RADICULOPATHY

Types of Radiculopathy

Cervical radiculopathy

This occurs when a nerve root in the neck or upper back gets “pinched” and causes:

• Pain in the neck, shoulder, upper back, or arm
• Muscle weakness

Thoracic radiculopathy

This occurs when a nerve root gets compressed in the mid-back area. However, this happens rarely and can sometimes wrongly identified as shingles, cardiac, stomach, or gallbladder problems. Doctors normally treat these symptoms without surgery; however, they may recommend minimally invasive surgery in certain cases.

As an example, the following identify symptoms of this condition:

• Rib, side, or abdominal scorching or shooting pain
• Band-like pain
• Weakness, numbness, and tingling
• When nerve compression develops in the mid-back area, a person may suffer pain throughout the chest and torso.
• Numbness and tingling in the ribs, side, or abdomen numbness and tingling in the ribs, side, or belly
• When the cause relates to disc herniation or trauma, advanced stages may show motor impairment

When pinched nerves occur, doctors find them in various places throughout the mid-back area.

• Stenosis, bone spurs, disc herniation, or other disorders will cause the narrowing of the space
• Thoracic vertebrae (T1-T12)
• The thoracic vertebrae’s intervertebral disc
• 12 nerve roots in the spine.

Lumbar radiculopathy

When a nerve root becomes compressed in the lower region of the back, a person may suffer pain in the lower back, legs, and hips. So, sciatica refers to another name for lumbar radiculopathy. With this condition,  the symptoms cause pain and numbness in the lower back, hips, buttocks, legs, or foot, which become worse by prolonged sitting or walking. As such, nerves related to the colon and bladder can get squeezed in rare cases, resulting in a lack of control. Other symptoms include:

• A searing pain that starts in the back.
• A strong ache when sitting or coughing.
• Numbness or weakness in the leg and foot.
• Tingling in the back or leg
• Changes in feeling or reflexes.

Epidemiology / Etiology

The diagnosis of radiculopathy often gets missed since the cause rarely gets identified. Therefore, there has not been a lot written on this condition and doctors consider it as being very rare. Although the most prevalent cause of radiculopathy occurs when a nerve root gets compressed, finding the affected nerve requires significant testing.  However, the following also cause this condition:

• Diabetic thoracic polyradiculopathy affects 15% of insulin-dependent diabetics and 13% of non-insulin-dependent diabetics.
• Spondylosis and disc herniation provide examples of degenerative spine alterations that can cause a pinched nerve.
• Tumors, trauma, scoliosis, viral infection/inflammation, connective tissue disease, and TB are some of the other probable reasons for patients to get a pinched nerve.

Diagnosis of Radiculopathy

The first step in identifying radiculopathy begins with a thorough physical examination and a study of a patient’s medical history. For instance, your doctor will evaluate your neck, shoulders, arms, and hands.  Depending on the location of your symptoms, doctors will check:

• Numbness or a lack of sensation
• Reflexes in your muscles
• Muscular endurance
• Posture, or how your spine curves

To conduct a thorough diagnosis, your doctor may also recommend the following diagnostic tests:

X-rays to detect the position of the bones in your neck and any disc narrowing or damage.

• An X-ray provides physicians with imaging of the spinal bones, allowing them to determine if there is a narrowing of the spinal column or other bone-related complications resulting in or worsening a pinched nerve.

Spine MRI or CT scan to diagnose bone spurs and bulging or ruptured discs pushing on the nerve roots or spinal cord.

• An MRI is especially useful if your spinal physician suspects the pain from from nerve root compression. MRIs use radio waves and a strong magnetic field to create detailed images of the spinal column and body. Where X-rays show the spinal bones, MRI images show a surgeon the soft tissues surrounding the bones, like nerves, spinal discs, and ligaments.

An electromyogram (EMG) identifies which nerve root causes the condition.

• An EMG involves inserting a needle electrode through the skin into the body’s muscles to evaluate the electrical activity present in the muscles when they are at rest or contracting. A physician can use the results of an EMG to determine if there is any damage to the spinal nerves and muscles

Nerve Conduction Study measures the body’s electrical nerve impulses and the health of the nerves and muscles through electrodes placed on the skin.

• Your physician will pass a small current through the nerve to measure electrical impulses related to your nerve signals. Nerve conduction studies can help a physician detect potential nerve damage.

High-resolution ultrasound uses sound waves to create images of the body’s internal structures.

• Ultrasound technology appears especially effective in diagnosing nerve compression syndromes, including pinched nerves.

Diagnostic Spinal Injections involve a surgeon strategically placing diagnostic injections at key spinal levels to confirm or relieve a patient’s source of pain.

• Once the source of pain is confirmed, a physician can customize a treatment to fit your unique symptoms and needs.

Blood Tests 

• In some cases assess thyroid levels or fasting blood glucose readings, which can provide additional insights into your condition.

