Pinched nerve in neck


Q: I have a pinched nerve in my neck which makes my shoulder feel like a giant toothache. My neck pops occasionally giving me relief for a little while until my neck pops back out of place then the pain comes back. During the time my neck is out and my shoulder is hurting i can only move my shoulder a little. when the pain is not present i have full mobility. what should i do to remedy this situation permenently?


A:    Most likely what you described seems to correspond to a cervical nerve compression, but it would be also important to rule out inflammation of the peripheral nerves at the level of the arm and hand  as well a rotator cuff tendinitis or impingement syndrome. In the younger patients, cervical radiculopathy may be a result of a disc herniation (bulging discs) or an acute injury causing impingement of an exiting nerve. In the older patient, cervical radiculopathy is often a result of spinal canal narrowing from bone (osteophyte) formation, decreased disc height and degenerative changes due to aging process. The same described before for the cervical spine applies to the lower back in terms of cause of pain and numbness in the legs, same causes, different spinal level. The treatment strategy usually includes: physical therapy program aimed to reduce pain and inflammation, and the use of anti-inflammatory drugs (“Motrin”, “Aleve”), also a re-education of habits and posture to improve quality of life. You should be independent in a stretching and strengthening program and continue with these exercises under the periodic supervision of a physical therapist initially and then completely on your own. Patients whose condition fails to improve with a comprehensive rehabilitation program and selective injections should be presented with a surgical evaluation. Often, patients should show progressive improvement over the first 6-8 weeks with conservative treatment. If there is no significant improvement in this time frame, consider a surgical evaluation.

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