Pinched Nerve (cont.)
How is a pinched nerve diagnosed?
The doctor will begin by asking the patient various questions about his or
her pain,
numbness, tingling, weakness, and other symptoms. The patient may also be asked about
other medical conditions, work history, and family medical history. This
information can often assist in identifying the nerve(s) affected.
The doctor will then examine the part of the body involved. This may include
testing the patient's strength, sensation, and muscle tone in specific muscles. Depending
on the results of the medical history and the physical examination, the patient may need
additional tests.
If the doctor suspects the patient has a pinched nerve (compression of the
nerves) in the
neck or lower back, X-rays may be necessary to assess possible injury to the
spine or
arthritis of the spine. Depending on the
severity and duration of the patient's symptoms, he or she may also need a CT scan or an MRI
scan. These imaging studies provide additional information about a pinched nerve
not seen on regular X-rays, and can provide additional information in
preparation for surgical intervention if necessary.
The doctor may also recommend specific tests for the affected nerve including a
nerve conduction study or an electromyography (EMG). In the nerve conduction
study, the test stimulates the nerves with a mild electrical impulse and
measures speed of the impulse traveling in the nerve. In the EMG, a small needle
is placed into the muscle while the patient contracts the muscle to measure the
electrical activity of the muscles.
How is a pinched nerve treated?
Support braces
In many cases a pinched nerve can be treated with rest
and ice. If the pinched nerve is in the arm (carpal tunnel syndrome or cubital
tunnel syndrome)
the doctor may recommend a brace for a short period of time. The brace limits the
amount of movement around the nerve, which allows it to rest and recover. The
brace also prevents the patient from movements that may further compress or
pinch the affected nerve. A brace used for carpal tunnel syndrome covers the wrist
and and is extended slightly back. This is because
during flexion (bending the wrist down) the median nerve in the wrist is
further pinched. The brace for cubital tunnel syndrome in the elbow can be used
to keep the elbow from bending too much which further stretches the ulnar
nerve.
Medication
Various medications can also be used to treat a pinched
nerve. Anti-inflammatory medications, for example, ibuprofen or naproxen can reduce
the inflammation (swelling) around the affected nerve. Other medications used
specifically for nerve related pain include
gabapentin (Neurontin) or
pregabalin (Lyrica.
Physical therapy
Physical therapy can
assist to stretch and strengthen specific muscles in the body, which helps
relieve the pressure on the pinched nerve.
Surgery
If the symptoms from a pinched nerve do not improve with the above treatments,
surgery may be
recommended. Surgery may also be recommended if the patient develops additional weakness
in the muscles, or if the particular nerves being pinched cause loss of control
of the bowel or bladder (cauda equina syndrome). These
are signs of more severe nerve damage.
Surgery for a pinched nerve depends on the location of
the nerve being pinched. If the pinched nerve is in the wrist (carpal tunnel
syndrome) or elbow (cubital tunnel syndrome), the surgeon can release the tissues over the nerve in
the wrist or elbow to free the nerve tissue pressure.
If the pinched nerve is in the neck or lower back a
spine surgeon or neurosurgeon can remove a portion of the
disc or bone spurs that are compressing the nerve in the spine.
In some cases, if it is necessary to remove large portions of bone or disc, the surgery
may
require a spinal fusion to stabilize the spine after freeing the nerve.
In the MRI image below, the herniated disc is occluding the nerves in the
spinal cord.
Next: What is a patent's prognosis for a pinched nerve? »
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