How Are Diagnostic Spinal Injections Used to Confirm the Source of Back Pain?

When you first consult with a spinal specialist, they will conduct a comprehensive evaluation, which includes discussing your symptoms and performing a physical exam. If there are indications of a pinched nerve, the specialist may recommend diagnostic spinal injections for a more precise diagnosis.

Purpose of Diagnostic Spinal Injections

Diagnostic spinal injections are strategically administered to pinpoint the exact source of your back pain. These injections help to either confirm or rule out certain areas of your spine as the cause of discomfort. By targeting specific spinal levels, these injections offer crucial insights into your condition.

Procedure and Effectiveness

The injections contain a local anesthetic that temporarily numbs the targeted area. If your pain stops after the injection, it indicates that the pinpointed area is likely the source of your pain. This immediate feedback allows the physician to customize a treatment plan tailored to your symptoms and needs.

Benefits of Accurate Diagnosis

Using diagnostic spinal injections helps ensure that subsequent treatments are appropriately focused, leading to more effective management of your back pain. By isolating the pain source, your specialist can better recommend therapies, medications, or surgical options suited to your condition.

Diagnostic Difficulties

The following identifies some of the problems with diagnosing radiculopathy

• Because there is usually no concomitant motor deficiency, the symptoms of this condition can easily get overlooked.
• The appearance of a band-like stomach pain might signal a variety of ailments.
• With so many possible causes, it’s no surprise that this condition gets missed for months or even years after symptoms appear.

Treating Radiculopathy

In some cases, radiculopathy symptoms improve with time and may not require treatment. Based on the symptoms and location of the injured nerve root, our Specialists may propose a surgical treatment if pain or other symptoms continue. Additionally, our Doctors recommend therapy to treat movement problems as this treatment works to help joint limitations or muscle weakness. Also, the region’s range of motion (ROM) is required for a variety of everyday activities and sports, including golf, throwing sports, tennis, and rowing. Moreover, problems with the spine can cause respiratory problems and cause postural problems later in life. In addition, increasing spine ROM also provides a positive effect on the body.

Physical therapy and guided exercises are excellent ways to alleviate back pain from a pinched nerve and minimize other uncomfortable symptoms. When you go to a physical therapist, they will assess your unique symptoms and create a customized physical therapy plan for your needs.

• Motion restrictions can create a negative influence on performance.
• The spine moves in tandem with the ribs. When you bend to the side, your spinal segments bend to the side, and your ribs on the same side join together while your ribs on the opposite side separate. Thus, people who cannot move properly in all directions become more prone to injury and suffering.

There are passive and active physical therapy treatments depending on the severity of your symptoms and range of mobility. Physical therapy helps improve spinal health by increasing flexibility and strength. When the muscles of your spine are stronger and more flexible, they can better support sore areas, such as where a pinched nerve is located.

In Conclusion

Physical therapies such as joint mobilization and manipulation can help with joint stiffness and movement. As such, most spine mobility therapies need an experienced therapist to conduct and oversee the procedures. Also, the capacity of the patient to include therapeutic exercise regimens may aid in a speedy recovery.

Physical therapy is an effective treatment for spinal pinched nerves and related pain because it helps improve spinal health at the source of a pinched nerve rather than simply masking the pain. Stronger spinal muscles can minimize the risk of injury, improving coordination, posture, and balance.

Detailed Surgical Treatments for a Pinched Nerve

Endoscopic Discectomy

Endoscopic discectomy is a common surgery for spinal pinched nerves in the lower back. It can also address pinched nerves in the middle back. During this procedure, a spinal surgeon directly visualizes the spinal nerves and discs to decompress the nerve roots compressed and damaged by spinal discs.

This ultra-minimally invasive surgery results in less soft tissue and muscle damage, leading to a shorter recovery period. Most patients experience immediate relief from pain and discomfort, with minimal discomfort or pain following the procedure. The smaller incision (¼ inch) means very minimal scarring and little to no blood loss, making it a highly successful and reliable treatment option.

Endoscopic Foraminoplasty

Endoscopic foraminoplasty is one of the least invasive spinal surgeries available to treat a pinched nerve in the neck or back. This procedure enlarges the area around the spinal bone near the pinched nerve, alleviating compression and pressure on the nerves.

A spinal surgeon makes a small incision in the neck or back, depending on the pinched nerve’s location, to widen the intervertebral foramen and remove any blockages or compression causes. This surgery promotes spine and muscle preservation, has minimal blood loss, and offers a shorter recovery time with minimal scarring. Often performed under local anesthesia or mild sedation, foraminoplasty is typically an outpatient procedure, allowing patients to go home the same day. Recovery generally takes two to three weeks.

