Trapped Nerves

What Is a Trapped Nerve?

spinal region diagramThe term trapped nerve, also commonly referred to as a pinched or compressed nerve, is a general term encompassing a variety of different medical problems, relating to the compression or irritation of nerve roots exiting the spinal canal, caused by alterations in surrounding tissue. Radiculopathy is the medical term for this particular set of conditions. It is possible for nerves to become irritated or compressed in any place in the body, however outside of the spinal region is uncommon. The nervous system comprises of a complex network of nerves and cells that transmit signals and messages to and from the brain and spinal cord, all over the body; the compression of any one of the nerve roots interferes with the transmission of these signals.

The spinal cord is divided into four different regions and nerve irritation or compression can occur within any of these regions.

What Causes a Trapped Nerve?

There are a variety of different conditions that can cause irritation or entrapment of a nerve:

Herniated Disc

herniated discThis is one of the more common causes of a trapped nerve. Between each vertebrae in the spinal column are intervertebral discs; their function is to prevent the vertebrae bones from grinding against one another, as well as acting as shock absorbers, keeping the vertebrae separated from each other during physical activity. Each disc comprises of two parts; the annulus fibrosus, this is a tough fibrous material that forms the hard outer portion of the disc, and the nucleus pulposus; the centre of the disc, containing a soft gel like substance. A herniated disc, also referred to as a slipped disc or bulging disc, occurs when the tough exterior fibrous ring cracks or tears, allowing the gel like substance of the centre to protrude through the crack, bulging out and compressing nearby nerve roots.

Herniated discs are more common in the lower region of the back, but can occur at any point along the spine affecting either an individual nerve, or putting pressure on the actual spine cord. It’s not always possible to discern an exact cause of a herniated disc, but there are several factors that may contribute towards it, these include:

  • Spondylosis (various different age related conditions)
  • Trauma caused by an injury
  • Long term poor posture, lack of exercise
  • Smoking – Notoriously bad for general health, also associated with causing discs to lose some of their flexibility
  • Lifting heavy objects

Where pain, resulting from the compression of a nerve root caused by a herniated disc, is felt, will depend on the function of the particular nerve it is compressing. Treatment may include physiotherapy and pain relief medication, in more severe cases, surgery may be an option; however in the majority of cases, the protruding gel like substance compressing the nerve, will eventually shrink away from it with time, and symptoms will resolve themselves.

Trauma or Injury

An injury from an accident such as a fall or a car crash may result in inflammation of muscles, joints and tendons, ruptured or fractured vertebrae; all of which could cause the misalignment of the natural position of bones and tissues in the body. This results in them exerting pressure on the nerve roots exiting the spinal cord causing compression or irritation.

Poor Posture and Repetitive Movement

Poor posture over long periods of time can cause inflammation of tissues and muscles which may result in the compression of nerve endings. The same is true of certain repetitive movements during everyday work or routines.

Spondylosis

This is a descriptive, general term rather than a diagnosis, referring to spinal conditions caused by degeneration. Some of the conditions this term encapsulates may have secondary effects, such as the compression or irritation of nerves. Examples of conditions associated with Spondylosis include but are not limited to, the following:

Degenerative Disc Disease

As a natural part of the ageing process, the intervertebral discs lose their water content and begin to dry out, resulting in shrinkage and increased fragility; leaving them in turn, more prone to herniation where bulging disc nucleus comes into contact with a nearby nerve roots causing nerve pain.

Osteoarthritis

A form of arthritis in the spinal region causing the breakdown of the protective cartilage of the joints that link the spinal vertebrae together, intervertebral discs dry out and shrink, as the discs lose height due to shrinkage, the vertebrae are moved closer together. In response to the collapsed disc and break down of cartilage in the joints, the body produces more bone to try and repair the damage. Bone at the edge of the joints begins to grow outwards in spurs – commonly referred to as bone spurs. They grow around the disc in an attempt to strengthen it, causing the spine to become stiffer, as well as narrowing the openings where the spinal nerves exit the spinal cord, therefore pinching or trapping them.

Spondylolisthesis

This describes a condition where one of the spinal vertebrae slips out of place, when this happens it can compress or irritate nearby nerve roots, this can occur at any place in the spine. If for example, the slipped spinal vertebrae compress the sciatic nerve, it can cause Sciatica.

