What is a pinched nerve?
A pinched nerve is a compressed nerve. Surrounding tissues that press on nerve roots can cause pain, numbness and tingling in different areas of your body. In many cases, the cause is a herniated disk slipping out between vertebrae in the spinal cord and pressing on the spinal nerve that goes down the leg.
Most pinched nerves originate in the neck (cervical radiculopathy), upper middle back (thoracic radiculopathy) or lower back (lumbar radiculopathy). You can also experience pinched nerves in your hand, elbow and wrist (carpal tunnel syndrome for the wrist).
Pinched nerves can affect several areas of your body:
- A pinched nerve in the cervical spine can give you a stiff neck, and the pain and numbness can affect the shoulder and arm.
- A pinched lumbar nerve in the lower back can cause pain in your back, hips, buttocks and legs.
- Thoracic radiculopathy causes pain in your chest area. If you have severe chest pain, play it safe and call your healthcare provider.
A pinched nerve can be painful, but it’s usually treatable with rest, over-the-counter medication and physical therapy. Most people recover fully from a pinched nerve.
How common is a pinched nerve?
Pinched nerves are common; every year about 85 out of 100,000 adults in the United States are affected by pinched nerves. People of any age can experience pinched nerves, but those aged 50 and older are most likely to have them, due to arthritis and degeneration in the spine and other parts of the body.
Where do pinched nerves occur in my body?
Pinched nerves can happen throughout your body based on the location of the nerves being affected. The most common areas where you’ll feel the effects of a pinched nerve are the:
- Neck and shoulder (compressed cervical nerves).
- Back and upper chest (compressed thoracic and lumbar nerves).
- Arm and elbow (caused by pressure on the ulnar nerve; for example, pain in this nerve is felt when you hit your elbow’s “funny bone”).
- Wrist and hand (often caused by carpal tunnel syndrome).
Will a pinched nerve go away on its own? How long does it take?
Yes, most will with time (normally four to six weeks). You can improve symptoms with rest and pain medications such as naproxen, ibuprofen or acetaminophen. If home treatment doesn’t provide you relief after several days, call your provider, who’ll give you more guidance. You may be asked to come to the office for evaluation and tests.
Can a pinched nerve lead to more serious problems?
A pinched nerve can become serious, causing chronic pain, or even lead to permanent nerve damage. Fluid and swelling can do irreversible damage to the nerves, so be sure to contact your provider if your symptoms worsen or don’t improve after several days.
Symptoms and Causes
What causes a pinched nerve?
Some conditions can cause tissue or bone to compress a nerve and cause symptoms. These include:
- Rheumatoid arthritis causes inflammation in the joints that may pressure nearby nerves.
- Aging leads to “wear and tear” on the spine and its discs. Over time spinal discs can lose water content and flatten. The vertebrae (bones in the spinal cord) move closer together, and in response the body forms growths of bone. These bone growths, or spurs, can compress nerves.
- Sudden injury from sports or an accident can result in a pinched nerve. Awkward lifting, pulling, or twisting movements can cause a herniated disc.
- Repetitive motion tasks, like extended periods of typing on a keyboard, can cause stress in your wrist and hand. This may lead to carpal tunnel syndrome (tendon inflammation pressuring the median nerve in your arm).
- Obesity: Excess weight can swell your nerve pathway, putting pressure on nerves.
- Pregnancy: The extra weight can result in compressed nerves.
- Diabetes: High glucose (sugar) levels in the blood damage your nerves.
What are symptoms of a pinched nerve?
- Pain (sharp or a dull ache).
- Muscle weakness.
- Tingling (“pins and needles” sensation).
- Sensation that your hand or foot has fallen asleep.
Diagnosis and Tests
How is a pinched nerve diagnosed?
You’ll want to visit a healthcare provider about your pinched nerve if it’s not responding to conservative treatment at home. To find the source of the pinched nerve, providers physically examine your neck, arms, shoulders, and wrist and hands. They’ll look for muscle weakness, test change in reflexes and ask about the different sensations you’re feeling.
If necessary, you may be asked to undergo one or more of these procedures to track the source of the problem:
- X-ray: An X-ray can show narrowing and changing alignment of the spinal cord, and fractures.
