Often times patients will come into our office complaining of neck pain that radiates into their shoulder and even into their hands/fingers. They almost always are on some sort of over the counter or prescription medicines including hydrocodone, naproxen, prednisone just to name a few. The pain can be dull or sharp, constant or intermittent, and sometimes they can have tingling or numbness into their arm. Sometimes there is a history of trauma but the majority of the time when I ask them what do they think caused the pain, the most common response is "I have no idea." I begin to ask questions about any change in activities at home or work, any new work out routines, any new changes in their work station or even a new pillow. And very often there are no coinciding factors that can explain the pain.
In the example above the condition is easy enough to diagnose. I bet everyone reading this post, ( all nine of you), would say it's a pinched nerve and you would be right. The tougher question is what is doing the pinching. There are several things that can cause a nerve to be pinched or compressed.
Some can be ruled out simply by the age of the patient. For instance, arthritic degeneration can cause a narrowing of the opening that the nerve exits causing compression (spinal or foraminal stenosis), but you wouldn't expect this in 20-40 year olds. Another example would be a herniated disc putting pressure on the nerve as it exits off of the spinal cord. Usually, but not always, that person would have a history of some sort of trauma to the neck. Other causes can be inflammation around the nerve root and muscle tension which is much more common in the above mentioned 20-40 crowd quite often from poor posture due to over texting. Often times in someone who is 50 plus it can be a combination of all of the above which is called degenerative disc disease.
There are some simple orthopedic tests that I can do in the office that can often times rule out or rule in the causes. Sometimes if there is no relief with a couple of treatments I may want to order diagnostic studies (x-ray, mri or emg). These studies will confirm the presence of arthritis, disc herniation or inflammation. A small percentage of patients with an MRI that is positive for inflammation and foraminal narrowing may be referred out to see if they are a candidate for epidural steroid injections (esi's). Only a small percentage of patients that come into my office with symptoms of a pinched nerve will go on to need surgery, although that is a possibility.
Most oftentimes with a combination of chiropractic treatments, stretching, ice and some in office physiotherapeutic modalities (ultrasound, traction, ems) most patients receive relief from their pain. If you or someone your know has been diagnosed with a pinched nerve or think you have a pinched nerve give Dr. Kevin E. Crowley a call today at to schedule an appointment.