What is a pinched nerve. How does it occur in the spine. What are the common symptoms of a pinched nerve. How is a pinched nerve diagnosed and treated. Can pinched nerves be prevented.

Understanding Pinched Nerves: A Comprehensive Overview

A pinched nerve, medically known as radiculopathy, occurs when excessive pressure is applied to a nerve by surrounding tissues. This condition can manifest in various parts of the body, most commonly affecting the spine. To understand the intricacies of this ailment, let’s delve deeper into its causes, symptoms, and treatment options.

The Anatomy of a Pinched Nerve

Our spine consists of numerous bones called vertebrae, which form a protective canal housing the spinal cord. Nerve roots branch off from this cord, passing between the vertebrae to innervate different parts of the body. When these nerve roots become compressed or irritated, the resulting condition is termed radiculopathy or, more commonly, a pinched nerve.

While pinched nerves can occur anywhere along the spine, they are most prevalent in the lower back (lumbar radiculopathy) and neck (cervical radiculopathy). Additionally, nerves can become pinched by tendons and ligaments as they traverse through the arms or legs, a condition known as mononeuropathy.

Common Causes of Pinched Nerves

Several factors can contribute to the development of a pinched nerve. Understanding these causes is crucial for both prevention and treatment. Here are some of the primary culprits:

• Herniated or slipped disks
• Age-related spinal degeneration
• Bone spurs
• Injuries or trauma
• Repetitive motions
• Poor posture
• Obesity

Herniated Disks: A Leading Cause

One of the most common causes of pinched nerves is a herniated disk. The vertebrae in our spine are cushioned by soft, gel-like disks that act as shock absorbers. When these disks become damaged or slip out of place, they can press on nearby nerves, resulting in a pinched nerve.

Is a herniated disk always painful? Not necessarily. Many people over 50 have damaged disks or pinched nerves without experiencing any symptoms. This phenomenon underscores the complexity of spinal health and the importance of comprehensive diagnostic approaches.

Age-Related Factors

As we age, our spinal anatomy undergoes natural changes. The intervertebral disks may lose water content and become shorter, causing the vertebrae to move closer together. This process can lead to nerve compression. Additionally, the body may develop bone spurs – small, bony projections that form along joint margins – which can also press on nerve roots.

Recognizing the Symptoms of a Pinched Nerve

The symptoms of a pinched nerve can vary depending on its location. Being able to identify these signs is crucial for seeking timely medical attention and preventing further complications.

Symptoms of a Pinched Nerve in the Lower Back

When a nerve is pinched in the lumbar region, it can lead to a condition known as sciatica. The symptoms often include:

• Sharp, shooting pain that may radiate from the back down to the foot
• Numbness or tingling sensations in the leg or foot
• Muscle weakness in the affected leg
• Pain that worsens with certain activities like sitting or coughing

Symptoms of a Pinched Nerve in the Neck

Cervical radiculopathy, or a pinched nerve in the neck, presents with a different set of symptoms:

• Sharp pain in the arm
• Shoulder pain
• Numbness or a pins-and-needles sensation in the arm
• Arm weakness
• Pain that intensifies with neck movements or head turning

Do these symptoms always indicate a pinched nerve? While these signs are characteristic of nerve compression, it’s important to note that other conditions can present similarly. Therefore, a proper medical evaluation is essential for an accurate diagnosis.

Diagnosing a Pinched Nerve: A Multi-Step Approach

Accurate diagnosis of a pinched nerve involves a comprehensive evaluation process. Healthcare providers employ various methods to confirm the presence of nerve compression and determine its exact location and severity.

Physical Examination

The diagnostic journey typically begins with a thorough physical examination. During this assessment, your healthcare provider will:

• Test your reflexes
• Evaluate your sensory perception
• Assess your muscle strength and movement
• Perform specific movements to elicit pain or other symptoms

How does a physical exam help in diagnosis? These tests allow the healthcare provider to identify which nerve might be affected and gauge the extent of the compression. For instance, you may be asked to lie on your back and lift your leg while keeping it straight. Pain or difficulty with certain movements can provide valuable diagnostic clues.

Imaging Studies

To gain a clearer picture of the affected area, your healthcare provider may order one or more imaging tests:

• X-rays: To visualize bone structures and identify any abnormalities
• CT scans: For a more detailed view of the bony structures
• MRI: To obtain high-resolution images of soft tissues, including nerves and disks

In some cases, a contrast material (dye) may be injected into your spinal canal to enhance the visibility of the problem area in imaging studies.

Electrodiagnostic Tests

To assess nerve function more directly, your healthcare provider might recommend:

• Nerve conduction studies: To measure how fast electrical signals travel through your nerves
• Electromyography (EMG): To evaluate the electrical activity in your muscles

These tests can help confirm the presence of nerve compression and pinpoint its exact location.

Treatment Options for Pinched Nerves: From Conservative to Surgical Approaches

The treatment of pinched nerves aims to relieve pain, reduce inflammation, and prevent further nerve damage. The approach can range from conservative measures to more invasive interventions, depending on the severity of the condition and the patient’s response to initial treatments.

Conservative Management

For many individuals with pinched nerves, conservative treatments can provide significant relief. These may include:

• Medications:
  • Nonsteroidal anti-inflammatory drugs (NSAIDs) to reduce pain and inflammation
  • Muscle relaxants to alleviate muscle spasms
  • Narcotic medications for severe pain (used cautiously and for short durations)
• Physical therapy or supervised home exercise programs
• Weight loss, if necessary, through diet and exercise
• Use of a soft collar for short periods (in cases of cervical radiculopathy)

How long does conservative treatment typically last? The duration can vary depending on the individual and the severity of the condition. Many people experience improvement within a few weeks to months of consistent conservative care.

Advanced Interventions

If conservative measures fail to provide adequate relief, more advanced treatments may be considered:

• Steroid injections: Corticosteroids can be injected into the area around the affected nerve to reduce inflammation and pain
• Surgery: In some cases, surgical intervention may be necessary. Options include:
  • Discectomy: Removal of all or part of a herniated disk
  • Laminectomy: Removal of a portion of the vertebral bone to create more space for the nerve
  • Spinal fusion: Joining two vertebrae together to provide stability

Is surgery always necessary for a pinched nerve? No, surgery is typically considered only when conservative treatments have failed to provide relief after several weeks or months, or if there are signs of progressive nerve damage.

Preventing Pinched Nerves: Proactive Measures for Spinal Health

While not all cases of pinched nerves can be prevented, there are several steps you can take to reduce your risk and maintain overall spinal health:

• Maintain good posture: Practice proper ergonomics at work and during leisure activities
• Stay physically active: Regular exercise can help strengthen the muscles that support your spine
• Maintain a healthy weight: Excess weight puts additional stress on your spine
• Practice proper lifting techniques: Bend at your knees, not your waist, when lifting heavy objects
• Take frequent breaks: If you sit for long periods, get up and move around regularly
• Quit smoking: Smoking can accelerate disk degeneration
• Eat a balanced diet: Proper nutrition supports overall bone and muscle health

Can these preventive measures guarantee you won’t develop a pinched nerve? While they significantly reduce your risk, it’s important to remember that some factors, such as age-related changes and certain medical conditions, are beyond our control. However, adopting these healthy habits can contribute to better overall spinal health and potentially reduce the severity of symptoms if a pinched nerve does occur.

Living with a Pinched Nerve: Coping Strategies and Long-Term Outlook

Dealing with a pinched nerve can be challenging, but with proper management and patience, many individuals experience significant improvement. Here are some strategies to help you cope with the condition:

Pain Management Techniques

• Apply heat or cold therapy to the affected area
• Practice gentle stretching exercises as recommended by your healthcare provider
• Use over-the-counter pain relievers as directed
• Consider alternative therapies like acupuncture or massage (with your doctor’s approval)

Lifestyle Modifications

Making certain changes to your daily routine can help alleviate symptoms and prevent exacerbation:

• Adjust your workstation to maintain proper ergonomics
• Use supportive pillows when sleeping or sitting for long periods
• Avoid activities that worsen your symptoms
• Incorporate regular breaks and gentle movement into your day

Long-Term Prognosis

What is the long-term outlook for individuals with pinched nerves? The prognosis is generally favorable, especially with prompt and appropriate treatment. Many people experience complete resolution of their symptoms within a few weeks to months. However, some may have recurring episodes or persistent symptoms that require ongoing management.

It’s crucial to follow your healthcare provider’s recommendations and attend all follow-up appointments to monitor your progress and adjust your treatment plan as needed.

When to Seek Medical Attention: Red Flags and Emergency Situations

While many cases of pinched nerves can be managed with conservative measures, certain symptoms warrant immediate medical attention. Be alert for the following red flags:

• Sudden, severe pain in your back or neck
• Loss of bladder or bowel control
• Progressive weakness in your limbs
• Numbness in the genital or anal region
• Fever accompanying back or neck pain

These symptoms could indicate a more serious condition, such as cauda equina syndrome, which requires emergency medical intervention.

