The nervous system is an intricate network that allows information to travel through your body. A Pinched nerve in your neck is agonizing. Information from various places in the body is delivered to the brain. Information regarding the position of where your neck is in relation to your body (proprioception). Sensory information of how soft the fabric is you just touched.
Your nerves also enable your brain to send messages to your muscles to move your joints. Any precision task, like writing or playing an instrument, is planned in the brain. Information of which muscle to contract when is then delivered to your hands. Damage or injury to the nerves can lead to an interruption of this communication system, with painful and debilitating consequences.
Each person’s case is unique and we want to address your specific needs. If you would like us to investigate or provide some insight, we invite you to contact us by clicking the link below.
What do the nerves in my neck do?
Your nerves function like power cables. Your nerves run from the main power supply (the brain) all the way to the tips of your fingers. Like power cables, our nerves are also enclosed within a sheath (Myelin sheath). The myelin sheath protects the nerve, like the plastic around a power cable. It also enhances the speed at which a messages is carried. Think broadband versus fibre. Our nerves can also glide within the myelin sheath that surrounds it.
These power cables are responsible for two way communication from the brain to the fingertips. The brain can send instructions to the nerves to move the muscles to write or type. The nerves can send information to the brain about sensation (touch, temperature, pressure, position and nociception & pain).
Where are the nerves in my neck?
From the spinal cord nerve roots exits above each vertebra, forming nerve roots C1 – C8. These nerves come together and split apart to form an intricate network of routes, almost like a train map, think Gautrain interchanges and multiply that to form Berlin’s Ubahn. Your nervous system is very complex. These routes run along the neck to the arm, to form the brachial plexus and then divide to form the three main peripheral nerves (median, ulnar and radial) that supply the arm and hand.
Nociceptors are found abundantly in our bodies. Their function is to relay noxious (potential or actual damage) messages from the body to the brain. Nociception acts as an alarm to warn you of possible or actual damage to your tissues. The alarm going of will cause pain in order for you to get away from the danger or stop doing what is hurting you. Our nerves activate reflexes to protect us from injury or further tissue damage.
Nerves serve a very important role in our bodies. Therefor nerves have a lot of nociceptors themselves. This might sound confusing. The heart pumps blood through your body, right? The heart also pumps blood to the heart (through coronary arteries). That means the heart has a supply of oxygen and nutrients that it needs to do it’s job. The nerves have nociceptors to protect them, an early warning for the important power cables of communication. This makes nerves highly sensitive, that means easy to set off the alarm. Pain from the nerve itself have been compared to toothache. Now imagine pinching this highly sensitive structure, just like the dentist drilling into your tooth without any analgesic.
What can go wrong?
Pinched nerves in the neck can be divided into two categories.
Nerve root irritation because of an overstretch injury (Neuropraxia). When the myelin sheath is damaged, but the nerve inside is intact, the nerve may become irritated because of direct pressure and an inability to glide within the sheath. This may cause a temporary interruption of the nerve impulses, leading to weakness of grip strength and a lot of protective muscle spasm.
This usually happens when the entire nerve is pulled. For adults think grabbing onto something if your body is falling and coming to a sudden stop when your body falls below your hand. It can also happen during natural childbirth if the baby’s head is pulled at an angle.
Inflammation around the nerve
Inflammation can accumulate around the nerve due to injury to the disc or facet joint. This is quite a close knit space, so anything extra in the area will affect the nerve. OR the nerve in the neck may be compressed, usually by a another structure very close to the nerve, the main culprit is a disc bulge (herniation).
Compression – Think hose pipe that gets pinched close. This may happen if you had pressure on that area for a long time. This can happen at the nerve root, where a short period of compression will lead to major pain or further along the nerve, which mostly happens when people are under the influence and spend the night sleeping on their arms at the bar. The entire nerve is intact, but the pressure at that point causes the signal to be diminished or lost. This can lead to numbness and an inability to move your arm. Long term compression may compromise the circulation to the nerve, which can lead to permanent damage.
Axonal injury – the nerve is still intact but the strands are stretched like an elastic that’s worn out and unable to recoil, this mostly happens with a direct pull, like falling from a tree and grabbing onto a branch This may influence the nerves ability to work at the same speed as before surgery (Neurotmesis).
Completely severed nerve: The nerve is cut, and the two ends separated completely, so no signal or message can be relayed along the path of the nerve. This will only happen in traumatic injuries, like a knife stab.
How does nerve pain feel?
When the nerve is pinched you will experience neck pain and muscle spasm, but more excruciating will be the actual nerve pain. Nerve pain may feel like pins and needles, numbness and toothache type pain spreading down your arm. This may lead to strange sensations running up and down your arm, like ants crawling over your skin, or water running down your arm. You are not losing your mind. Your power cables are sending abnormal signals.
