Radiculopathy (Pinched Nerve)
Radiculopathy is the compression or irritation of a nerve. The pressure on the nerve by surrounding bones, muscles, tendons, or cartilage can result in pain, weakness, or a tingling sensation. Pinched nerves can occur anywhere in the body, but when a pinched nerve occurs in the spinal area, the irritation occurs where the nerve branches away from the spinal cord. While any nerve root can be affected, the lower cervical (neck) and lower lumbar (low back) levels are the most common. Nerve compression is commonly related to disc herniation or spondylosis (degenerative changes in the spine) and may occur with or without trauma.
Symptoms
The symptoms associated with radiculopathy are typically unilateral (affecting one side of the body). The pain can worsen with certain movements of the neck or low back and with prolonged sitting or walking.
- Pain. For cervical radiculopathy, the pain can radiate from the neck and down the arm. The pain radiates from the lower back down the buttock and leg with lumbar radiculopathy.
- Numbness or tingling often in the arm/hand or leg/foot.
- Weaknesses in the arm and hand with cervical radiculopathy and there may be difficulty lifting or holding things. Weakness occurs in the leg and /or foot with lumbar radiculopathy and this may be accompanied by difficulty walking.
- Loss of control and incontinence of bladder or bowel function is less common and can occur if the associated nerves become compressed.
Causes
- Radiculopathy is caused by impingement of a spinal nerve root. The most common cause of compression is disc herniation and/or degenerative changes in the spine.
- Spondylolisthesis (when a vertebra is out of alignment relative to the adjacent vertebra) may also contribute.
- Less common causes of nerve compression include cyst, fracture, infection, and tumor.
- Some research indicates that Radiculopathy may be more common in those who participate in contact sports, when compared to non-contact sports.
Risk factors for radiculopathy include:
- Family history of degenerative arthritis
- Poor posture
- Aging
- Repetitive motions
- Improper lifting techniques
- Obesity or excessive weight
Diagnosis
Radiculopathy may be diagnosed by:
- History and Physical Examination which may include evaluation of nerve function (testing reflexes, strength, and sensation).
- X-ray can show if there is arthritis, spine fracture, degenerative changes in the spine and/or vertebra alignment.
- CT scan or MRI for further evaluation of disc herniation and nerve compression or to rule out other causes
- EMG (electromyogram) can be done to assess the health of muscles and nerves
Treatment
Typically, radiculopathy can be treated successfully without surgery. Treatment recommendations depend on the severity of the radiculopathy and associated symptoms. Once the symptoms are gone, it is important to return to normal activities gradually.
- Medications such as non-steroidal anti-inflammatory drugs may be recommended for pain. Oral steroids are sometimes considered to reduce pain and inflammation.
- Steroid injections may be ordered for severe pain or pain that does not respond to other medications
- Surgery may be necessary to remove the compression on the nerve if symptoms don’t improve or worsen with more conservative treatments.
- Physical Therapy for exercises and sport-specific rehabilitation for athletes. Also, guidance on activity modification to improve symptoms.