How quickly should you seek medical care if you experience these symptoms? If you develop any of these red flag symptoms, it’s crucial to seek immediate medical attention, ideally within 24 hours, to prevent potential permanent nerve damage.

In conclusion, understanding pinched nerves – their causes, symptoms, diagnosis, and treatment options – empowers individuals to take proactive steps in managing their spinal health. While the condition can be painful and disruptive, with proper care and attention, most people can find relief and return to their normal activities. Remember, early intervention and a comprehensive approach to treatment often lead to the best outcomes. If you suspect you have a pinched nerve, don’t hesitate to consult with a healthcare professional for an accurate diagnosis and personalized treatment plan.

Pinched Nerve | Cedars-Sinai

Not what you’re looking for?

What is a pinched nerve?

Your spine is made of many bones
called vertebrae. Your spinal cord runs downward through a canal in the center of these
bones. Nerve roots branch off the cord and go between each vertebrae. When problems
affect these nerve roots, the condition is called radiculopathy, or more commonly, a
pinched nerve.

This problem is most likely to
occur in your lower back (lumbar radiculopathy), but it can also affect your neck
(cervical radiculopathy) or other parts of your spine. Nerves can also get pinched by
tendons and ligaments as they course through your arms or legs. This is called
mononeuropathy.

What causes a pinched nerve?

One cause of a pinched nerve is a herniated disk. Soft disks act as cushions between your vertebrae. Sometimes, these disks slip out of place or become damaged and press on nerves. This is commonly called a slipped disk.

As people age, it’s common for the
disks to become shorter and the vertebrae to get closer together. Bone growths called
spurs could also press on the nerve roots. But many people ages 50 and older have
damaged disks and pinched nerves yet don’t have symptoms.

What are the symptoms of a pinched nerve?

Symptoms of a pinched nerve in the lower back include:

• A sharp pain in the back that may travel all the way to your foot—pain may become worse with certain activities like sitting or coughing
• Numbness of the skin in areas of the leg or foot
• Weakness in the leg

Symptoms of pinched nerve in the neck include:

• A sharp pain in the arm
• Pain in the shoulder
• A feeling of numbness or pins and needles in the arm
• Weakness of the arm
• Worsening pain when you move your neck or turn your head

How is a pinched nerve diagnosed?

You will first have a physical
exam. Your healthcare provider will test your reflexes and your ability to sense things.
He or she will also check your ability to move your muscles. You may need to lie on your
back and lift your leg while holding it straight or do other movements. If you have pain
with certain movements, it may help with the diagnosis.

You may also need:

• Imaging tests, such as an X-ray, CT
  scan, or MRI. These tests let your healthcare provider see the structures in your
  neck or back. Your healthcare provider may also inject a contrast material (a dye)
  into your spinal canal to help show the problem area.
• Nerve conduction tests and
  electromyography (EMG). These check nerve function.

How is a pinched nerve treated?

In many cases, these simple steps may treat your symptoms:

• Medicine such as nonsteroidal
  anti-inflammatory drugs (NSAIDs), narcotic medicines for more severe pain, and muscle
  relaxants
• Losing weight, if needed, with diet and exercise
• Physical therapy or a supervised home
  exercise program
• For a pinched nerve in the neck, wearing a soft collar around your neck for short amounts of time

Some people need more advanced
treatments. Your healthcare provider might suggest injections of steroid medicine in the
area where a disk is herniated. Some people might benefit from surgery. During a
surgical procedure called a discectomy, the surgeon removes all or part of the disk that
is pressing on a nerve root. Along with this procedure, the surgeon may need to remove
parts of some vertebrae or fuse vertebrae together.

What can I do to prevent a pinched nerve?

Staying physically fit may reduce
your risk of having a pinched nerve. Using good posture at work and in your leisure
time, such as lifting heavy objects properly, may also help prevent this condition. If
you sit at work for long periods, consider getting up and walking around regularly. A
healthy lifestyle that includes not smoking and eating well may also reduce the risk
for a pinched nerve.

Living with a pinched nerve

Medicines like nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroids, or stronger narcotic medicines help reduce nerve swelling and relieve pain. Corticosteroids may also be given as an injection, which will also reduce inflammation and pain allowing the nerve to heal.

Losing weight, if needed, will help
relieve pressure on the joints. Physical therapy may use specialized exercises to
strengthen and stretch the back or neck muscles. A physical therapist may suggest
wearing a soft collar or using traction to help the neck muscles rest and heal. Your
healthcare provider may suggest a home exercise program that you can do on a routine
basis. These measures also relieve pressure on the nerve.

Your healthcare provider may be able to suggest self-care steps to help prevent or treat a pinched nerve.

When should I call my healthcare provider?

Call your healthcare provider right away or go to the emergency room if you have:

• Sudden onset of numbness, weakness, or paralysis of an arm or leg that does not go away
• Loss of bladder or bowel control
• Loss of sensation in your genital or anal regions

These could be signs of a serious condition that needs treatment right away.

Key points about a pinched nerve

• A pinched nerve (radiculopathy) is
  caused by a disk or bone in the spine that presses on a nerve root coming out of the
  spinal cord.
• Symptoms can include pain, numbness, or weakness in an arm or leg.
• A pinched nerve can often be helped with medicines, physical therapy, weight loss, and rest, although more involved treatments might be needed in some cases.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

• Know the reason for your visit and what you want to happen.
• Before your visit, write down questions you want answered.
• Bring someone with you to help you ask questions and remember what your provider tells you.
• At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.
• Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.
• Ask if your condition can be treated in other ways.
• Know why a test or procedure is recommended and what the results could mean.
• Know what to expect if you do not take the medicine or have the test or procedure.
• If you have a follow-up appointment, write down the date, time, and purpose for that visit.
• Know how you can contact your provider if you have questions.

Not what you’re looking for?

THC Bone and Joint – Symptoms Chart

 View Back Pain Chart PDF

The vast majority of back problems improve on their own or with nonsurgical
treatment. There are a few warning signs, however, that may indicate
serious spinal problems. If you experience any of these symptoms, seek
medical attention immediately.

Loss of control of the bowel or bladder and retention of
urine may indicate damage to the spine’s cauda equina nerves. The cauda
equina is a bundle of nerves in the low back where the spinal cord ends.
Damage to these nerves can be permanent if not treated immediately (within
a day or so). See a spine specialist, or go to an emergency room if necessary.

Weakness or numbness in a leg or arm, especially if it
is severe—and it is getting worse—also points to nerve damage.
This includes “foot drop,” a condition where the muscles of
the leg and foot are too weak to raise the foot up as the individual
attempts to walk. Again, nerve damage associated with these symptoms
can be permanent if not treated immediately. This problem should be seen
within 24 hours by a spine specialist.

Numbness, pain or tingling that radiates into the arm or
leg is also a source for concern and should be seen within a few days
by a spine specialist.

High fever accompanied by back pain may indicate a possible
infection of the spine and should be treated within 24 hours.

[Top]

Rules of Thumb on Symptoms

Here’s an encouraging back
fact: 80 percent of the time, back and neck pain
is simply a result of strain or soft tissue injury. In many of
these simple cases of back or neck strain, your condition will
improve with specialized exercises, rest, and anti-inflammatory
medicine. Other times, you may need to see a doctor, perhaps
even as soon as possible. Briefly, here are some rules of thumb
to keep in mind about your back or neck problems:

• Trauma – If you fall down,
  are in a car accident, or do anything abrupt that may have fractured
  your back, go to a spine specialty clinic within 24 hours.
• Radicular pain – Anytime
  you have back or neck pain that radiates down into your leg or arm,
  you probably need to be evaluated by a spine specialist within two
  to three days, especially if it is getting worse.
• Persistent pain – If pain
  limited to the low back or neck area does not begin to subside after
  three days with anti-inflammatories and rest, then you probably need
  to be evaluated by a spine specialist. For example, if you first noticed
  back or neck pain on Monday, and it’s now Thursday, and it’s not getting
  better, it’s time to see a spine specialist to find out what is causing
  your problem.
• Anytime you experience loss of
  control of your bowel or bladder, that is an EMERGENCY signal
  that you need to see a spine specialist THE SAME DAY. If you wait
  too long, you could suffer permanent paralysis of the nerves that
  control these functions.
• Foot drop – If you notice
  that your toe is dragging as you walk, this is a DANGER SIGNAL for
  serious neurological problems. Again, if you delay, you could experience
  permanent damage. This problem should be seen within 24 hours by a
  spine specialist.
• Weakness, numbness or pain that
  extends below a knee or elbow is a serious symptom. Go to
  a spine center within two days.

What is Nerve Pain? – Cleveland Clinic

“Can you describe your pain?” This will likely be one of the first questions your doctor asks if you complain of chronic pain. Unless there’s an obvious reason for pain, your doctor needs a lot of information to identify the underlying cause. This includes the location, type, intensity and frequency of pain. The doctor is partly trying to determine whether the pain is nociceptive or neuropathic (also called nerve pain), or possibly both.

Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy

“This can be tricky because all pain is experienced through the nerves,” says sports medicine specialist Dominic King, DO. Damage to bodily tissues, such as muscles, tendons, ligaments or the capsules around joints, causes nociceptive pain. Nerve receptors adjacent to the damaged tissue, called nociceptors, transmit a pain signal to the brain. This type of pain tends to feel sharp, achy, dull or throbbing.

Understanding ‘electric pain’

If you’re experiencing something that feels more like burning, stabbing, or shooting pain ― especially if there also is numbness or tingling ― it’s likely to be neuropathic pain. This means there is direct damage or irritation to a nerve. “It can cause a lightning strike type of electric pain,” says Dr. King.

Nerve pain can arise from a variety of causes, including diabetes, infections (such as shingles), multiple sclerosis, the effects of chemotherapy or trauma. When it comes to orthopeadic issues, nerve pain often stems from a nerve being pinched by nearby bones, ligaments and other structures.

For example, a herniated disk in the spine or a narrowing of the spinal canal (stenosis) can press on a nerve as it leaves the spinal canal. This can cause pain along the path of the nerve. When nerves that originate in the lower spine are affected, symptoms might be felt in the buttocks or down a leg. If the compressed nerve is in the upper spine, the pain and other symptoms can shoot down the arm. Numbness or tingling may also occur because the brain is not receiving a consistent signal due to the compression.

Another common cause of nerve pain is carpal tunnel syndrome. A nerve and several tendons travel through a passageway in the wrist (the carpal tunnel) to the hand. Inflammation in the tunnel can press on the nerve, causing numbness and tingling in the thumb and fingers.

How is the cause of nerve pain found?

“There are so many orthopaedic conditions that overlap between pain stemming from problems with tendons, muscles, joints and nerves that you need a very discerning physician to do a good physical exam to figure out the cause,” says Dr. King. “I make my determination based on when the patient experiences pain, where the pain is located and what the pain feels like.”

Pain related to joints, such as from arthritis, will feel more like stiffness when going from sitting to standing. With tendon pain, it will feel sore when you push on the affected area. “Nerve pain is more of a burning, fiery pain,” says Dr. King. And it tends to come and go.

“Nerve pain typically gets worse with more and more use and can be associated with numbness,” says Dr. King.  

Ultimately, getting the right treatment depends on getting the right diagnosis. For many bone and joint conditions, nondrug treatment will be tried first. Sometimes pain medication is needed. However, neuropathic pain does not respond to drugs commonly used for nociceptive pain, such as nonsteroidal anti-inflammatory drugs.

This article originally appeared in Cleveland Clinic Arthritis Advisor.

Radiculopathy | Johns Hopkins Medicine

What is radiculopathy?

Your spine is made of many bones called vertebrae, and your spinal cord runs through a canal in the center of these bones. Nerve roots split from the cord and travel between the vertebrae into various areas of your body. When these nerve roots become pinched or damaged, the resulting symptoms are called radiculopathy.

Types of Radiculopathy

Radiculopathy can have different symptoms and different names depending on where in the spine it occurs.

Lumbar Radiculopathy

When radiculopathy occurs in the lower back, it is known as lumbar radiculopathy, also referred to as sciatica because nerve roots that make up the sciatic nerve are often involved. The lower back is the area most frequently affected by radiculopathy.

Radiculopathy Prevention

While radiculopathy can’t always be prevented, staying physically fit and maintaining a healthy weight may reduce your risk of radiculopathy. Using best practices for good posture while sitting, playing sports, exercising or lifting heavy objects is also important for preventing injuries.

Cervical Radiculopathy

Cervical radiculopathy describes a compressed nerve root in the neck (cervical spine). Because the nerve roots in this area of the spine primarily control sensations in your arms and hands, this is where the symptoms are most likely to occur.

Thoracic Radiculopathy

Thoracic radiculopathy refers to a compressed nerve root in the thoracic area of the spine, which is your upper back. This is the least common location for radiculopathy. The symptoms often follow a dermatomal distribution, and can cause pain and numbness that wraps around to the front of your body.

Symptoms of Radiculopathy

When a nerve root is compressed, it becomes inflamed. This results in several unpleasant symptoms that may include:

• Sharp pain in the back, arms, legs or shoulders that may worsen with certain activities, even something as simple as coughing or sneezing

• Weakness or loss of reflexes in the arms or legs

• Numbness of the skin, “pins and needles,” or other abnormal sensations (paresthesia) in the arms or legs

Your specific symptoms will depend on where in the spine the nerve root is pinched. However, it’s also possible that you don’t experience any symptoms or you go through periodic flare-ups of symptoms.

Causes of Radiculopathy

Radiculopathy is typically caused by changes in the tissues surrounding the nerve roots. These tissues include bones of the spinal vertebrae, tendons and intervertebral discs. When these tissues shift or change in size, they may narrow the spaces where the nerve roots travel inside the spine or exit the spine; these openings are called foramina. The narrowing of foramina is known as foraminal stenosis, which is very similar to spinal stenosis that affects the spinal cord.

In most cases, foraminal stenosis is caused by gradual degeneration of the spine that happens as you age. But it can also be a result of a spinal injury.

Herniated Discs

One common cause of foraminal stenosis and radiculopathy is a bulging or herniated disc. Spinal discs act as cushions between your vertebrae. On occasion, these discs slip out of place or become damaged and press on nerves. This problem is most likely to occur in your lower back, but it can also affect your neck.

Bone Spurs

Another possible cause of radiculopathy that may lead to narrowing of foramina is bone spurs — areas of extra bone growth. Bone spurs can form in the spine due to inflammation from osteoarthritis, trauma or other degenerative conditions.

Other Causes

Thickening (ossification) of the spinal ligaments may also lead to narrowing of the space around the nerve roots and subsequent nerve compression. Less common causes of radiculopathy include spinal infections and various cancerous and noncancerous growths in the spine that may press against the nerve roots.

Radiculopathy and Myelopathy

Sometimes, radiculopathy can be accompanied by myelopathy — compression of the spinal cord itself. Herniated or bulging discs can sometimes press on the spinal cord and on the nerve roots. When the spinal cord is involved, the symptoms can be more severe, including poor coordination, trouble walking and paralysis.

Radiculopathy Versus Neuropathy

Radiculopathy symptoms may overlap with those of peripheral neuropathy, making it difficult to pinpoint the source of the problem. Peripheral neuropathy is the damage of the peripheral nervous system, such as carpal tunnel syndrome that involves trapped nerves in the wrist. Radiculopathy is the pinching of the nerves at the root, which sometimes can also produce pain, weakness and numbness in the wrist and hand. Consult a spine specialist for an accurate diagnosis.

Radiculopathy Diagnosis

Your doctor may take several steps to diagnose radiculopathy:

• A physical exam and physical tests may be used to check your muscle strength and reflexes. If you have pain with certain movements, this may help your doctor identify the affected nerve root.

• Imaging tests, such as an X-ray, CT scan or MRI scan, are used to better see the structures in the problem area.

• Nerve conduction studies, along with electromyography, can also be used to help pinpoint whether the problem is neurological or muscular.

Radiculopathy Treatment

Radiculopathy treatment will depend on the location and the cause of the condition as well as many other factors. Nonsurgical treatment is typically recommended first and may include:

• Medications, like nonsteroidal anti-inflammatory drugs, opioid medicines or muscle relaxants, to manage the symptoms

• Weight loss strategies to reduce pressure on the problem area

• Physical therapy to strengthen the muscles and prevent further damage

• Steroid injections to reduce inflammation and relieve pain

Some people may need more advanced treatments, such as surgery. Surgery is typically used to reduce the pressure on the nerve root by widening the space where the nerve roots exit the spine. This may involve removing all or parts of a disc and/or vertebrae. Cervical posterior foraminotomy is one of the minimally invasive spine surgery options available.

Thoracic Radiculopathy – Physiopedia

Thoracic radiculopathy refers to a compressed nerve root in the thoracic area of the spine. This is the least common location for radiculopathy. The symptoms often follow a dermatomal distribution, and can cause pain and numbness that wraps around to the front of your body..

• The pinched nerve can occur at different areas along the thoracic spine
• Symptoms of radiculopathy vary by location but frequently include pain, weakness, numbness and tingling.
• A common cause of radiculopathy is narrowing of the space where nerve roots exit the spine, which can be a result of stenosis, bone spurs, disc herniation or other conditions.
• Radiculopathy symptoms can often be managed with nonsurgical treatments, but minimally invasive surgery can also help some patients.

The most important structures which are involved with a thoracic radiculopathy are the:

• Thoracic vertebrae (T1-T12)
• Intervertebral disc of the thoracic vertebrae,
• 12 pairs of spinal nerve roots,
• 12 rami – posterior rami innervate the regional muscles of the back, ventral rami innervate the skin and muscles of the chest and abdominal area.^[1]

Epidemiology /Etiology[edit | edit source]

Unknown, the diagnosis of thoracic radiculopathy is overlooked. 