Spinal Stenosis

Another age related condition that involves changes to the spine, Spinal Stenosis occurs when the spinal canal, containing the spinal cord begins to narrow. This results in the compression or entrapment of nerve roots and the spinal cord, producing various nerve related symptoms depending on where the narrowing occurs. Spinal Stenosis can have various different causes including Osteoarthritis, Ankylosing Spondylitis, a tumour, an unusually narrow spinal canal amongst other things. Spinal Stenosis can possibly result in further complications such as Cervical Myelopathy.

Treatments for Spondylosis

For most symptoms associated with differing conditions of Spondylosis, traditional conservative treatments are used such as; physiotherapy, specific strengthening exercises and pain relieving medication are all used to manage symptoms. In some severe and extremely persistent cases, surgery can be an option.

Rarer Conditions Relating to Trapped Nerves

Cauda Equina

A rare and extremely serious condition that requires immediate medical attention. The nerves and nerve endings in the lower back become suddenly compressed, causing various problems such as lower back pain, incontinence, uncontrollable bowel movement, numbness or paralysis, which if left untreated may become permanent.

Cervical Myelopathy

This occurs when severe Spinal Stenosis causes excessive narrowing of the spinal cord resulting in pronounced compression of the spinal cord, interfering with the messages sent to and from the brain to the rest of the body. It can result in serious problems such as; difficulty walking, severe loss of coordination, bowel incontinence and urinary incontinence. This condition requires immediate medical attention, as permanent spinal cord damage can occur if left untreated.

Tumours

A growth within the spinal region may compress nerve root endings or the spinal cord itself, causing nerve pain related symptoms, depending on the area affected by the tumour.

Symptoms and Diagnosis

Symptoms can include pain of varying intensity, from mild to severe; it can produce other sensations such as pins and needles, numbness and weakness in the muscles. The sensation of numbness and weakness of muscle around the area of pain, may denote that the compression of the nerve is increasing and the condition is therefore worsening.

Symptoms may vary considerably depending on where the irritation or compression of the nerve occurs. One of the main complications when diagnosing a trapped nerve, is pain may be felt in the area of the actual trapped nerve itself, or as in many cases, referred to the part of the body that the particular nerve serves, manifesting itself in that area.

Referred pain can at times also be confusing for patients, as pain radiates away from its source; a classic example of this is Sciatica, where compression of the sciatic nerve in the lower back often causes shooting pains felt through the legs, and further symptoms felt right into the feet and toes.

trapped nerves and spinal cordThe symptoms are the first step in evaluation, before moving on to further diagnostic procedures such as CT scans – these provide detailed examinations of the bones, MRI scans to examine tissues, the spinal cord and nerve roots.

Do You Have Pain in Your Neck?

Trapped or Irritated Nerves in the Cervical Region

In the majority of cases, pain will be felt in the neck itself, as well as in the arms. This is one of the most common symptoms of Cervical Radiculopathy, shooting pains that travel down one of the arms, described as Brachialgia. Certain neck movements, such as turning the head to the side may provoke more pain. Other symptoms include the following:

  • a loss of sensation
  • feeling of pins and needles in the hand and or fingers
  • weak muscles in the shoulder, arm and hand

Do You Have Pain in Your Chest?

Trapped or Irritated Nerves in the Thoracic Region

Pain felt in the chest and torso area may occur when the nerves are trapped in the middle portion of the spine (thoracic region) it is not however, common in this region.

Do You Have Pain in Your Lower Back?

Trapped or Irritated Nerves in the Lumbar Region

Pressure and irritation of the nerve roots in the lower back region is known as Lumbar Radiculopathy; more commonly referred to as Sciatica. The sciatic nerve is the largest single nerve in the whole body and is responsible for the movements and sensations of large portions of the legs; it also innervates other principal nerves in the legs and feet such as, the tibial nerve and common peroneal nerve. Compression of the sciatic nerve can cause a range of different symptoms, typically felt in the legs. These vary in severity, from sharp excruciating pain that can be debilitating, to only mild symptoms. Other patients may experience sensations of pins and needles, numbness or tingling, that can radiate from the lower back down as far as the feet and toes.