Understanding Laminectomy: A Crucial Procedure for Pinched Nerve Relief

A laminectomy is a surgical procedure designed to relieve pressure on the spinal nerves. This is achieved by removing a portion of the lamina, a section of bone that forms the vertebral arch in the spine. By taking away this small piece of bone, surgeons can alleviate the strain on nerves that cause significant pain or discomfort.

When Is a Laminectomy Recommended?

Laminectomy is often suggested for patients experiencing pinched nerves due to various spinal conditions. Here are the primary scenarios where this surgery is considered:

• Herniated Disc: When a spinal disc protrudes out of its normal space, it can compress nearby nerves.
• Spinal Stenosis: This condition involves the narrowing of the spinal canal, which can put pressure on the spinal cord and nerves.
• Spondylolisthesis: In some cases, where a vertebra slips over another, a laminectomy may help in alleviating nerve compression.

The Procedure and Its Benefits

During the surgery, the surgeon will:

• Remove the bony spinous process.
• Excise the lamina and any thickened tissues that are compressing the nerves.

Advancements in surgical techniques now allow for minimally invasive methods, reducing the risk of complications and improving recovery times.

In summary, a laminectomy is a highly effective intervention for those suffering from pain due to pinched nerves. It provides significant relief and improves overall spinal health by addressing the root cause of nerve compression.

Manual Techniques and Exercises

Doctors recommend therapy to treat movement problems as this treatment works to help joint limitations or muscle weakness. Also, the region’s range of motion (ROM) is required for a variety of everyday activities and sports, including golf, throwing sports, tennis, and rowing. Moreover, problems with the spine can cause respiratory problems and cause postural problems later in life. In addition, increasing spine ROM also has a positive effect on the body.

Physical therapy and guided exercises are excellent ways to alleviate back pain from a pinched nerve and minimize other uncomfortable symptoms. When you go to a physical therapist, they will assess your unique symptoms and create a customized physical therapy plan for your needs.

• Motion restrictions can create a negative influence on performance.
• The spine moves in tandem with the ribs. When you bend to the side, your spinal segments bend to the side, and your ribs on the same side join together while your ribs on the opposite side separate. Thus, people who cannot move properly in all directions become more prone to injury and suffering.

There are passive and active physical therapy treatments depending on the severity of your symptoms and range of mobility. Physical therapy helps improve spinal health by increasing flexibility and strength. When the muscles of your spine are stronger and more flexible, they can better support sore areas, such as where a pinched nerve is located.

Physical therapies such as joint mobilization and manipulation can help with joint stiffness and movement. As such, most spine mobility therapies need an experienced therapist to conduct and oversee the procedures. Also, the capacity of the patient to include therapeutic exercise regimens may aid in a speedy recovery.

In Conclusion

Physical therapy is an effective treatment for spinal pinched nerves and related pain because it helps improve spinal health at the source of a pinched nerve rather than simply masking the pain. Stronger spinal muscles can minimize the risk of injury, improving coordination, posture, and balance.

Physical Therapy for the Spine Provides a Wide Range of Options

Physical therapists are educated in a variety of approaches to select the ones that will improve a patient’s health. For further information, the information below will help support further research.

• Traction
• Massage
• Trigger Point Therapy
• Active Release Techniques: A doctor uses touch to detect the location of adhesions, and then connects the patient’s active movement with his or her touch.
• Assisted Active Range of Motion (AAROM)
• Passive Range of Motion
• Stretches (muscle, neural tissue, joints, fascia)
• Instrument Assisted Soft Tissue Mobilization
• Joint Manipulation: A passive, high-velocity, low-amplitude push to a joint complex to remove a gas bubble to restore optimum mobility, function, and/or pain relief.
• Joint Mobilization: A manual therapy approach that consists of a series of competent passive motions applied to the joint complex at changing speeds and amplitudes, to restore optimal mobility, function, and/or pain relief.

Clinical Bottom Line

Mild Cases

Rest, ice, and medicine alleviate pain in minor instances. To avoid the recurrence of the injury, physical therapy may establish a program of postural, stretching, and strengthening exercises. Doctors recommend a gradual return to activity to avoid a repeat of symptoms.

Moderate to Severe Cases

In conclusion, patients should not live with pain from any condition.  We specialize in treating radiculopathy and know how to best treat the condition; so we sincerely invite you to call us if your condition persists.

We Can Help At the Southwest Scoliosis and Spine Institute

From the first time you walk into one of our offices in either Dallas, Plano, or Frisco, Texas, you will feel at ease. You will talk to one of our expert doctors.  Our doctors will listen and understand your problem and perform a detailed exam. The doctor will review your X-rays and other tests with you, in detail, and provide a diagnosis. After you become well-informed, you and your doctor will plan the right treatment. Finally, if your spine doctor feels surgery is not the right decision in your case, he’ll tell you that, too, and offer a non-surgical remedy as to the first course of treatment.

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Footnote:

Physio-Pedia: Radiculopai