Thoracic radiculopathy has been infrequently reported and described as uncommon.

Radiculopathy typically is a mechanical root compression , most commonly caused by:

• Diabetes mellitus – 15% insulin-dependent and 13% non-insulin-dependent have diabetic thoracic polyradiculopathy.^[2]
• Degenerative spine changes such as disc herniation and spondylosis.

Other possible causes of mechanical root compression are a metastatic tumor, trauma, scoliosis, viral infection/inflammation, connective tissue disease and tuberculosis.

Characteristics/Clinical Presentation[edit | edit source]

• A person may experience pain in the chest and torso when the nerve compression or irritation occurs in the mid back region.
• Thoracic radiculopathy is an uncommon condition that may be misdiagnosed as shingles, heart, abdominal, or gallbladder complications.

Symptoms associated with thoracic radiculopathy include:

• Burning or shooting pain in the rib, side, or abdomennumbness and tingling

The symptoms of thoracic radiculopathy, regardless of the cause, are often not recognized, as there is typically no associated motor deficit.

• When the etiology is disc herniation or trauma, motor deficit or myelopathy may be observed in the advanced stages.
• The typical presentation of band-like thoracic or abdominal pain can mimic a myriad of conditions .
• With many differential diagnoses to consider, it is not surprising that thoracic radiculopathy is often not discovered for months, or years, after symptoms arise^[3]

In addition to a physical exam and symptom review, doctors may diagnose radiculopathy using:

• radiologic imaging with X-ray, MRI, and CT scans
• electrical impulse testing called electromyography or EMG, to test nerve function
• The exclusion of other causes of pain is the most important step in the diagnostic procedure as there are a lot of generators of thoracic pain and differentiating these differential diagnoses will be difficult^[1]

Differential Diagnosis

• Postherpetic neuralgia
• Chronic abdominal wall pain
• Malignancy
• Other spinal disorders (e.g. spinal cord tumors, compression by intervertebral discs)^[4]
• Spinal: Infectious, neoplastic (primary, metastatic), degenerative (spondylosis, spinal stenosis, facet syndrome, disc disease/HNP), metabolic (osteoporosis, osteomalacia), deformity (kyphosis, scoliosis, compression fracture, somatic dysfunction), neurogenic (radiculopathy, Herpes Zoster, anteriovenous malformation)
• Extraspinal: Intrathoracic (cardiovascular, pulmonary, mediastinal), Intra abdominal (Hepatobiliary, gastrointestinal, retroperitoneal), Musculoskeletal (Post-thoracotomy syndrome, polymyalgia rheumatica, myofascial pain syndrome, somatic dysfunction, rib fractures, costochondritis), Neurogenic (Intercostal neuralgia, peripheral polyneuropathy, RSD/CRPS)

Outcome Measures[edit | edit source]

VAS

Oswestry Disability Index.^[2]

Includes

• Symptoms (already discussed earlier).^[5]
• Due to non-universal tenderness and the sensory changes, it is not reliable to do a sensory examination.
• Physical examination is not the best way to evaluate thoracic radiculopathy, unlike the lumbosacral and cervical radiculopathies the affected muscles cannot be tested isolated.
• The examination will rather be used to exclude other diagnoses then to determine a thoracic radiculopathy.^[1]

Thus the examination will be done with more medical strategies and therefore we can use: EMG, MRI, CT, radiographs

Physical Therapy Management[edit | edit source]

Physical modalities of the therapy include:

• heat,
• ultrasound
• TENS.
• Spinal extension exercises..^[1]
• Rest Education: avoid the activities that produce the pain (bending, lifting, twisting, turning, bending backwards, etc).
• Apply ice in acute cases to the thoracic spine to help reduce pain and associated muscle spasm.
• An exercise regiment designed specifically to address the cause of the symptoms associated with pinched nerve and improve joint mobility, spinal alignment, posture, and range of motion.
• Restore joint function ( eg Spinal manipulations or mobilisations^[6])
• Improve motion
• Help the return of full function.

Clinical Bottom Line[edit | edit source]

Mild Cases

• In mild cases many patients found that rest, ice and medication were enough to reduce the pain. Physical therapy is recommended to develop a series of postural, stretching and strengthening exercises to prevent re-occurrence of the injury. Return to activity should be gradual to prevent a return of symptoms.

Moderate to Severe Cases

• If the problem consultation with your health care provider. Your physician should perform a thorough evaluation to determine the possible cause of your symptoms, the structures involved, the severity of the condition, and the best course of treatment.^[7]

1. ↑ ^1.01.11.21.3 Thoracic radiculopathy, Ryan C. O’Connor et al., Physical & Medical Rehabilitation Clinics of North America, 2002 (evidence level 3B)
2. ↑ ^2.02.1 Non-Surgical Interventional Treatment of Cervical and Thoracic Radiculopathies, Pain Physician, Richard Derby, Yung Chen, Sang-Heon Lee, Kwan Sik Seo, and Byung-Jo Kim, Pain Physician, 2004 (evidence level 1A)
3. ↑ Choi HE, Shin MH, Jo GY, Kim JY. Thoracic radiculopathy due to rare causes. Annals of rehabilitation medicine. 2016 Jun;40(3):534. Available from:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4951374/ (last accessed 25.4.2020)
4. ↑ The Clinical Anatomy and Management of Thoracic Spine Pain, L.G.F. Giles, 2000 (table 18.1 elements of the physical examination p 288) (evidence level 5)
5. ↑ Surgical Treatment of T1-2 Disc Herniation with T1 Radiculopathy: A Case Report with Review of the Literature, T1-2 Disc Herniation / 199, Eun-Seok Son et al., Asian Spine Journal, 2012 (evidence level 3A)
6. ↑ T2 radiculopathy: A differential screen for upper extremity radicular pain. Sebastian D., Physiotherapy Theory and Practice, 2013 (evidence level 3B)
7. ↑ Redefine HC Thoracic radiculopathy Available from:https://redefinehealthcare.com/thoracic-radiculopathy/ (last accessed 25.4.2020)

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Radiculopathy – Physiopedia

Radiculopathy is a clinical condition which involves one or more nerves resulting in impaired function (a neuropathy). The site of injury in radiculopathy is at the level of the spinal nerve root. The result is pain (known as radicular pain), weakness in limbs, numbness/paresthesia, and difficulty in controlling specific muscles.

In radiculopathy, the problem occurs at or near the site of the origin of the nerve root as it exits from the spinal cord, but the pain and accompanying symptoms usually radiate to the part of the body that is supplied by that specific nerve. For example, a nerve root impingement in the cervical spine may result in pain and weakness in the forearm. Similarly, an impingement in the lumbar region can be manifested with symptoms in the foot.

The radicular pain that results from radiculopathy should not be confused with referred pain, which is different both in mechanism and clinical features. Polyradiculopathy is a condition in which more than one spinal nerve root is affected.

Cervical radiculopathy is found to be less prevalent in the USA than lumbar radiculopathy, with an overall occurrence of 83 cases per 100,000 population. The most common age group for cervical radiculopathy is found to be from 40^th – 50^th. Female gender, white race, and cigarette smoking are considered to be risk factors. With an incidence of 1.79 per 1000, 63.5 per 100,000 for females, and 107.3 per 100,000 for males^[1][2]. Private insurance is found to be the paying party in 41.69% of the incidents followed by Medicare in 38.81% incidents. Geographically, the South is the most severely affected region in the US with 39.27% of cases. According to a study conducted in the state of Minnesota, the most common site is the C7 monoradiculopathy, followed by C6 ^[3]. Lumbar radiculopathy prevalence 3%-5% of the population^[4].

Clinically Relevant Anatomy[edit | edit source]

Radiculopathy is a mechanical compression of a nerve root usually at the exit foramen or lateral recess. It may be secondary to degenerative disc disease, osteoarthritis, facet joint degeneration/hypertrophy, ligamentous hypertrophy, spondylolisthesis, or a combination of these factors. Rarer causes of radiculopathy may include radiation, diabetes mellitus, neoplastic disease, or any meningeal-based disease process.

Radiculopathy can occur in any part of the spine but the most common site of radiculopathy is the cervical (Cervical Radiculopathy) and the lumbar spine (Lumbar Radiculopathy). It is less commonly found in the middle portion of the spine (thoracic radiculopathy) ^[5].

Certain injuries can also lead to radiculopathy. These injuries include lifting heavy objects improperly or suffering from a minor trauma such as a car accident. Less common causes of radiculopathy include injury caused by tumor (which can compress nerve roots locally) and diabetes (which can effectively cause ischemia or lack of blood flow to nerves).

The symptoms of radiculopathy depend on which nerves are affected. The nerves exiting from the neck (cervical spine) control the muscles of the neck and arms and supply sensation there. The nerves from the middle portion of the back (thoracic spine) control the muscles of the chest and abdomen and supply sensation there. The nerves from the lower back (lumbar spine) control the muscles of the buttocks and legs and supply sensation there.

