Pinched Nerve

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 neck, shoulder, arm, hand and fingers Spurling’s test
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 wrist, forearm and the first 3 fingers Phalen’s test Tinel’s sign
The ulnar nerve in the wrist (Guyon’s canal syndrome)	The wrist and the 4th and 5th finger Froment’s sign
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…	Pain, tingling, numbness and color changes in the fingers
Arthritis, tendonitis, coronary heart disease…	Arm pain

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.

• References

  1. Pinched nerve information page  National Institute of Neurological Disorders and Stroke
  2. Tarsal tunnel syndrome ACFAS.org
  3. LeBlanc KE et al, 2011, Carpal tunnel syndrome  American Family Physician
  4. Cubital tunnel syndrome American Society for Surgery of the Hand
  5. Carpal tunnel syndrome fact sheet National Institute of Neurological Disorders and Stroke
  6. What Is Raynaud’s Phenomenon? Fast Facts: An Easy-to-Read Series of Publications for the Public  National Institute of Arthritis and Musculoskeletal and Skin Diseases
  7. Porr J et al, 2013, Entrapment of the saphenous nerve at the adductor canal affecting the infrapatellar branch – a report on two cases  PubMed Central
  8. Multiple sclerosis symptoms Mayo Clinic
  9. Peripheral neuropathy fact sheet National Institute of Neurological Disorders and Stroke
  10. Marshall SC et al, 2007, Local corticosteroid injection is effective in the short-term for the treatment of carpal tunnel syndrome  Cochrane
  11. van Middelkoop M et al, 2013, Surgery versus conservative care for neck pain: a systematic review  PubMed Central
  12. Hanna AS, Nerve entrapment syndromes  Emedicine
  13. Mitchell DI et al, 2013, Can Orthotics Have An Impact On Tarsal Tunnel Syndrome? PodiatryNetwork
  14. Assmus H et al, 2015, Carpal and Cubital Tunnel and Other, Rarer Nerve Compression Syndromes  PubMed Central
  15. Thatte MR et al, 2011, Compressive neuropathy in the upper limb  PubMed Central
  16. Ballestero-Perez R et al, 2016, Effectiveness of Nerve Gliding Exercises on Carpal Tunnel Syndrome: A Systematic Review  ScienceDirect
  17. Koes BW et al, 2007, Diagnosis and treatment of sciatica  PubMed Central
  18. Malon H, 2006, Pain in multiple sclerosis  National Multiple Sclerosis Society
  19. Piazzini DB et al, 2007, A systematic review of conservative treatment of carpal tunnel syndrome  PubMed
  20. Huisstede BM et al, 2010, Carpal tunnel syndrome. Part I: effectiveness of nonsurgical treatments–a systematic review  PubMed
  21. Hong CZ et al, 1996, Splinting and local steroid injection for the treatment of ulnar neuropathy at the elbow: clinical and electrophysiological evaluation  PubMed
  22. Neal SL et al, 2010, Peripheral Nerve Entrapment and Injury in the Upper Extremity
      American Family Physician
  23. Eubanks JD et al, 2010, Cervical Radiculopathy: Nonoperative Management of Neck Pain and Radicular Symptoms  American Family Physician