If you have numbness, tingling and weakness in your arm or hand, there is a pretty good chance that you have a pinched nerve in neck. Oftentimes, people don’t realize several important factors that help doctors come up with the correct diagnosis of whether or not a person is having a pinched or "compressed" nerve or not. I am going to share with you some very interesting facts about how to determine what you, a family member or a friend may be having; whether it be pain, stiffness, weakness or abnormal sensations that are running down into your shoulders, arms or hands.
First, and very importantly, let me point out that there are literally hundreds of reasons that neck pain, shoulder pain, numbness and tingling, weakness and other neurological signs may appear. So please be aware of this and consult your medical doctor and/or chiropractic physician for more information regarding your condition. But generally, the most common signs of that I have seen in my practice for almost 33 years as a spine specialist is that a true pinched nerve in neck creates pain that radiates (transfers) into the arm, shoulder and/or hand, weakness in that extremely and paresthesia (abnormal sensations such as numbness, or tingling). Ironically, albeit unusual, there are times when a pinched nerve in neck will not produce much if any pain in the neck (cervical spine) itself; only neurological signs into the shoulder or arm. The nerves that control muscles and sensation into the arms and shoulders start in the lower neck (C5-T1) and travel into the shoulder, arm and hand via what is known as the “brachial plexus”.
The actual pinching of a nerve comes from various conditions but in people 20 to 55 years of age, the compression usually comes from a herniated or severely protruding disc. To visualize this, think of a main pipe line (spinal cord) that travels down within the spine itself (the spinal canal) and consider that at each vertebral level, there is a pair of small existing nerves (right and the other on the left) that transmit and receive neurological impulses corresponding to each vertebral level. Most commonly, a pinched nerve in neck will be what is called unilateral, meaning that the nerve root impingement is effecting only one side of your body, effecting one of the two nerves that exists that particular level. There certainly are conditions that effect both upper extremities simultaneously but these are less common, can be more severe in nature and usually involve the collapsing of almost the entire disc at that level vs. the more common “focal” herniation that extrudes into a quarter or perhaps one-half of the disc’s circumference.
I noted above the at disc lesions commonly effect people 20-55 years of age and the reason is that the discs are more hydrated, have more protein and are more “plump” if you will, and thus are more sucesseptable to tearing and bulging because of those properties. On the other hand, a person 55 and older generally have discs that are slightly thinner, have less hydration and have less protein content, in their discs, properties that ironically reduce their chances of tearing but lead to more joint and bone changes associated with degenerative arthritis or degenerative joint disease (DJD). These boney changes and decreased disc height can literally decrease the dimensions of the windows (foramen) that the nerves exit each level also lending a possibility of a pinched nerve in neck.
However, in contrast, is it important to understand that there are also some very common conditions that mimic a pinched nerve from a disc protrusion or herniation. So many people are over diagnosed or improperly diagnosed with a “pinched nerve” but in actuality, have an issue with muscle strain, a subluxation, ligamentous injury, trigger points, joint or cartilage inflammation, and other types of strains and inflammatory conditions that produce similar if not identical radiating pain into the shoulder blades, shoulder girdle, arms and hands.
One of the main defining differences between a true compression of a nerve, what in this article I am referring to as a “pinched nerve in neck”, and other causes of pain and tingling into an extremity is MUSCLE WEAKNESS. This is a sign to me that I will need to order an MRI to better ascertain the exact level and degree of pathology as generally, these cases are more serious and oftentimes need surgical intervention. With that said, it is also possible to have minor compression or chemical irritation to a nerve root that is a precursor or create very minor weakness that can be treated conservatively and be very successful. However, if a nerve is severely compromised, it will generally not respond to gentle conservative care such as mobilization and traction and may indeed need surgical intervention to relieve the prevailing cause.
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