The most common symptoms of radiculopathy are pain, numbness, and tingling in the arms or legs. It is common for patients to also have localized neck or back pain as well. Lumbar radiculopathy that causes pain that radiates down a lower extremity is commonly referred to as sciatica. Thoracic radiculopathy causes pain from the middle back that travels around to the chest, it is often mistaken for shingles.

Some patients develop a hypersensitivity to light touch that feels painful in the area involved. Less commonly, patients can develop weakness in the muscles controlled by the affected nerves. This can indicate nerve damage^[6].

Radiculopathy’s diagnosis commonly made by physicians in primary care specialties, Chiropractic, orthopedics, physiatry, and neurology. The diagnosis may be suggested by symptoms of pain, numbness, and weakness in a pattern consistent with the distribution of a particular nerve root. Neck pain or back pain may also be present.

Physical examination may reveal motor and sensory deficits in the distribution of a nerve root. For example, in the case of cervical radiculopathy, Spurling’s test may elicit or reproduce symptoms radiating down the arm. In the case of lumbar radiculopathy, a Straight leg raise (SLR) maneuver may exacerbate symptoms. Deep tendon reflexes (also known as a Stretch reflex) may be diminished or absent in areas innervated by a particular nerve root.

For further workup, the American College of Radiology recommends that projectional radiography is the most appropriate initial study in all patients with chronic neck pain. Two additional diagnostic tests that may be of use are magnetic resonance imaging and electrodiagnostic testing, consisting of NCS (Nerve conduction study) and EMG (Electromyography),

On nerve conduction studies, the pattern of diminished compound muscle action potential and normal sensory nerve action potential may be seen given that the lesion is proximal to the Posterior root ganglion. Needle EMG is the more sensitive portion of the test and may reveal active denervation in the distribution of the involved nerve root, and neurogenic-appearing voluntary motor units in more chronic radiculopathies. Given the key role of electrodiagnostic testing in the diagnosis of acute and chronic radiculopathies, the American Association of Neuromuscular & Electrodiagnostic Medicine has issued evidence-based practice guidelines, for the diagnosis of both cervical and lumbosacral radiculopathies^[7][8]. The American Association of Neuromuscular & Electrodiagnostic Medicine has also participated in the Choosing Wisely Campaign and several of their recommendations relate to what tests are unnecessary for neck and back pain^[9].

Outcome Measures for Cervical Radiculopathy[edit | edit source]

1. Neck disability index (NDI)
2. Patient Specific Functional Scale (PSFS)
3. Numerical Pain Rating Scale (NPRS)
4. Neck Pain and Disability Scale (NPAD)

Outcome Measures for Lumbar Radiculopathy[edit | edit source]

1. Roland Morris Disability Questionnaire (RMDQ)
2. Back Pain Functional Scale
3. The Maine-Seattle Back Questionnaire
4. Fear Avoidance Belief Questionnaire (FABQ)
5. Oswestry Low Back Pain Disability Questionnaire
6. The Quebec back pain disability scale (QBPDS)

Fortunately, most people can obtain good relief of their symptoms of radiculopathy with conservative treatment. This may include anti-inflammatory medications, physical therapy or chiropractic treatment, and avoiding activity that strains the neck or back. The majority of radiculopathy patients respond well to this conservative treatment.

If patients do not improve with the treatments listed above they may benefit from an epidural steroid injection. With the help of an X-ray machine. It is a rapid short-term treatment to reduce the inflammation, and irritation of the nerve and help reduce the symptoms of radiculopathy^[10][11].

While conservative approaches for rehabilitation are ideal, some patients will not improve and surgery is still an option. Patients with large cervical disc bulges may be recommended for surgery, however, most often conservative management will help the herniation regress naturally^[12]. The goal of the surgery is to remove the compression from the affected nerve. Depending on the cause of the radiculopathy, this can be done by a laminectomy or a discectomy. A laminectomy removes a small portion of the bone covering the nerve to allow it to have additional space. A discectomy removes the portion of the disc that has herniated out and is compressing a nerve.

Physical Therapy Management[edit | edit source]

Ideally, effective treatment aims to resolve the underlying cause and restores the nerve root to normal function. Common conservative treatment approaches include physical therapy and chiropractic.

A systematic review found moderate-quality evidence that spinal manipulation is effective for the treatment of acute lumbar radiculopathy^[8] and cervical radiculopathy ^[13][14]. But there is no evidence about the safety of cervical spine manipulation.^[15] Only low level evidence was found to support spinal manipulation for the treatment of chronic lumbar radiculopathies, and no evidence was found to exist for the treatment of thoracic radiculopathy^[15]. Also for patients with lumbar nerve root compression, lumbar traction as extra treatment is not superior to extension-oriented exercises alone^[16].

Therapeutic exercises are frequently used in combination with many of the previously mentioned modalities and with great results. Following one of the studies adding mechanical traction to exercise for patients with cervical radiculopathy results in long term positive effects on disability and pain^[17]. A variety of exercise regimens are available for patient treatment. An exercise regimen should be modified according to the abilities and weaknesses of the patient ^[18]. 

For further details on the management of radiculopathy, read the following articles;

Cervical Radiculopathy

Lumbar Radiculopathy

Pathologies which mimic the signs and symptoms of radiculopathy are^[19].

1. Spinal Tumor
2. Systemic diseases known to cause peripheral neuropathies
3. Cervical myelopathy
4. Ligamentous Instability
5. Vertebral Artery Insufficiency (VBI)
6. Herniated nucleous pulposos (HNP)
7. Shoulder Pathology
8. Peripheral nerve disorders
9. Thoracic outlet syndrome
10. Brachial plexus pathology
11. Systemic disease
12. Parsonage-Turner syndrome
13. Superior pulmonary sulcus tumor

Cervical Radiculopathy

Lumbar Radiculopathy

1. ↑ Iyer S, Kim HJ. Cervical radiculopathy. Current reviews in musculoskeletal medicine. 2016 Sep;9(3):272-80.
2. ↑ Schoenfeld AJ, George AA, Bader JO, Caram Jr PM. Incidence and epidemiology of cervical radiculopathy in the United States military: 2000 to 2009. Clinical Spine Surgery. 2012 Feb 1;25(1):17-22.
3. ↑ Radhakrishnan K, Litchy WJ, O’fallon WM, Kurland LT. Epidemiology of cervical radiculopathy: a population-based study from Rochester, Minnesota, 1976 through 1990. Brain. 1994 Apr 1;117(2):325-35.
4. ↑ Berry JA, Elia C, Saini HS, Miulli DE. A review of lumbar radiculopathy, diagnosis, and treatment. Cureus. 2019 Oct;11(10).
5. ↑ Iversen T, Solberg TK, Romner B, Wilsgaard T, Nygaard Ø, Brox JI, Ingebrigtsen T. Accuracy of physical examination for chronic lumbar radiculopathy. BMC musculoskeletal disorders. 2013 Dec;14(1):1-9.
6. ↑ Eck, Jason C. “Radiculopathy”. MedicineNet.com. Retrieved 12 April 2012.
7. ↑ Fuglsang-Frederiksen A, Pugdahl K. Current status on electrodiagnostic standards and guidelines in neuromuscular disorders. Clinical Neurophysiology. 2011 Mar 31;122(3):440-55.
8. ↑ ^8.08.1 Cho SC, Ferrante MA, Levin KH, Harmon RL, So YT. Utility of electrodiagnostic testing in evaluating patients with lumbosacral radiculopathy: An evidence‐based review. Muscle & nerve. 2010 Aug;42(2):276-82.
9. ↑ Meekins GD, So Y, Quan D. American Association of Neuromuscular & Electrodiagnostic Medicine evidenced‐based review: Use of surface electromyography in the diagnosis and study of neuromuscular disorders. Muscle & Nerve: Official Journal of the American Association of Electrodiagnostic Medicine. 2008 Oct;38(4):1219-24.
10. ↑ House LM, Barrette K, Mattie R, McCormick ZL. Cervical epidural steroid injection: techniques and evidence. Physical Medicine and Rehabilitation Clinics. 2018 Feb 1;29(1):1-7.
11. ↑ Rivera CE. Lumbar epidural steroid injections. Physical Medicine and Rehabilitation Clinics. 2018 Feb 1;29(1):73-92.
12. ↑ Heckmann JG, Lang CJ, Zöbelein I, Laumer R, Druschky A, Neundörfer B. Herniated cervical intervertebral discs with radiculopathy: an outcome study of conservatively or surgically treated patients. Journal of spinal disorders. 1999 Oct 1;12(5):396-401.
13. ↑ Leininger B, Bronfort G, Evans R, Reiter T. Spinal manipulation or mobilization for radiculopathy: a systematic review. Physical Medicine and Rehabilitation Clinics. 2011 Feb 1;22(1):105-25.
14. ↑ Young IA, Pozzi F, Dunning J, Linkonis R, Michener LA. Immediate and Short-term Effects of Thoracic Spine Manipulation in Patients With Cervical Radiculopathy: A Randomized Controlled Trial. journal of orthopaedic & sports physical therapy. 2019 May;49(5):299-309.
15. ↑ ^15.015.1 Zhu L, Wei X, Wang S. Does cervical spine manipulation reduce pain in people with degenerative cervical radiculopathy? A systematic review of the evidence, and a meta-analysis. Clinical Rehabilitation. 2016 Feb;30(2):145-55.
16. ↑ Thackeray A, Fritz JM, Childs JD, Brennan GP. The effectiveness of mechanical traction among subgroups of patients with low back pain and leg pain: a randomized trial. journal of orthopaedic & sports physical therapy. 2016 Mar;46(3):144-54.
17. ↑ Fritz JM, Thackeray A, Brennan GP, Childs JD. Exercise only, exercise with mechanical traction, or exercise with over-door traction for patients with cervical radiculopathy, with or without consideration of status on a previously described subgrouping rule: a randomized clinical trial. journal of orthopaedic & sports physical therapy. 2014 Feb;44(2):45-57.
18. ↑ Cleland JA, Whitman JM, Fritz JM, Palmer JA. Manual physical therapy, cervical traction, and strengthening exercises in patients with cervical radiculopathy: a case series. Journal of Orthopaedic & Sports Physical Therapy. 2005 Dec;35(12):802-11.
19. ↑ Mamula CJ, Erhard RE, Piva SR. Cervical radiculopathy or Parsonage-Turner syndrome: differential diagnosis of a patient with neck and upper extremity symptoms. Journal of Orthopaedic & Sports Physical Therapy. 2005 Oct;35(10):659-64.