- Computed tomography (CT) scan: A CT shows 3D images and more detail of the spine than an X-ray.
- Magnetic resonance imaging (MRI): An MRI can show if damage to soft tissues are causing the nerve compression, or if there is damage to the spinal cord.
- Electromyography (EMG): Electrical impulses of muscles measured by an EMG, along with nerve conduction studies, can help determine if a nerve is working normally. This helps your provider see if symptoms are caused by pressure on spinal nerve roots, or if nerve damage is caused by another condition like diabetes.
Management and Treatment
How is a pinched nerve treated?
Medical management (non-surgical) is the first line of treatment for pinched nerves. This includes:
- Time and rest: For many people, time takes care of a pinched nerve and it doesn’t need treatment. The pain should go away in a few days or weeks.
- Ice and heat: Apply ice and heat as you would with any swollen area for temporary relief.
- Over-the-counter pain relievers: Acetaminophen and non-steroidal anti-inflammatory drugs (NSAIDs) may help your symptoms. NSAIDs include ibuprofen and naproxen.
- Splints and cervical collars (for wrist and hand or neck): Your provider may advise you to wear a soft hand splint or neck collar for a short time to limit motion as you heal.
- Corticosteroids: Your provider may prescribe strong anti-inflammatory medications like prednisone to relieve pain. These can be taken orally (through the mouth) or injected directly into the affected area.
- Physical therapy: Stretches and light exercise can help ease pressure on your nerves and relieve minor pain. Talk to your provider or physical therapist about what types of exercises are best for the type of pinched nerve you’re experiencing.
Surgery is the last resort in treating a pinched nerve when non-surgical treatment hasn’t relieved pressure on nerves. Examples of surgeries that fix spinal nerve compression include:
- Anterior cervical diskectomy and fusion (ACDF): Surgeons remove disk or bone spurs that have compressed nerves from the spine, then stabilize the spine through fusion. In fusion, the vertebrae are joined, eventually forming a single, solid bone.
- Artificial disk replacement (ADR): The injured disckis removed from the spine and replaced with an artificial part, much like a knee or hip replacement. This allows more flexibility in the spine.
- Posterior cervical laminoforaminotomy: The lamina is the arching bone backside of the spinal canal. The surgeon thins down the lamina for better access to the damaged area and removes the bone spurs and any tissues that are compressing the nerve.
After these surgeries, a full recovery of strength and motion may take several months. Most people can return to a desk job within a few days to a few weeks after surgery. Depending on your surgery, a return to full activities may take three to four months. Your surgeon will give you a general idea of your recovery time, and some people may take longer.
- Surgery for carpal tunnel syndrome: To relieve nerve compression in your hand’s carpal tunnel, there are two surgical options: open (one 2-inch cut) and endoscopic (minimally invasive, with one or two ½- inch cuts). Both are done to cut the ligament around the carpal tunnel to take pressure off the median nerve. In the open surgery, the surgeon makes a 2-inch incision into your wrist and directly cuts the ligament. In the endoscopic, the surgeon makes one or two small cuts and a tiny camera guides the surgery. This should relieve your symptoms and the ligament will grow back together with more space for the nerve to pass through. Full recovery can take 10 to 12 weeks but you will be able to do limited activities (such as driving) very soon after the surgery.
How do I prevent a pinched nerve? Not all pinched nerves can be prevented, but you can lower your risk if you:
- Maintain a healthy weight and good posture.
- Do stretching exercises to keep muscles strong and flexible.
- Don’t sit or lie in one position too long, or cross your legs for an extended period. This can lead to a compressed nerve in your leg.
- Try to limit and take breaks from repetitive motions (such as typing). Use wrist rests while working with a keyboard.
Outlook / Prognosis
What is the outlook for a pinched nerve?
Many people recover fully from a pinched nerve with home treatment. When medical or surgical treatment is needed, the outlook for full recovery is excellent.
When should I see my healthcare provider about a pinched nerve?
If the pain and other symptoms of your pinched nerve hasn’t shown signs of easing up after several days, call your provider.