A common complaint that we hear almost daily in clinic from patients is, “Do I have a pinched Nerve?”
Pharmaceutical companies don’t help the confusion with advertisements over the last couple of years labelling most pains in the body as potential nerve pain with the suggestion that you should see your doctor for some drugs.
However, nerve pain is usually more specific.
We can divide nerve pain into a number of categories.
Firstly, systemic or central nerve issues, these maybe be significant such as MS, related to deficiencies of B12 and Folate, peripheral neuropathies associated with diabetes or hyperthyroidism. These will often present with transient pain, numbness or pins and needles.
Peripheral nerve entrapments, such as carpal tunnel syndrome, tarsal tunnel syndrome and similar conditions will usually impact a specific nerve in a specific area giving either weakness in the muscles supplied by that nerve or numbness, pain and pins and needles in a relatively well defined and traceable area. Usually this pain is only distal (further down the arm or leg) from the entrapment site and doesn’t usually spread towards the body.
Space occupying lesions, including brain and spinal cord tumors are probably the scariest condition for most to consider. In these cases the area that symptoms are felt are related to where the tumor is and what it is compressing. At the brain level, this can include all our higher senses; sight, smell, taste, hearing as well as facial expressions, speech and cognition.
Lastly Central level entrapments, disc bulges, prolapses and sequestrations and degenerative conditions in the spine that reduce the size or diameter of the canal, which truly compress or “pinch” the nerve. These are generally readily identifiable. 80% of disc bulges and prolapses are conservatively manageable. That means, no need for surgery.
When a disc injury presents, our first concern is are there “Hard neuro signs”? Is there complete loss of sensation or strength? A simple screen for the lower limb or leg is to get the patient to march on their toes, lift their toes, stand on their heels, do a basic squat. This screens the lower 3-4 nerve roots to help us assess if they are working. Total loss of function is a concern and would normally be an on referral for an mri to allow us to assess further. In the upper limb, loss of ability to lift, grip or push would be concerning for us once again.
Most patients reporting a pinched nerve are experiencing pinching or sharp pain in the neck and shoulders or in the low back, the sharpness of the pain is the concern for them with the thought that this must be a pinched nerve. More often than not, these presentation don’t turn out to be a pinched nerve and are related to muscle spasm or irritation to the small facet joints of the spine, which, although painful are not usually related to serious pathology.
Ironically, people often think that muscle spasm couldn’t be that painful, however, severe muscle spasm can be crippling and often regarded as upto 10/10 pain.
If you think you have a pinched nerve book in for an assessment and we can help you identify the cause of the pain and the best course of action to get it sorted.
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