Trapped Nerves: Causes & Treatment

Trapped nerves in the back – sciatica and femoral nerve impingement

Our new IDD Therapy programme is effective in treating trapped nerves, is non-invasive (unlike surgery) and is pain-free. IDD Therapy bridges the gap between what manual therapy cannot achieve and surgery. This therapy is the fastest growing therapy for trapped nerves and degenerative disc issues in the UK.

Each vertebra in the spine has numbers as you can see in the diagram below. In the lower back or ‘lumbar spine’, the vertebrae are numbered L1 to L5.  The chest or ‘thoracic spine’ uses the letter T and is numbered T1-T12, and the neck or ‘cervical spine’ uses a C and is numbered C1-C7.

Slipped, herniated or disc bulges or protrusions usually occur at the bottom of your lower back at L3, L4 or L5 (and at C4/C5 or C5/C6 or C6/C7 at the bottom of the neck). There are also five rudimentary levels in the sacrum (although these are fused vertebra) where nerves exit, and these are numbered S1-S5.

The discs at the bottom of your lower back (L3/L4, L4/L5 and L5/S1) are the levels most likely to suffer from trapped nerves because these areas help support most of the weight of your upper body (two thirds of your total body weight). The sciatic nerve runs from the bottom three vertebra (as seen below) and innervates the area around your hip, the back of the thigh and lower leg and foot.

If a nerve is trapped at L2 or L3 or L4 this will affect the femoral nerve (as seen below) and we suffer from femoral nerve impingement which provides both feeling and power to the front of the thigh. Therefore we experience pain in this specific anatomy.

These conditions cause a characteristic pain distribution down the leg. The areas of skin a single nerve innervates in the leg is called a dermatome. Each specific nerve will be responsible for sensory perception in a very specific area of skin (sensory perception being temperature, touch, vibration, pressure and pain). Therefore, if a nerve is impinged in the lower back, pain and pins and needles (or paraesthesia) will refer to any given dermatome.

So sciatic pain will potentially refer to any of those areas innervated from L3 to S3 levels (these levels innervate the back of the leg) and femoral nerve impingement will cause pain L2-L4 levels (these dermatomes innervate the front of the thigh) which provide both feeling and power to the front of the thigh.

Things to be aware of that are clinically significant and indicate that you need to take further action when you have sciatica are:

• Severe impingement can weaken the ankle when walking (known as foot drop)
• Progressive leg weakness
• In extreme cases loss of bowel or bladder control and tingling/numbness in the groin area indicates a possible medical emergency.

For the femoral nerve, this generally provides both feeling and power to the front of the thigh (it innervates what we call the hip flexors and knee extensors). Movements such as climbing stairs (the knee may unstable and prone to buckling) will be difficult as your thigh muscles will feel weak. Pain may also be felt on the side of the buttock, groin, inside of the knee and lower leg.

It is also worth mentioning that all the muscles in the legs are also innervated by nerves from different levels in the spine as well. These are called myotomes. The sciatic nerve, for example, will carry nerves for both sensory and motor innervation (motor as in ‘motor power’).

The information you give us in clinic and our clinical testing will help establish at which level in your spine you have a trapped nerve.

Causes of trapped nerves in the spine

Herniated or Bulging Discs

There are a few terms commonly used when describing discs which we can quickly clarify.

A disc bulge is where the outer wall of the disc bulges out from its normal position. The disc wall is not broken, and the nucleus material is contained inside the disc. As the disc bulges, it may press against nerves directly. Often a bulge can be associated with a loss of disc height and this may lead to impingement of a nerve as it exits the spinal canal via a gap (called a foramen) between two vertebrae.

A herniated disc is the same as a prolapsed disc.  This is where the nucleus of the disc breaks through the outer disc wall. There will be a loss of disc height as the disc loses pressure and the nucleus material can press directly on to the spinal nerves causing pain. Or, the material of the disc nucleus may act as a biochemical irritation to the nerve in which case the result is the same… pain!

A ‘slipped disc’ is an everyday expression which doesn’t have a true medical definition.  It can imply a disc bulge or a herniation, usually a herniation.  

This MRI below demonstrates a herniated disc pressing on nerves. The nerves are demonstrated by the broad white descending line seen in the scan. This is the spinal cord and departing spinal nerves. If you look carefully you can see the herniation making contact with these delicate structures.

The resulting pain from a herniated disc will often refer (hence the term radicular pain) down the pathway of a nerve and into the limb it innervates, causing either sciatica (in the case of the lower back) or pain into the neck, shoulder and arm (if in the neck). This can often be accompanied with pins and needles in the foot or hand depending on this location. 

Our new IDD Therapy programme is effective in treating trapped nerves, is non-invasive (unlike surgery) and is pain-free. IDD Therapy bridges the gap between what manual therapy cannot achieve and surgery. This therapy is the fastest growing therapy for trapped nerves and degenerative disc issues in the UK.

Trapped Nerves and Spinal Stenosis

Spinal stenosis refers to a build-up of bony deposits in the vertebrae. It is typically associated with the ageing process. As we get older, in the same way that our skin ages, so too do our discs.  Everyone will have degenerative discs to some degree; it goes with the territory unfortunately.

In some cases, the loss of disc height as we lose water leads to more load pressure being exerted on the vertebrae.  

The body reacts to the increased load by laying down more bone to reinforce the vertebrae. In some cases, the extra bone can narrow and exert pressure on the spinal cord (central stenosis) or exiting nerve roots (lateral stenosis).

Facet Joint Arthopathy

In the spine, facet joints link the vertebrae and are important for preventing excessive rotational and twisting forces which would damage the discs. They also share some of the load bearing of the spine.  

When there is a loss of mobility in the spine, the facet joints bear a greater load than normal. This is particularly the case if there is some imbalance in the body and one side of the spine takes more strain than the other.  

Imbalance in weight distribution not only adds to the stress borne by the facets but effectively deteriorates bone and cartilage. Constant movement on these worn structures activates an inflammatory reaction to the joint which is full of nerve endings. The result is chronic pain as the body continuously sends pain signals to the brain.  

Just like the vertebra the body reacts to the increased load on the facet joints by laying down more bone in the joint margins (this is called facet joint arthropathy). 

In some cases, the extra bone can narrow the gap where the nerves exit the spine and if the bone pinches against the bone, it can cause nerve root irritation (or a trapped nerve) causing lateral stenosis (or pressure on the nerve as it departs the spinal cord).

Degenerative Disc Disease

Disc degeneration is common in the neck (cervical spine) and lower back (lumbar spine). This is because these areas of the spine undergo the most movement and stress and are subsequently most susceptible to disc degeneration (as these bear much of our weight).

Degenerative disc disease refers to symptoms in the neck pain (this can refer to the shoulder) caused by wear-and-tear on a spinal disc. In some cases, degenerative disc disease also causes weakness, numbness, and hot, shooting pains in the arms and shoulder (radicular pain). Degenerative disc disease typically consists of a low-level chronic pain with intermittent episodes of more severe pain.

The discs are made of a compressible inner nucleus (nucleus pulposus) that deforms under load (as seen below) and an outer fibrous wall (anulus fibrosus) made of collagen. 

The spongy intervertebral discs absorb shocks and pressure from the load of our bodies and squash as we lean or bend in any direction. They stop the vertebrae rubbing against each other (bone on bone) and they create a space between the vertebrae. This space is very important.  