Treatments

In the majority of cases of trapped nerves, conservative medical management is the chosen form of treatment. Conservative treatments include pain relief medication and physiotherapy to help correct poor posture as well as encouraging mobility and exercise. Some form of psychological treatment may also be needed to help patients cope with their symptoms.

Pain Medication Used to Relieve Trapped Nerve Symptoms

  • over the counter analgesics
  • over the counter non-steroidal anti-inflammatory drugs (NSAIDs)
  • muscle relaxants
  • stronger prescription painkillers such as opiods
  • tricyclic antidepressants
  • anticonvulsants
  • spinal injections of corticosteroid and anaesthetic

Physiotherapy

A good physiotherapy program can be extremely beneficial in the treatment of trapped nerve related conditions. Regular use of certain stretches and exercises can help improve strength, mobility and posture, as well as encouraging a more active day to day routine.

Pain Management Programmes

This is a combination of treatments to help relieve symptoms, improve the trapped nerve related condition and overall quality of life. A Pain Management program consists of a multi-disciplinary team of pain management consultants, physiotherapists, psychologists, surgeons and other health professionals.

Any type of chronic pain can have negative effects on a patient’s overall quality of life. For fear of suffering from even more pain, patients do in some cases, begin to develop beliefs about their own physical limitations, and therefore become less and less active. A good pain management program can help address and overcome these issues with the combined use of physiotherapy, medication and psychological treatment; it can also not only help patients cope with attacks of compressed nerves, but also help them adopt necessary beneficial lifestyle changes.

Prevention

As an overall preventative measure, maintaining an active healthy lifestyle is extremely beneficial to general health. Regular exercise, upholding correct posture and a healthy diet throughout life will strengthen bones, muscles and tissues; therefore, minimising the effects of wear and tear during the ageing process, and ultimately decreasing the likelihood of various age related conditions.

Surgery

Minimally Invasive Surgery

Sometimes referred to as keyhole surgery, this procedure as its name would suggest, is the least invasive form of surgery and is usually the preferred surgical option for clinicians as it only involves a small incision and is performed using micro instruments. A small incision is made and a tubular retractor is inserted, to create a small tunnel to access the spine by holding the muscles out of the way. Via the retractor, the surgeon inserts small instruments into the retractor and is able to operate, a microscope or fluoroscopy is used to help guide the surgeon during the procedure.

This type of surgery is less traumatic with a comparatively shorter recovery time than conventional open surgery – many patients are able to return home the same day as the procedure, there is also a lower risk of complications arising, less post-operative medication is needed and an earlier return to daily activities can be expected.

Conventional Surgery

A single larger incision is used to access the spinal column, the surgeon then retracts the surrounding muscles and tissue to reveal the treatment area and perform the procedure. It also however, increases the risk of complications, and recovery time can be lengthy with no guarantee of success.

Surgical Procedures for Trapped Nerve Treatment

The following procedures can be performed as conventional open surgery or minimally invasive surgery depending on the individual circumstances.

Laminotomy

This involves the partial removal of the lamina in order to relieve the trapped nerve.

Foraminotomy

The widening of the foramen (the opening in between the vertebrae and the nerve root) to relieve pressure on the nerves.

Laminectomy

Complete removal of the lamina

Discectomy

Removal of part of the bulging disc causing nerve compression

Risks of Surgery

  • Infection
  • Bleeding
  • Damage to the spinal cord
  • Adverse reaction to anaesthesia

Recovering from Surgery

Each patient responds differently to treatment, some better than others. The recovery process will very much depend on the extent of damage to the nerve prior to surgery as well as the type of treatment.

Pain relief medication and anti-inflammatories may be prescribed to reduce pain and swelling around the wound. Physio therapy may also be helpful and in some more severe cases, steroid injections may provide pain relief. Practising good posture and sleeping positions also play an important role in the recovery process.

Do Trapped Nerves Go Away?

In many cases, pain-related issues caused by trapped nerves will go away by themselves. A herniated disc causing trapped nerve pain, for example will in many cases repair itself, thus relieving the pressure on the nerve. Positive postural and lifestyle changes will be beneficial for a number of patients – in some cases however, pain becomes chronic and requires medical intervention.

 

Image credit: BruceBlaus Via Wikimedia Commons

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