Do you have any numbness, tingling or shooting pain? Does it go into your hands or feet? While a “pinched nerve” may be an accurate description, the truth is that a pinched nerve is really not the best diagnosis because it is a general term. The real question is, where is the location of the pinched nerve?
Often times, patients come into the office with numbness or tingling into the extremities and they are often diagnosed with a disc bulge or disc herniation, but that is often times incorrect!
Disc Herniation and. Peripheral Nerve Entrapment
A disc bulge or herniation is when material of the disc (fibrocartilage in the spine) protrudes out or even leaks out of the spine. In this condition, there can be direct pressure onto the nerve or irritation of the nerve roots from inflammation. If severe enough, it can cause symptoms that include shooting pain, numbness, tingling, and even weakness. Compression from the spine is considered a nerve root impingement.
A Nerve Entrapment is when a nerve gets “caught up” or compressed within the path that it runs. Nerve entrapments can occur as a result of bone spurs, trauma, weight gain, fluid retention, inflammation, scar tissue buildup, overuse syndrome, tight muscles, etc. When structures surrounding a nerve no longer (soft tissue) glide and slide properly, it can cause compression to these structures. Compression of a nerve within the extremities is called a peripheral nerve entrapment.
How to tell the difference?
Telling the difference between a pinched nerve from the back or a nerve entrapment can often be difficult since the symptoms may often be similar, that is one reason why you need an healthcare practitioner who is well versed in the diagnosis and treatment of it. The practitioner should test for nerve tension signs, weakness, as well as a host of other orthopedic testing prior to treatment. History of the injury is very important as well.
Typically (but not always), a pinched nerve that comes from the spine (herniation) may accompany pain in or around the spine. In both cases, patients may have radiating pain but in a nerve root impingement, the pain may extend from the spine and into the extremities (we call this peripheralization). There may also be a loss of range of motion within the spine and patients will have difficulty with sitting to standing as well as pain with abdominal core testing.
A peripheral nerve entrapment on the other hand, may exhibit localized pain and then show signs of peripheralization (radiation of the pain). Often times, the pain may come from a select area or region of the body and there may be an increase in symptoms after use of the joint or muscle. There are common locations (like the carpal tunnel, cubital tunnel, pronator teres syndrome, etc) in the body where nerves commonly become “trapped.” These areas should not be mistaken for a neck or spine injury. Again, these are referred to as peripheral entrapment sites.
Treatment
Both treatments focus on taking pressure off of the nerve; however, a pinched nerve in the spine should focus more on the musculature around the spine and decompressing the spine itself. Peripheral nerve entrapments should focus on releasing the pinched nerve as well as the associated soft tissue structures along the kinetic chain.
What to look for?
If left untreated, both of these conditions can get worse and can possibly lead to weakness as well as muscle atrophy. If you see muscle atrophy and weakness, this should not be neglected and you should seek treatment sooner than later.