Make It Stop

August 14, 2008 11:12 AM

What can physicians do to "fix" a pinched nerve?

The orthopedist thinks my shoulder and scapula pain and arm numbness may be caused by a pinched nerve in my neck, so I had a c-spine MRI this morning. Provided those reading the MRI do, in fact, detect a pinched nerve, what next? How can they make all the ouch go away?

posted by netbros to Health & Fitness (8 answers total)

Physical therapy, acupuncture, chiropractry, or more serious procedures, like where they cauterize part of the nerve
posted by poppo at 11:25 AM on August 14, 2008

A lot depends on exactly how the nerve is pinched, and whether there's any kind of damage to the vertebrae themselves.

In the best case scenario, you can have it worked out by a few chiropractic adjustments. This will only work if your discs and vertebrae are in good shape, but just misaligned.

Now, if you have any damage to the working parts in the area, it gets a lot different - and worse. Possibilities range from: "Let it heal" and get some physical therapy, to surgery to unb0rk the vertebrae that are pinching the nerve, to "you're out of luck, go for pain management".

Unfortunately, the fact is that there are SO many variables here means that none of us are going to be able to give a lot of meaningful advice.

The one thing that I will say is that you should probably get three different medical opinions. orthopedics is surprisingly subjective, and you might get different answers from every doctor you meet. Try to get a consensus based on what they see in the imaging, and work from there.

Good luck! I hope you find a way out. It's always bad to see someone in constant pain.
posted by Citrus at 11:25 AM on August 14, 2008

Unless they find something spectacularly wrong via the MRI, I would do everything I could to convince them to let me try therapy first if they start suggesting surgery. I cracked a vertebra in my neck and have a bulging disk. Every two years or so I get some severe nerve pressure related pain but a week or so of 15 or 20 minute per day sessions of light traction has always straightened it out so far.
posted by Carbolic at 12:20 PM on August 14, 2008

If, in fact, you are dealing with some sort of disc or vertebral damage that is compressing a nerve, make sure you get opinions from both orthopedists AND neurosurgeons.
posted by mistsandrain at 1:03 PM on August 14, 2008

Don't rush into surgery without exhausting physical therapy options first. Find a physical therapist who performs manual therapy and has an OCS certification (Orthopedic Certified Specialist), or is NAIOMT certified. These PTs should really know their stuff, and I'd recommend them over a chiropractor.

(no offense to chiros, there are many who are very good, but I'm not aware of a similar certification for DCs that would signify the level of expertise that these certifications would. I say to avoid chiros because the business model of some (not all) of them is to manipulate manipulate manipulate, not to get you out the door.)

If surgery is recommended to you, get a couple of opinions if you can, and ask your MD about the specific surgery to be performed. How many people who get this surgery have fewer symptoms, five years out? How many have symptoms that are worse? Has she performed this surgery before?

Do not be too alarmed by the MRI results -- keep in mind that many feel that a normal MRI result is in fact abnormal, and that it is not uncommon for people to be walking around symptom-free with MRIs that look quite alarming. Your objective in healing is to be performing functionally and be free from pain, not to have a pretty and flawless MRI result.

Best of luck!
posted by jennyjenny at 4:30 PM on August 14, 2008

I had a disc in my cervical spine that was putting pressure on a nerve, with resulting pronounced pain and tingling in my arm and hand. I had a lot of physical therapy that didn't help much. I tried acupuncture, which amazed me when a needle in my upper back sent a very perceivable twang down the same nerve that I'd been feeling in my arm and hand, but sadly, it too failed to solve the problem. Surgery seemed likely, but an epidural steroid injection was tried first. It cleared the problem completely. Years later, I still am 99% cured. Every time I see my doctor, she's a little incredulous that it worked and that it's still working, so I guess I'm something of an anomaly -- I think the injection has to hit the exact right spot or something. But, I'm so glad I avoided surgery, because while it can be minimally invasive, I've since learned that there tends to be something of a domino effect, with the discs above and below the repair bearing more stress afterwards, and eventually needing surgery themselves. So, avoid that route if you possibly can. Good luck.
posted by daisyace at 6:03 PM on August 14, 2008

Here is an older thread about pinched nerves in the spine, including my positive results from Cortisone shots over a couple of months.

I would not go to a chiropractor unless specifically referred to one by a specialist. There is a very real risk of doing permanent damage to the nerve if not treated correctly.
posted by shinynewnick at 7:02 PM on August 14, 2008

Response by poster: Followup after learning the results of the MRI.

While I do have a couple of slightly bulging cervical vertabrae, they are neither touching the spinal column nor nerves. The discs are not ruptured. All good news.

Unfortunately, the orthopedist is basically at a loss for my continuing shoulder pain. She did four cortisone injections last winter and will not do anymore for fear of damaging the rotator cuff. Time to seek a second opinion.

Thanks to everyone for your answers in this thread.
posted by netbros at 10:50 AM on September 4, 2008