What exactly is a Trapped Nerve?
Nerves may be trapped at several points along their course. Those points of entrapment outside of the spine are rare. The focus of this page is upon nerves becoming trapped in the spine. The term trapped covers a range of situations in which the following may produce a range of symptoms from irritation to frank loss of function presenting as pain, pins& needles, numbness or weakness.
These symptoms may arise from:
- Nerves may become tethered by scarring, by excessive bulging of the disc wall (slipped disc)or overgrowth of the facet joint or slippage of one vertebra upon another as the nerve exits the spine through the outlet tunnel termed the foramen.
- In the midline of the spinal canal the disc may bulge or disrupt (“Slipped Disc”) thus irritating, tethering or compressing the nerve(s). This may be worsened by in-folding of ligaments in the back of the spinal canal as the discs loose height in the front or the facet joints become overgrown or form small cysts which crowd towards the midline reducing available canal space.
In reality, this is a ‘catch-all’ term for a range of medical problems that relate to the degree of irritation or compression of the nerve by the ‘discs’ of soft tissue which separate the vertebrae in the spinal column or problems in the exit route of the nerve as they leave the spine.
Where does it hurt?
A Trapped Nerve can occur anywhere along the length of the spinal column from the neck to the lower back. The condition may arise in the neck (cervical spine), back of chest (thoracic spine) or lower back (lumbar spine). The symptoms may be a combination of pain in the local area of the spine and pain radiating outwards from that point.
- So in the neck, there may be midline neck pain with pain radiating to the shoulder and down the arm to the fingers.
- In the thoracic region, there may be midline posterior chest pain with pain radiating around the ribs to be felt as deep chest pain or pain in the abdomen.
- In the lumbar spine, there may be midline lower back pain with pain radiating to the flank, buttock and down the leg to the toes.
As the trapping becomes more pronounced so the nerve function gradually fails with numbness and muscle weakness developing in the area of the pain. On occasions the compression becomes so pronounced that the muscle function deteriorates markedly but because the nerve is so tethered the nerve does not move and pain diminishes. Consequently the patient thinks they are improving when in fact the condition is worsening.
How is a Trapped Nerve diagnosed?
One of the complications in diagnosing a Trapped Nerve is that whilst the apparent pain or problem may manifest itself in one part of the body, the actual cause of the problem can lie in a different part of the spinal region. For this reason, medical professionals pay close attention to the symptoms as a first step in evaluating what the problem may be, before moving on to more focused diagnostic procedures such as MRI scans but these can be misleading – hence the need for aware state diagnosis.
Is the pain in your lower back?
Various combinations of pain in the lower back, buttock, groin or leg can arise either from irritation within the disc itself, or when the disc causes irritation and tethering / trapping of the adjacent nerves. The pain, which when it spreads below the knee, (termed Sciatica), occurs when the nerve becomes increasingly trapped in the lumbar spine. This may cause numbness or pins and needles in the leg and be associated with weakness such as “foot drop” (difficulty lifting the toes and foot up) or weakness when pushing off with the foot.
Is the pain in your neck?
Neck pain, headaches and pain in the face, shoulders, arms and hands may be created when the nerve is trapped in the neck. This may cause numbness or ‘pins & needles’ in the face, shoulder, arm or hand and may also be associated with weakness of shoulder, elbow, wrist or hand movements. Any one of these symptoms, or a combination of them, can indicate a Trapped Nerve.
Is the pain in the middle of your back, chest or abdomen?
Pain in the middle of your back, chest wall, sternum, abdomen or deeply in your chest may be created when the nerve is trapped in the thoracic spine. This may cause numbness or ‘pins & needles’ in the rib cage or abdomen and may also be associated with weakness of the chest wall or abdomen on one side. Any one of these symptoms, or a combination of them, can indicate a Trapped Nerve.
How is the first attack treated?
The major symptoms arising from the first attack generally settle down over the first 6 weeks and half of the remainder will generally settle down over the following 6 weeks. Treatment during this period is focused upon reducing the irritation. This may include: anti-inflammatory drugs (Steroids or Non-Steroidal Anti-Inflammatory; therapy such as Ibuprofen, Diclofenac or Acemethacin); and Muscle Balance Physiotherapy to correct the posture and maintain mobility.
How are repeated attacks treated?
Repeated attacks or enduring symptoms need more radical treatment and these may be grouped in to three treatment pathways; Conservative Therapy, Conventional Open Surgery and Endoscopic Minimally Invasive Spine Surgery. (To see these diagrammatically, please click here for lumbar treatment pathways and here for cervical treatment pathways).
- Conservative therapy consists of Muscle Balance Physiotherapy, injection, Cognitive Behavioural Therapy and coping courses, plus a restricted lifestyle, and the hope that the symptoms will abate over time.
- Conventional Open Surgery, carries greater risk than conservative therapy and cannot guarantee success. The surgical options are tabulated below and details of these treatments may be explored through the list on the left.
- Endoscopic Minimally Invasive Spine Surgery has shown encouraging results in over 80% of 4,300 procedures carried out. This includes patients treated for Slipped discs, Failed Back Surgery, Failed Fusion Surgery, Spine Instability, Chronic Lumbar Spondylosis and Back pain, Lateral Recess Stenosis and Axial Stenosis, Spondylolytic Spondylolisthesis and Disc infections. In addition, our current and yet incomplete survey of patients operated upon 10 years ago is proving surprisingly encouraging.
|Procedure||Complications||Success @ Year 2|
|Microdiscectomy||6% (Recurrent protrusions 3 - 13%)||Leg but not back pain 90%|
|Open Decompression||8% (Instability & Scarring)||Poor Data 75%|
|Instrumented Fusion||11 - 18% (International Controlled Frials)||60%|
|Total Disc Replacement||16 - 45%||50%|
|Interspinous Spacers||Spinous Process Fractures, settlement, infection||Insufficient Data|
|Endoscopic Transforaminal Decompression||2.4%||80%|