Pinched Nerve

Author:
Published: July 5, 2017
Last reviewed: July 7, 2017

What is a pinched nerve?

A pinched nerve means a compression of a nerve by a nearby tissue, such as bone or tumor, resulting in pain, tingling, numbness or weakness.

The common medical term for pinched nerves in the limbs is entrapment neuropathy and in the spine radiculopathy.

What does a pinched nerve feel like?

Symptoms of a pinched nerve can include [3,12,14,15]:

  • Pain in the neck, lower back, arm or leg radiating outward and aggravated by pressure and movements
  • Tingling or burning in the fingers or toes or a feeling of a hand or foot falling asleep
  • Late symptoms: constant numbness or weakness in a hand or foot

What causes a pinched nerve?

A pinched nerve can result from [2,4,12,15]:

  • Repetitive movements or physical stress
  • Sleeping with bent elbows or wrists
  • An injury
  • An underlying condition: pregnancy, obesity, cervical rib, flat feet, diabetes mellitus, hypothyroidism, rheumatoid arthritis, a herniated disc, tumor or ganglion cyst

Chart 1. Pinched Nerve Examples

Pinched Nerve (Condition)

Symptoms Locations and Tests

The nerve roots in the neck spine (cervical radiculopathy)
The ulnar nerve in the elbow (cubital tunnel syndrome) [3,5,12]
  • The elbow and the 4th and 5th finger
  • Elbow flexion test
The median nerve in the wrist (carpal tunnel syndrome) [3,5,12]
The ulnar nerve in the wrist (Guyon’s canal syndrome)
The nerve roots in the lower back spine (lumbar radiculopathy)
  • The lower back, buttock, leg, foot
  • Straight leg raise test
The posterior tibial nerve behind the inner ankle (tarsal tunnel syndrome) [2]
  • The inner ankle and sole of the foot
  • Triple compression test

Chart 2. Similar Conditions With Arm/Leg Pain

Condition

Symptoms

Muscle strain or tear
  • Local pain, swelling and tenderness
Multiple sclerosis [8,18]
  • Continuous burning pain in both legs or arms, vision problems, dizziness, fatigue
Generalized peripheral neuropathy [9]
  • Bilateral pain, tingling or numbness progressing from the toes and feet to the fingers and hands
Raynaud’s phenomenon, vasculitis…
Arthritis, tendonitis, coronary heart disease

What kind of a doctor to see for a pinched nerve?

A general practitioner or family doctor can recognize symptoms of a pinched nerve and suggest appropriate treatment in mild cases. If you have severe or chronic pain, you can ask for a referral to a neurologist or orthopedist.

How is a pinched nerve diagnosed?

Often, a doctor can make a diagnosis of a pinched nerve solely by a physical examination, including provocative tests mentioned in Chart 1 above.

Investigations, such as nerve conduction studies, electromyography (EMG), ultrasound, computed tomography (CT) or magnetic resonance imaging (MRI) are sometimes necessary for a final diagnosis [19].

An X-ray does not show pinched nerves but can reveal underlying conditions, such as fractures or bone spurs [5,14].

What is a treatment for a pinched nerve?

Treatment of Acute Pain

Home remedies that may relieve pain after a mild injury or repetitive activities:

  • Relative rest for the affected part of the body [1,14,15]
  • Ice packs wrapped in a cloth and held over the painful area for 15 minutes several times a day for few days [2,7]

There is MODERATE EVIDENCE that the following can provide a short-term (~1 month) pain relief:

  • Splints [3,14,19,20,21]
  • Steroids by mouth or an injection [3,10,14,19,23]

Treatment of Chronic Pain

For pinched nerves in the limbs with persistent symptoms, surgery is considered more effective than conservative treatment [14,19,20]. For the pinched nerves in the neck or lower back spine, conservative treatment may be as effective as surgery, though [11,17].

There is INSUFFICIENT EVIDENCE about the effectiveness of acupuncture, botulinum toxin B, chiropractic manipulation, diuretics, foot orthotics, nonsteroidal anti-inflammatory drugs (aspirin, ibuprofen), physiotherapy (exercises, heat or laser therapy, massage, nerve gliding therapy, ultrasound), vitamin B6 or yoga in the symptoms relief from pinched nerves [3,5,14,15,16,17,19,21].

There seems to be NO EVIDENCE about the effectiveness of essential oils and homeopathy in the treatment of pinched nerves.

What is a healing time and prognosis of a pinched nerve?

Rest alone or conservative treatment with splints or steroids can result in healing of a pinched nerve in few weeks to several months [3,17].

In acute mild or moderate cases, the recovery of a pinched nerve is usually complete [12]. Long-lasting nerve entrapment can result in a permanent nerve damage with chronic pain, numbness and muscle weakness [3]. Recovery after a surgery for a chronic pinched nerve may last for several months and may not be complete [22].

Prevention

The following may (or may not) help you prevent a pinched nerve [5,22,23]:

  • Avoid repetitive movements and lifting heavy objects.
  • Do not sleep with bent elbows or wrists.
  • Have frequent rest breaks.
  • Maintain good posture: do not poke your chin, lean on elbows or cross your legs.
  • Pad an elbow or wrist.
  • Use an ergonomic keyboard or mouse pad.
  • Try stretching and strengthening exercises, according to a doctor’s advice.
  • Maintain a healthy weight.
  • If you have flat feet, wear custom insoles.

Leave a Reply

Your email address will not be published. Required fields are marked *