Each vertebra has a hole in the middle and when the vertebrae are stacked on top of one another combine to form a tunnel or canal through which the spinal cord travels down from the brain.  

In children, the discs are about 85% water. The discs begin to naturally lose hydration during the ageing process. Some estimates have the disc’s water content typically falling to 70% by the age of 70, but in some people the disc can lose hydration much more quickly. Loss of hydration can be seen in the bottom two discs below.

As the disc loses hydration, it offers less cushioning and becomes more prone to cracks and tears. The disc is not able to truly repair itself because it does not have a direct blood supply. As such, a tear in the disc either will not heal or will develop weaker scar tissue that has potential to break again. At the same time, as the disc loses moisture and its structural integrity content it will protrude and bulge and can press on nearby nerves.

Our new IDD Therapy programme is effective in treating trapped nerves, is non-invasive (unlike surgery) and is pain-free. IDD Therapy bridges the gap between what manual therapy cannot achieve and surgery. This therapy is the fastest growing therapy for trapped nerves and degenerative disc issues in the UK.

90,000 Treatment of vegetative-vascular dystonia – Family Doctor clinic in Moscow

Vegetovascular dystonia (VVD) is now called somatoform dysfunction of the autonomic nervous system by doctors. This is a common disease that women suffer from 2 times more often than men. VSD is just a syndrome, but it must be taken into account when prescribing a treatment for the underlying disease. To talk about pathology, let’s remember how the human nervous system works.

Table 1.Human nervous system – simplified diagram

The autonomic nervous system has a central and peripheral division. Its representation is in the cerebral cortex, trunk, hypothalamus, spinal cord. The peripheral section is represented by ganglia and nerve plexuses.With violations in any of these departments, symptoms of VSD appear.

Reasons

Dystonia vegetatively vascular in most cases is a secondary pathology that complicates the existing somatic and neurological diseases, but requires mandatory treatment. Distinguish between causing and provoking factors of its development.

Table 2. Types and causes of VSD

Vegetative-vascular dystonia occurs as a result of a psychoemotional reaction, its symptoms are superimposed on the existing vegetative anomalies of the human body, treatment should take this fact into account.

Manifestations

VSD is characterized by many different manifestations. Almost all body systems are affected.

• Cardiovascular. Heart rate, blood pressure change, cardiac-type pains, ECG changes are noted.

• Pulmonary. There is a lack of air, inhalation is disturbed, blood oxygen saturation worsens, paresthesias appear.

• Nervous. Disturbed by headaches, tinnitus, weakness, dizziness, fainting. Thinking slows down. Fluctuations in body temperature, hyperkinesis, episodes of depressive mood torment.

Table 3. Action of the sympathetic and parasympathetic systems

Vascular dystonia.Symptoms and Treatment

1. Sympathicotonia – the prevalence of the tone of the sympathetic nervous system. It is characterized by: pallor of the skin, vasoconstriction, hypertension, tachycardia, dilated pupils, lethargy of the intestines, aggravated anxiety, a feeling of fear.

2. Vagotonia is the opposite of sympathicotonia. It is accompanied by reddening of the skin, vasodilation, sweating, hypotension, bradycardia, constriction of the pupils, accelerated bowel movements, irritability.

Sometimes the symptoms of VSD are mosaic, in this case there are sympathetic and parasympathetic disorders at the same time.

Therapy is selected individually, taking into account the main manifestations and the predominance of a particular department.

Vegetovascular dystonia. Symptoms

Sleep disturbance. The most common problem for people with disorders of the autonomic nervous system. There are two extremes: increased sleepiness, when you constantly want to sleep and insomnia due to a failure of biorhythms.In both cases, the sleep is superficial, you rarely get a good night’s sleep. Normal treatment has no effect.

Instability of the psychoemotional sphere. As a result of insomnia, the ability to concentrate is impaired and memory is impaired. A person cannot do his job well. There are nervous breakdowns, mood swings. Periods of unbridled fun give way to apathy, depression, and sometimes directed aggression.

Dermographism. If you run your fingernail over a patient’s skin, a white stripe will appear in sympathotonics and a red one in vagotonics. This is due to a vascular reaction. In the first case, they narrow, in the second, they expand. This is exactly how the skin reacts to stress, sports. These features must be taken into account when doing physical education and sports.

Respiratory disorders appear with parasympathetic VSD. With an increase in the load on the bronchi, shortness of breath develops. Stress, physical activity, ARVI act as triggers.The state of health of patients worsens over the years, shortness of breath is replaced by attacks of suffocation. Some patients develop bronchial asthma.

Meteosensitivity. The human body reacts extremely violently to changes in atmospheric pressure, windy or rainy weather. Weakness, severe headaches appear, sometimes putting them to bed, a complete lack of working capacity.

Problems with digestion with VSD are varied and opposite in symptoms: increased and decreased appetite, diarrhea and constipation, abdominal pain, nausea, food selectivity.Treatment of a gastroenterologist is of little help.

Disorders of the genitourinary system. Increase or decrease in urination, pain in the perineum, lower abdomen in the absence of pathology, menstrual irregularities, libido, erectile dysfunction.

Headache and dizziness due to impaired cerebral vascular tone. They provoke their mental and emotional overload, stress. Sometimes fainting, tinnitus, nausea may appear.

Table 4. Severity of VSD

Crises with vascular dystonia.Symptoms and treatment in adults

Panic attack – sympathoadrenal crisis. A huge amount of adrenaline is released into the bloodstream. There is a sharp headache, blood pressure rises, the heart “jumps out of the chest”, the skin turns pale. The fingers and toes are chilly, numb. A person feels a strong sense of anxiety, fear. The crisis passes on its own. After it, the patient feels exhausted for a long time.

Vagoinsular crisis occurs when insulin is released into the bloodstream.As a result, the glucose level drops sharply, there are interruptions in the work of the heart. It seems to stop. The patient feels short of breath. The pulse slows down, the pressure drops, the eyes darken. Fainting may develop. The skin turns red, there is increased sweating. There may be diarrhea, flatulence.

Diagnostics

The doctor carefully records all the patient’s complaints. Draws attention to their abundance and diversity. Usually there is a connection between the onset of the disease and a stress factor.Then he conducts an examination, measures the pressure in two positions (lying and sitting), determines the predominant type of the autonomic nervous system.

Often the following is prescribed for diagnosis:

Vegeto-vascular dystonia. Treatment

A neurologist selects a therapy regimen, focusing on complaints, gender, age, examination and diagnostic results. There are no two people with VSD who would be treated in exactly the same way. Therefore, you can not self-medicate.

Sedatives, tranquilizers, antidepressants, nootropics and some other drugs are used as drug therapy.

Good help: psychotherapy, physiotherapy, reflexology, spa treatment.

But the main thing is the normalization of the regime of rest and work, the creation of a comfortable psychoemotional environment.

Prevention

Vegeto vascular dystonia is a long-term current disease, the symptoms are exacerbated from time to time. Every year there are new methods of treatment for adults and children. However, it is very important to follow the rules to minimize the risk of exacerbations.

• Provide adequate, but not excessive, physical activity.
• Give up bad habits, excessive consumption of coffee.
• Avoid stress, if they arise immediately, work them out with a psychotherapist.
• Observe the balance of work and rest.
• Eat rationally, preferring food of plant origin.
• Take massage courses twice a year.
• Try to go to a sanatorium every year or take preventive therapy courses in a clinic.

VSD treatment in the Family Doctor clinic

At the Family Doctor clinic, you will receive comprehensive treatment and return to your usual life. Make an appointment with a therapist or neurologist of our clinic by phone +7 (495) 775 75 66, use the online appointment service or contact the reception. The clinic has all the conditions for in-depth examination and therapy of patients with disorders of the autonomic nervous system.There are more than 50 medical directions, so it is easy to organize consultations of specialists, hold a consultation in a difficult case. This allows you to establish an accurate diagnosis in a short time and prescribe an effective therapy. Remember that the child may also have manifestations of VSD, which should not be ignored.

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neurologist, reflexologist

neurologist, chiropractor

neurologist, reflexologist

neurologist

neurologist

Mechanisms of abdominal pain | Remedium.ru

Chapter four pocket recommendations for
Abdominal pain in a child – pediatrician tactics
Zakharova I.N., Berezhnaya I.V., Kholodova I.N., Zaydenvarg G.E.
Specialized edition,
intended for medical and pharmaceutical workers .

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Pain syndrome in the abdominal cavity occurs due to irritation of numerous nociceptive (pain) receptors located mainly in:

• the muscular membrane of the wall of hollow organs,
• capsule parenchymal organs,
• mesentery,
• parietal peritoneum.

