What Is It
Nerve root irritation is commonly referred to as a pinched nerve. The nerves that supply the neck, shoulder and arm exit the spine between each vertebra, through a tunnel made up by the vertebra above and below, known as the lateral foramen.
Nerve root compression and irritation can result from anything that acts to restrict the size of this tunnel, thus restricting the room the nerve root has to move. This may result from degenerative changes to the neck such as disc degeneration, disc bulges or bony spurs restricting the available space in the tunnel. Poor postures commonly play an important role. Certain positions of the neck such as a slump posture will close the tunnel down and poor shoulder postures will place additional stretch and load on both the nerves exiting the spine as well as the muscles of the shoulder girdle, many of which attach onto the neck.
Symptoms
- Pain, pins and needles or burning radiating into the top of the shoulder or down into the arm
- Weakness of the muscles that are supplied by the nerve
- Protective muscle spasm in the neck around the irritated area
- Pain with movement of the neck, especially with looking up and turning or leaning towards the painful side
- Pain is often relieved in a forward head position which opens up the exit foramen
Management
Accurate diagnosis by your physiotherapist as to the source of the irritation is vital. Treatment will usually involve tissue release, stretching and joint mobilisation techniques to decrease spasm and restore normal spinal alignment. This generally acts to open up the tunnel for the nerve allowing it more room to move. The nerve root has often become swollen and enlarged, now taking up more room in an already restricted tunnel. Anti-inflammatory medication normally plays an important role in this stage to decrease swelling and inflammation of the nerve. Nerve root mobilisation techniques may be necessary to free up nerve tissue that has become stuck.
Correction of any underlying postural drivers is essential in order to prevent ongoing overload to the neck and possible return of symptoms. This commonly involves exercises aimed at loading and training the muscles of the shoulder girdle which play an important role in maintaining ideal shoulder posture and alignment.
In cases of severe degeneration and encroachment into the exit foramen by the disc or bony changes, surgery may be required to remove some of the offending tissue and increase the size of the tunnel in order to give the nerve adequate room to move.
