You've heard it a million times before, and perhaps you've even said it yourself — "I have a pinched nerve in my neck." We hear it so frequently these days that it has lost quite a bit of its impact. People use it to describe a variety of conditions and a wide range of symptoms.
This is not good practice, however, because the treatment for a true pinched nerve is not the same as treatment for a benign, stiff neck.
What is a pinched nerve? In medical terms, a pinched nerve is formally called a compressive neuropathy. A structure in the neck such as a peripheral nerve, or in extreme cases, the spinal cord, is being squeezed by something that is out of place. Although this can occur anyplace in the body, the most common site is in the lower cervical levels and the junction where the neck meets the upper back.
What are the symptoms of a pinched nerve? The symptoms of a pinched nerve vary broadly from patient to patient. The main hallmark of a pinched nerve is numbness and tingling in the upper arm, elbow or hand. Other signs of nerve pain include the sensation of burning, cool or iciness, pulsating pain, cramping and knotting of the muscle, a feeling of extreme tightness or the feeling that your arm is 'dead.' While this is not a full list of nerve-related problems, these adjectives describe a bulk of the symptoms related to a nerve lesion.
Where are the most common places to feel pain if I have a pinched nerve? Although possible, it is more rare to feel pain directly in the neck. While there are a handful of patients who will describe the back of their neck as being numb, most patients will describe an area across the tops of their shoulders and upper back with some of the symptoms mentioned previously. Additionally, one arm will often be sore (in the absence of trauma) and the hand may feel thick or heavy.
What are the outward signs that I have a pinched nerve? Because pinched nerves often occur without warning, patients first notice there is a problem when they being to drop things or have trouble holding onto things or when their arm begins to hurt. Additionally, loss of strength and dexterity of the hand is also common. Your arm will become quickly fatigued with normal daily activities and will feel slow or heavy to move in general. Importantly, most patients will not be able to fully turn their head towards the side of the arm or shoulder that has pain.
Clinical Diagnosis. There are a number of ways to determine if you have a pinched nerve. Through a complex series of arm and neck movements, a physical therapist can determine which nerve is involved. Additionally, through mobility testing in the neck, we can determine where the compression neuropathy is occurring and the extent of the damage it is causing. As compared with EMG or conduction velocity testing done with needles by a neurologist, a physical therapy exam is just as accurate and much less painful.
Treatment. There is a wide array of non-invasive treatments available for patients with a pinched nerve. Physical therapy can offer everything from decompressive therapies to skilled cervical mobilization and manipulation. While there is some discomfort associated with treatment, nearly all patients leave each clinic visit with substantial, appreciable gains in both range of motion and strength, and a significant reduction in overall pain.
By itself, a pinched nerve will get worse — often indefinitely. The longer a nerve is compressed, the more difficult it is to restore normal function and eliminate pain. If the pain in your arm and neck is getting on your nerves, come into the clinic for an evaluation.
Joe DiVincenzo is a physical therapist and clinical specialist in manual therapy. He works in the outpatient division of Beverly Hospital and writes "On the Mend" weekly. Questions may be submitted to On the Mend by email: firstname.lastname@example.org