The visceral peritoneum and the greater omentum are devoid of pain sensitivity. In accordance with the anatomy of the nervous system of the abdominal cavity, there are three main types of abdominal pain:

1. Visceral (autonomic) pain. The organs of the abdominal cavity and the visceral peritoneum covering them are equipped with a network of nerve endings related to the celiac nerve system. The branches of the autonomic nervous system branch out and overlap each other, there is no clear representation of the abdominal organs in the cerebral cortex.Pain impulses arising in the internal organs during ischemia, overstretching, as well as with increased intestinal peristalsis in case of complete blockage of its lumen, propagate along the nerve fibers of the autonomic (autonomic) nervous system. This pain, as a rule, is not clearly localized, most often diffuse, appears approximately in the middle part of the abdomen, and occurs when the visceral peritoneum is irritated. This is due to the multisegmental innervation of the internal organs and a small number of nerve endings in them in comparison with the skin and muscles.Most often, indicating the localization of this pain, patients pass their open palm circularly over the entire abdomen or most of it. Visceral pain is noted in the epigastric, umbilical areas or above the bosom ( Fig. 7 ).

Figure 7. Projection of visceral pain

Receptors that perceive visceral pain respond to changes in intracavitary pressure in the organ (spasm, stretching of the hollow organ, disruption of blood flow in non T.NS.). Visceral pain is often accompanied by autonomic disorders – pale or reddening of the skin, sweating, nausea, vomiting.

2. Reflected pain is a manifestation of the reflex mechanism of visceral pain conduction along the sensory fibers of the cerebrospinal nerves. Segmental anatomical relationships between the autonomic (autonomic) nervous system and spinothalamic nerves are often the cause of the spread and irradiation of visceral pain.

Pain does not always occur at the site of the true localization of the pathological process in the abdominal cavity. Often it radiates outside the abdomen. For example, with a perforated stomach or duodenal ulcer, pleurisy, hemoperitoneum, or subphrenic abscess, irritation of the diaphragm may occur. As a result, pain impulses along the phrenic nerves are transmitted to the fourth cervical segment, and then spread to the areas innervated by C4 – the upper part of the shoulder and the lateral surface of the neck.Often this irradiation of pain helps to make a correct diagnosis. At the same time, hypersensitivity and increased pain sensitivity occur in certain areas of the skin (Zakharyin-Ged zones). Reflected pains are clearly localized, can be felt superficially on the skin and more deeply in the muscles. Irradiation of pain can be confused with migration, which is also characteristic of some diseases of the abdominal organs. The difference is that during migration, pain occurs in one place, then gradually disappears and appears with renewed vigor in another place.With irradiation, pain that has arisen in any place remains moderate in intensity, and at the same time, pain arising again in another place is usually less intense.

A classic example is the irradiation of pain to the left shoulder with irritation of the diaphragm and the cheekbone and the superciliary space with pathology of the biliary system ( Fig. 8 ).

Figure 8. Scheme of pain irradiation in pathology of the diaphragm and biliary tract

3.Parietal (somatic) pain. The parietal peritoneum is supplied with somatic afferent nerves, which makes it possible to accurately localize the inflammatory process that occurs in the area of ​​nerve endings. Parietal pain is associated with structural abnormalities in the wall of the affected organ or in the parietal peritoneum, has a localized character, may be accompanied by skin hyperesthesia, local muscle protection. It increases with physical exertion (walking, jumping), vibration in transport, sharp bending or extension of the trunk, and coughing.Pain impulses originating in the abdominal cavity are transmitted both through autonomic nerve fibers (autonomic nervous system) and through the anterior and lateral spinothalamic tracts. Pain impulses that are conducted through the spinothalamic tracts are characterized by clear localization. Patients can usually show a specific point with one or two fingers. This pain occurs with the development of an intra-abdominal inflammatory process that spreads to the parietal peritoneum ( Fig.9 ).

Table 5, 6 presents the main diseases accompanied by the occurrence of
visceral or parietal pain, as well as the main distinguishing features of data
types of pain.

The perception of pain can be influenced by the patient’s personality: the pain threshold decreases with anxiety, fear, anger, sadness, fatigue, insomnia and increases with the elimination of negative emotions.

Figure 9.Parietal pain projection



Table 6. Main causes of abdominal pain

Common causes of abdominal pain

1. Motility disorders – spasm of smooth muscles of hollow organs and excretory ducts (esophagus, stomach, intestines, gallbladder, biliary tract, pancreatic duct), intestinal hyperperistalsis.
2. Stretching of the walls of hollow organs and tension of their ligamentous apparatus, tension of the organ capsule.
3. Structural (inflammatory) damage to the abdominal organs (ulceration, gastritis, tumors, etc.).
4. Hypoxia and ischemia of the abdominal organs (congenital stenosis of the branches of the abdominal aorta, thrombosis and embolism of mesenteric vessels, strangulated hernia, intussusception).
5. Perforation and penetration with the transition of the process to the peritoneum (parietal pain).

Abdominal pain: functional and organic

Abdominal pain against the background of functional disorders is symptomatic complexes on the part of various organs of the digestive system, arising in the absence of organic pathology of the digestive tract (Table.7). According to literature data, in about 90% of children with abdominal pain, an organic disease is not detected during the initial examination, and only in 10% of cases it is possible to establish an organic cause of the pain syndrome.

In accordance with the Roman criteria, general signs of functional disorders of the gastrointestinal tract are distinguished, regardless of the level of damage:

• duration of the main symptoms at least 1 time per week for 3 months. within the last 6 months.,
• absence of organic pathology of the digestive tract,
• multiple nature of complaints with the general good condition of the patient and a favorable course of the disease without noticeable progression,
• The importance of psychosocial factors and disorders of neurohumoral regulation in the formation of basic symptoms.

In 1994 D.A. Drossman defined functional gastrointestinal tract disorders as “a varied combination of gastrointestinal symptoms without structural and biochemical abnormalities,” consistent with Rome II criteria.In 2016, the updated Rome IV criteria were developed, according to which functional diseases of the gastrointestinal tract are a group of disorders characterized by a violation of the interaction of the central nervous system (brain) and the peripheral link of the nervous system, which ensures the activity of the gastrointestinal tract organs (axis “brain – gastrointestinal tract”)

Table 7. Abdominal pain of a functional nature

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The effect of drugs on the human body

Drug addiction is the scourge of our time, annually leading to the death of up to hundreds of thousands of people. Statistics show that the majority of drug users are young people and adolescents. What is the danger of this “plague of the 21st century” and what is the effect of drugs on the body – the topic of our article.

Effects of drugs on the brain

The human brain is the control center of the entire organism. Even a single dose of a drug is enough to cause irreparable harm to it and start irreversible processes. When a drug enters the body, the brain produces large amounts of dopamine, which causes incredible pleasure and euphoria. After several doses, the body develops a persistent addiction to the drug, it requires it over and over again.

The effect of drugs on the nervous system

The nervous system is one of the most important in the human body.Any type of drug, from the first use, destroys nerve cells that cannot be restored. Even the first doses that enter the body contribute to the disorder of the psyche of the addict. In such a person, character deteriorates noticeably, memory is impaired, attention becomes scattered and indistinct, mental activity is significantly reduced. The former member of society becomes unrecognizable, he sharply degrades, his behavior is inadequate and cannot be understood. Teenagers involved in this dangerous “game with death” become simply uncontrollable, they do not perceive their parents in any way, whose words and actions for a drug addict are an empty phrase.

The influence of drugs on the human psyche

A person who takes narcotic substances for a certain time becomes mentally unhealthy. He closes in on himself, he ceases to be interested in everything that happens around him, the center of the Universe for a drug addict – he himself, his family and loved ones cease to exist for such a person. The addict is characterized by all negative qualities and character traits: deceit, dishonesty and dishonesty in relation to others, callousness and indifference to loved ones and their feelings.The worst thing is that for the sake of a dose this person is capable of anything, even to kill, because he no longer has anything sacred in his soul, the addict lives for the sake of one goal – to inject. Of course, a person is no longer able to be a full-fledged member of society, work, lead a normal life, create a family and raise children. He needs a full-fledged long-term treatment in the clinic, often compulsory.

The effect of drugs on other human organs

The effect of drugs on the human body is very harmful.So, when smoking a drug, the lungs are greatly affected. At first, this can be expressed in chronic bronchitis and persistent cough, in the later stages there is a likelihood of the appearance of malignant tumors. Smoking grass – similar to smoking tobacco, all the tar and soot from it remains in the lungs, which leads to irreversible consequences.

The work of the cardiovascular system is also disrupted. Depending on the type of drug, the pulse becomes more rare or quicker, the blood pressure rises or falls.Those taking the dose are prone to strokes and heart attacks. In any case, a person’s heart wears out a lot; in a few short years of drug use it will be like that of a hundred-year-old man, if the addict survives at all.

All drug addicts have a decrease in the level of appetite, which ultimately leads to depletion of the body. Opiate metabolism slows down; essential nutrients are simply not absorbed. The stomach cannot function normally due to insufficient production of enzymes, and the intestinal function is impaired.This contributes to the appearance of symptoms such as abdominal pain, persistent constipation. If treatment is not started on time, death from exhaustion will follow.

Drugs have a destructive effect on the reproductive system. A person’s libido gradually decreases, which ultimately leads to impotence.