DEALING WITH PINCHED NERVES 
Due to popular demand we are reprinting this publication originally published in September 2003. Recently I have had a spate of patients telling me that the numbness/tingling/pain in their shoulder, arm and hand is usually due to a pinched nerve. Further, many have been told there is “nothing you can do.” The purpose of this newsletter is to present evidence to the contrary. I think the best place to begin is with what I have seen in my practice, mostly neck problems of varying types. THE NECK The human neck is the most mobile region of the spinal column and it’s continuous motion goes on and on throughout the day, even as we sleep. It is an exceedingly complex structure for such exceptional flexibility. The spinal cord, esophagus, trachea and carotid and vertebral arteries are all here. Yet despite these delicate and complex structures the neck can be understood and treated effectively. WORST CASE SCENARIO So lets discuss the greatest risk, spinal cord pressure, also referred to as myelopathy and stenosis. These are actually fairly easily identified. If one finds radicular pain into the shoulder or arm with either flexing (probably discogenic) or extension (usually stenosis) one can suspect pressure on the spinal cord. If weakness of the shoulder or muscle atrophy in the shoulder is present this further confirms the diagnosis. In cases of myelopathy, patients should immediately be referred to a competent neurosurgeon. I’m happy to report however this is far from typical. The ligament that protects the spinal cord; the thick posterior longitudinal ligament, keeps the disc from protruding on the spinal cord (Picture #1). Spinal compression is actually rare. Much more typical is nerve root entrapment or compression, as well as, cervical joint inflammation with nerve root irritation. TYPICAL NECK PROBLEMS Nerve roots, cervically and elsewhere exit via the inter-vertebral foramen, the vertebral joints form part of this exit area(Picture #2) . A sleeve of the dura mater is where these nerve roots exit (Picture #3). As long as these nerve roots continue to slide and glide, no problem. When the vertebral joints become inflamed this can cause pain by itself, which radiates (Picture #4) or it may irritate the nerves which run into the brachial plexus and/or the arm (Picture #5). C5— C6 is the most common site and its peripheral distribution is radial nerve related to the thumb and index finger. You may observe nerve root entrapments effects by keeping the elbow straight, extend the wrist and pull the arm back (gently) keeping it at a 90º abduction at the shoulder. The patient will relate a strong pulling sensation up into the neck or perhaps an “electrical shock” sensation into the arm. This as a positive nerve root traction test. The nerve root is “stuck” and pulling on it aggravates the patients pain. This is typically what I see in my practice. The disc may also entrap the nerve root (Picture #6). Sometimes the nerve receives a traction type injury from a severe arm pull or lifting sprain. These are often misdiagnosed as pure shoulder injuries. TREATMENT How to treat these injuries? Chiropractic is frowned upon due to the vertebral artery affect (Picture #7). These arteries may be compressed or/lacerated in high velocity neck movements. Studies are showing gentle joint vertebral mobilizations and stretching of the neck and shoulder muscles are more beneficial. In addition, patients can be taught home stabilization programs to keep the pain reduced and restore function. If you or someone you know has pain/numbness or tingling in the shoulders, arms or hands give us a call. We also can do painless nerve sensory testing to help you and your patient diagnostically. We can do something about ‘pinched nerves’ and would welcome the opportunity to serve your patients. So send us your problems with these patients and see the results for yourself |
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