinched nerve
• Sciatica
• Herniated disc (or herniated disk)
• Bulging disc
• Ruptured disc
• Slipped disc
• Disc protrusion
• Disc degeneration
• Degenerative disc disease

Another common place for nerves to get pinched is in the carpal tunnel. This is an area in the wrist through which all of the flexor tendons of the hand and the median nerve must pass to get to the hand.

Another example is a pinched nerve in the low back. Pain is perceived as radiating down the leg. Muscle spasm in the back commonly accompanies pinched nerves. Sometimes, nerves can be pinched and the only symptoms may be numbness and weakness in the arm or leg without any pain.

A clinical diagnosis of the cause of the patient’s pain comes through a combination of findings from a medical history, physical exam, and diagnostic tests.

•History. The physician will take the patient’s medical history, such as a description of when the low back pain, sciatica or other symptoms occur, a description of how the pain feels, and what activities, positions or treatments make the pain feel better, and more.

•Physical exam. The physician will conduct a thorough physical exam of the patient, such as testing nerve function and muscle strength in certain parts of the leg or arm, testing for pain in certain positions, and more. Usually, this series of physical tests will give the physician a good idea of the type of back problem or neck problem that the patient has.
•Diagnostic tests. After the physician has a good idea of the source of the patient’s pain, a diagnostic test, such as an MRI scan, is often ordered to confirm the presence of an anatomical lesion in the spine. The tests can give a detailed picture of the problem, such as the location of the herniated disc and impinged nerve roots.

Although the anatomic findings on an imaging study have significance, they are not necessarily diagnostic. A patient’s physical exam findings and symptoms need to match the anatomic findings to arrive at an accurate medical diagnosis.

•Pinched nerve: When a patient has a symptomatic herniated disc, the disc herniation is pinching a nerve in the spine. This produces pain that is called radicular pain (e.g., nerve root pain, or sciatica from a lumbar herniated disc, or arm pain from a cervical herniated disc).
•Disc pain: When a patient has a symptomatic degenerated disc (one that causes low back pain or other symptoms), it is the disc itself that is painful and is the source of pain. This type of pain is typically called axial pain.

The most frequently recommended treatment for pinched nerve is rest for the affected area. Corticosteroids help alleviate pain. In some cases, surgery is recommended.

For peripheral nerve pinching, physical therapy may be recommended, and splints or collars may be used.

A new form of therapy, "ultrasound-guided hydrodissection" can cure many forms of peripheral pinched nerves including carpal tunnel syndrome, ulnar nerve entrapment at the elbow, and peroneal nerve entrapment at the lateral knee.

With treatment, most people recover from pinched nerve. Hoever, if the pinching has gone on too long, permanent damage may occur. This is not reversible.

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