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PINCHED NERVE

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Definition

A pinched nerve occurs when too much pressure is applied to a nerve by surrounding tissues, such as bones, cartilage, muscles or tendons. This pressure disrupts the nerve's function, causing pain, tingling, numbness or weakness.


A pinched nerve can occur at several sites in your body. A herniated disk in your lower spine, for example, may put pressure on a nerve root, causing pain that radiates down the back of your leg. Likewise, a pinched nerve in your wrist can lead to pain and numbness in your hand and fingers (carpal tunnel syndrome).


With rest and other conservative treatments, most people recover from a pinched nerve within a few days or weeks. Sometimes, surgery is needed to relieve pain from a pinched nerve.


Symptoms

Pinched nerve signs and symptoms include:


  • Numbness or decreased sensation in the area supplied by the nerve
  • Sharp, aching or burning pain, which may radiate outward
  • Tingling, "pins and needles" sensations (paresthesia)
  • Muscle weakness in the affected area
  • Frequent feeling that a foot or hand has "fallen asleep"


The problems related to a pinched nerve may be worse when you're sleeping.


When to see a doctor

See your doctor if the signs and symptoms of a pinched nerve last for several days and don't respond to self-care measures, such as rest and over-the-counter pain relievers.


Causes

A pinched nerve occurs when too much pressure (compression) is applied to a nerve by surrounding tissues.


In some cases, this tissue might be bone or cartilage, such as in the case of a herniated spinal disk that compresses a nerve root. In other cases, muscle or tendons may cause the condition.


In the case of carpal tunnel syndrome, a variety of tissues may be responsible for compression of the carpal tunnel's median nerve, including swollen tendon sheaths within the tunnel, enlarged bone that narrows the tunnel, or a thickened and degenerated ligament.


A number of conditions may cause tissue to compress a nerve or nerves, including:


  • Injury
  • Poor posture
  • Rheumatoid or wrist arthritis
  • Stress from repetitive work
  • Hobbies or sports activities
  • Obesity


This pressure causes inflammation of the nerve and disrupts the nerve's function. If a nerve is pinched for only a short time, there's usually no permanent damage. Once the pressure is relieved, nerve function returns to normal. However, if the pressure continues, chronic pain and permanent nerve damage can occur.


Risk factors

The following factors may increase your risk of experiencing a pinched nerve:


  • Posture. Poor posture adds pressure to your spine and nerves.
  • Sex. Women are more likely to develop carpal tunnel syndrome, possibly due to having smaller carpal tunnels.
  • Bone spurs. Trauma or a condition that causes bone thickening, such as osteoarthritis, can cause bone spurs. Bone spurs can stiffen the spine as well as narrow the space where your nerves travel, pinching nerves.
  • Rheumatoid arthritis. Inflammation caused by rheumatoid arthritis can compress nerves, especially in your joints.
  • Thyroid disease. People with thyroid disease are at higher risk of carpal tunnel syndrome.

Other risk factors include:

  • Diabetes. People with diabetes are at higher risk of nerve compression.
  • Overuse. Jobs or hobbies that require repetitive hand, wrist or shoulder movements, such as assembly line work, increase your likelihood of a pinched nerve.
  • Obesity. Excess weight can add pressure to nerves.
  • Pregnancy. Water and weight gain associated with pregnancy can swell nerve pathways, compressing your nerves.
  • Heredity. Some people appear to be genetically predisposed to conditions that lead to pinched nerves.


Tests and diagnosis

Your doctor will ask about your symptoms and conduct a physical examination.

If your doctor suspects a pinched nerve, you may undergo some tests. These tests may include:


  • Nerve conduction study. This test measures electrical nerve impulses and functioning in your muscles and nerves. A specialist places electrodes on your skin. The study measures the electrical impulses in your nerve signals when a small current passes through the nerve.

Test results tell your doctor whether you have a damaged nerve.

  • Electromyography. During an EMG, your doctor inserts a needle electrode through your skin into various muscles. The test evaluates the electrical activity of your muscles when they contract and when they're at rest.

Test results tell your doctor if there is damage to the nerves leading to the muscle.

  • Magnetic resonance imaging (MRI). This test uses a powerful magnetic field and radio waves to produce detailed views of your body in multiple planes.

This test may be used if your doctor suspects you have nerve root compression.


Treatments and drugs

The most frequently recommended treatment for pinched nerve is rest for the affected area. Your doctor will ask you to stop any activities that cause or aggravate the compression.


Depending on the location of the pinched nerve, you may need a splint or brace to immobilize the area. If you have carpal tunnel syndrome, your doctor may recommend wearing a splint during the day as well as at night because wrists flex and extend frequently during sleep.


Physical therapy

A physical therapist can teach you exercises that strengthen and stretch the muscles in the affected area to relieve pressure on the nerve. He or she may also recommend modifications to activities that aggravate the nerve.


Medications

Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil, Motrin IB, others) or naproxen (Aleve), can help relieve pain and alleviate inflammation around the nerve.


Corticosteroids, given by mouth or by injection, may help minimize pain and inflammation.


Surgery

If the pinched nerve doesn't improve after several weeks to a few months with conservative treatments, your doctor may recommend surgery to take pressure off the nerve. The type of surgery varies depending on the location of the pinched nerve.


Surgery may entail removing bone spurs or a part of a herniated disk in the spine, for example, or severing the carpal ligament to allow more room for the nerve to pass through the wrist.


Prevention

The following measures may help you prevent a pinched nerve:


  • Maintain good posture.
  • Incorporate strength and flexibility exercises into your regular exercise program.
  • Limit repetitive activities and take frequent breaks when engaging in these activities.
  • Maintain a healthy weight.



Information retrieved from:  www.mayoclinic.org