Symptoms of nerve root irritation
- Over sensitivity to normally non painful sensations (irritation from clothes/sheets rubbing against your skin)
- Pins and needles
- Weakness (Less power in your shoulder, elbow or grip) because of the pain
- Sensation testing will reveal hypersensitivity/hyperactivity of reflexes
Symptoms of nerve root compression
- Numbness along the line of the nerve root/ branch being compressed
- Complete loss of muscle power or movement in the shoulder, arm, forearm hand or fingers
- Sensation testing will reveal decreased or absent sensation/loss of reflexes
As discussed the nervous system is very complex, and the evaluation of the nervous system is complex too. Nerves are tested to evaluate their ability to relay sensation, touch, temperature messages and reflexes. It is nearly impossible to test yourself. To determine if your neck pain may be caused by a pinched nerve in your neck you can do the following test. It will show irritation from the brachial plexus.
How bad is it?
As the nerves in the neck are protected by the spine and muscles, you cannot assess the severity of the situation on how your neck looks. Bruising will not be visible, even the inflammation might not be visible except your neck feeling warm.
As long as you can feel, even if it is excruciating pain, it is a good sign. There nerves are still working and sending a lot of warning signals to your brain. When your arm feels numb, you are unable to close a strong fist or letting objects fall, your nerve is not functioning anymore.
Diagnosis & Tests
We are able to determine if the pinched nerve is irritated or compressed through specific testing. You can expect sensation and reflex testing during your evaluation. If your symptoms have been going on for long there may be damage to the nerve. We can evaluate the nerve’s ability to function. We will tailor your treatment to fit your problem.
Soft tissue, like disc and nerves, can not be seen on X-rays. X-rays will show us the integrity and alignment of the cervical vertebrae. This will enable us to see if there are any pathology of the vertebrae or loss of disc space. This may be an indication that the pinched nerve is caused by either inflammation around the disc or a bulging disc.
Specialist referral is needed for a MRI scan. This will enable us to see all the structures in the neck, including the discs and nerves. The MRI will show exactly where the nerve is being pinched and what is pinching it. If you have already had imaging done, please bring it along to your first consultation.
Why is pinched nerve pain not going away?
You might have experienced the problem before, had it treated, the pain was gone but is now coming back. It is very important to complete treatment until the final phase. You might be aggravating your symptoms just by doing everyday tasks, like driving or computer work. It is important to not only look at your neck, but also at what’s pinching on the nerve. You can expect to make some changes to your posture or desk setup.
What makes pinched nerve in the neck worse
Repeated “testing” can aggravate your symptoms. Like looking over your shoulder to see if it is still sore.
‘Stretching’ your neck
A big problem we see with pinched nerves in the neck these days
A lot of patients come in terrified of moving their own necks because of X ray reports. “You have the spine of a 70 year old” is something we hear often. Do not fear, we are here to help you. Please bring any previous investigations and your concerns with you, we will discuss and explain anything that may be worrying you. A lot of people tend to stop their treatment as soon as they feel better. It is important to complete your rehabilitation to the end. If you wait too long the pinching may get progressively worse. Rather stop it in it’s tracks, than waiting until you have chronic pain.
Physio treatment for pinched nerves in the neck
The first aim of treatment will be to reduce your pain. The muscles are likely to cause a lot of stiffness. The spasm forms to protect the nerve. Joint mobilisation to increase space around the pinched nerve will be done. Neural mobilisation will be done and given as homework to ensure the nerve gets what it needs to heal and prevent the risk of long term damage. If the pinched nerve has been getting worse over the last few months or years, chances are your posture is contributing to the problem. Specific exercises will be included in your treatment to prevent this from happening again.
If your symptoms do not decrease with physiotherapy we will refer you to the right place to get the imaging you need done or consult a specialist.
Healing/ Recovery Time
You can expect to see us for up to two months. Initially twice a week until your symptoms have decreased, from there once a week. Your neck is just like other joints in the body and needs stability, which a lot of people lack. A rehabilitation program will be done with you to continue with at home.
In a severe case where the nerve is pinched because of compression from a bulging disc, medication may be needed to help reduce your pain. We are not prescribing practitioners and will refer you to your GP if needed. This is a short term strategy to relieve your symptoms while addressing the cause of the problem. If you are already taking over the counter medication with little relief it is worth having your neck properly assessed.
Surgery for pinched nerves in the neck
Surgery will only be considered if the nerve is in danger. That is you have no sensation and a lot of weakness. If not most specialists prefer their patients trying physiotherapy first.
If you do need surgery a decompression fusion is usually done from the front of the neck. Rods and screws and inserted to relieve the compression. There may be side effects to the procedure, neck rotation is sometimes limited because of the hardware.
What else could the pain be?
Pain from a tumor may present like a compression of the nerves in the neck. Your pain will be unrelenting and worse at night. You will probably have other symptoms too, like weight loss.
Vertebral artery insufficiency
The vertebral artery supplies oxygenated blood to the brain. If there is an injury to the artery you will experience symptoms of nausea, dizziness, double vision, loss of sensation around your mouth, difficulty swallowing or speaking.
Ligamentous instability may follow an injury. You will also experience symptoms of dizziness, headaches and nausea.
Thoracic outlet syndrome
Compression of the nerves and blood vessels in the neck. Symptoms will include poor circulation, discolouration and decrease in temperature of the affected arm.