Neural Impingement (Pinched Nerve): Causes, Symptoms, and Treatment
Neural impingement (radiculopathy/compressive neuropathy) occurs when a nerve is compressed, stretched, or irritated by surrounding tissues.
Common Causes by Region
| Region | Common Causes |
|---|
| Cervical (neck) | Herniated disc (C5–C6, C6–C7), foraminal stenosis (osteophytes, uncovertebral hypertrophy), spondylosis |
| Lumbar (low back) | Herniated disc (L4–L5, L5–S1), spinal stenosis, spondylolisthesis, facet cyst |
| Peripheral | Carpal tunnel (median at wrist), cubital tunnel (ulnar at elbow), peroneal (fibular head), tarsal tunnel (tibial at ankle) |
Other Etiologies
- Bone spurs (osteophytes): Degenerative joint disease narrowing neural foramina.
- Herniated discs: Nucleus pulposus extrusion → direct compression + chemical irritation (phospholipase A2, TNF-α).
- Muscle entrapment: Piriformis syndrome (sciatic), pronator teres (median), scalenes (brachial plexus).
- Tumors: Schwannoma, neurofibroma, metastatic deposits, synovial cysts.
- Edema/inflammation: Post-traumatic, post-surgical, inflammatory neuritis.
- Metabolic: Diabetic amyotrophy, hypothyroid neuropathy (compression susceptibility).
Clinical Features
- Pain: Radicular (dermatomal), burning, shooting, electric.
- Sensory: Numbness, paresthesia, hypoesthesia in dermatome.
- Motor: Weakness, atrophy, fasciculations (chronic), reflex loss.
- Aggravation: Valsalva, neck/back movement, specific positions.
Treatment Algorithm
- Conservative (6–12 weeks): Activity modification, NSAIDs, neuropathic agents (gabapentin, duloxetine), PT (traction, mobilization, nerve glides, core strengthening), epidural steroid injection (radiculopathy).
- Surgical indications: Progressive motor deficit, cauda equina syndrome, intractable pain >3–6 months, structural lesion (tumor, cyst).
- Peripheral entrapments: Splinting, ergonomics, decompression surgery (carpal/cubital tunnel release).
Prevention
- Core strengthening, posture, ergonomics, weight management, proper lifting, smoking cessation (disc health), regular movement breaks.
Early diagnosis prevents irreversible axonal loss. EMG/NCS confirms localization and severity; MRI visualizes structural compression.
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