Pinched Nerve in the Neck
About once every two weeks a patient comes in worried because they believe they have a pinched nerve in the neck. Typically they have had an MRI which some some degenerative arthritis and degenerated discs in the neck and they have tingling in the arm and hand. So is this cervical radiculopathy or is this just a referral pain from the upper thoracic area. How do you tell?
I look at people's eyes. People who have a true 'nerve' being pinched, really can't smile. The pain is awful. The referral pain patterns of ligaments can be awful but not nearly as awful as a nerve being pinched. When the eyes loose their luster and the look on the persons face is 'panic' I think cervical radiculopathy. If the person is able to converse with me and laughs at my jokes, then there is a good chance they have a thoracic ligament problem.
A person who puts their hand between the spin and the scapula and says that is where their pain emanates from, I think thoracic ligament problem. In cervical radiculopathy cases, the person will point to a specific area of their neck causing the pain. Thoracic ligament problems can cause some neck pain as the case study indicated but typically the person will tell you this is a referral pain and the neck pain is minimal compared to the thoracic pain.
Cervical radiculopathy gives 'true' numbness. If a person senses numbness in the fingers but can feel everything, this is called numbiness. This is a referral symptom typically from thoracic ligament problems (generally thoracic #1-3). Numbness that is true, meaning the person has lost sensation in part of their hand or fingers, indicates a nerve problem. Then one thinks of cervical radiculopathy.
Cervical radiculopathy is not affected by breathing and vice versa. Breathing can aggravate thoracic problems and thoracic problems can aggravate breathing. Someone whose symptoms are affected by deep breathing, makes me think thoracic ligament problem.
ARM MOVEMENT AGGRAVATION
Believe it or not in my experience, when arm movement aggravates the symptoms, I think more thoracic ligament problem. Simple movements of the arm only occur by stabilization of the scapula. Stabilization of the scapula affects the upper thoracic segments more then it does the cervical spine.
RESPONSE TO PROLOTHERAPY
Thoracic ligament problems often feel better right away with Prolotherapy. Cervical radicular symptoms generally need a nerve block to feel better right away. Prolotherapy can be used with cervical radiculopathy but often you need other modalities also to treat the person.
For people who have been told that they need surgery for cervical radiculopathy I would recommend that they get a second opinion from a Prolotherapist. You would hate to get surgery and not be better because your problem was a thoracic ligament problem and all you needed was Prolotherapy.
The thoracic ligaments that can refer pain down the arm are those involved with Thoracic segements #1,#2, and #3. The ligaments that connect th