Patient sometimes report than they wish their arm could be cut off when they are unlucky enough to suffer from the agonising pain of a nerve root impingement. Patients presenting with nerve root lesions look very tired as they have not slept for several nights, are not in the mood for jokes and hold their arm protected in a typical position. Depending on which nerve root is responsible the area of the pain in the arm varies, with pain running in severe waves down the limb and also feeling exceptionally sharp in nature. An immediate increase in pain severity follows any tension or stretch applied to the affected nerve root.
Patients typically find there are only one or two comfortable positions for the arm and maintain these carefully to ease the pain. They may hold the arm against the tummy or place the hand on top of the head to achieve relief. Countering the pain and the inflammation is very important in the early stages and patients should take maximum permitted doses of strong analgesics and anti-inflammatory drugs to prevent the escalation of pain mechanisms in the nervous system. Manual treatment is risky due to the condition's highly irritable nature but some input can be given to ease the joint movement and increase circulation.
Much of the management of nerve root lesions consists of not aggravating the condition at all as the results can be very unpleasant if the therapist goes in too hard. Wearing a collar, joint mobilisations, maintaining the least painful position and cervical traction are all possible treatments for this problem as we wait for nature to gradually settle down. As the disc, nerve or joint settles the patient breathes a sigh of relief as the pain reduces, they can get some sleep and start moving their head and doing normal activities again.
Therapeutic efforts can be intensified once the pain shows some sign of settling down but the therapist still needs to be aware of the potential for worsening with treatment. The neck can be gently restricted at night be wearing a soft collar and the patient encouraged to perform regular range of motion exercises within pain limits to increase mechanical inputs to the nervous system. The patient should continue to take painkillers for longer than they feel they need to initially as the syndrome relies on control of pain to settle and patients need to be able to do gradually more without too much pain.
If the arm pain does not settle after six weeks or so a referral to a spinal specialist may be useful. These kinds of syndromes almost always settle with time but the pain can be so severe that it is questionable in some cases whether we should wait for the length of time settling down might take. The examination will determine the history of the event, previous difficulties with the neck if any and the areas of symptoms and what aggravates or eases them. The physical examination is quite limited due to pain but consists of neck ranges of motion, muscle power, sensibility and reflex testing.
Since it is very likely that a single nerve root will be responsible for the pain it is also likely that a particular arm area will be painful and that particular muscle weakness, sensory loss and reflex changes will be present. These will reflect the changes which have occurred in the parts of the arm function which are controlled by the compromised nerve root. More than one nerve root affected is a red flag for medical referral.
After the examination the surgeon will have a clear idea of which nerve root is the likely culprit and will order an MRI scan to image the segment of the neck responsible. If a large disc protrusion is evident on the scan then a surgical removal of the disc prolapse is possible although this is less commonly performed than in the lumbar spine. After the recovery period it is useful for patients to keep themselves fit and try to return to as normal activity as possible in order to forestall any chances of developing consequences from the syndrome.
Patients typically find there are only one or two comfortable positions for the arm and maintain these carefully to ease the pain. They may hold the arm against the tummy or place the hand on top of the head to achieve relief. Countering the pain and the inflammation is very important in the early stages and patients should take maximum permitted doses of strong analgesics and anti-inflammatory drugs to prevent the escalation of pain mechanisms in the nervous system. Manual treatment is risky due to the condition's highly irritable nature but some input can be given to ease the joint movement and increase circulation.
Much of the management of nerve root lesions consists of not aggravating the condition at all as the results can be very unpleasant if the therapist goes in too hard. Wearing a collar, joint mobilisations, maintaining the least painful position and cervical traction are all possible treatments for this problem as we wait for nature to gradually settle down. As the disc, nerve or joint settles the patient breathes a sigh of relief as the pain reduces, they can get some sleep and start moving their head and doing normal activities again.
Therapeutic efforts can be intensified once the pain shows some sign of settling down but the therapist still needs to be aware of the potential for worsening with treatment. The neck can be gently restricted at night be wearing a soft collar and the patient encouraged to perform regular range of motion exercises within pain limits to increase mechanical inputs to the nervous system. The patient should continue to take painkillers for longer than they feel they need to initially as the syndrome relies on control of pain to settle and patients need to be able to do gradually more without too much pain.
If the arm pain does not settle after six weeks or so a referral to a spinal specialist may be useful. These kinds of syndromes almost always settle with time but the pain can be so severe that it is questionable in some cases whether we should wait for the length of time settling down might take. The examination will determine the history of the event, previous difficulties with the neck if any and the areas of symptoms and what aggravates or eases them. The physical examination is quite limited due to pain but consists of neck ranges of motion, muscle power, sensibility and reflex testing.
Since it is very likely that a single nerve root will be responsible for the pain it is also likely that a particular arm area will be painful and that particular muscle weakness, sensory loss and reflex changes will be present. These will reflect the changes which have occurred in the parts of the arm function which are controlled by the compromised nerve root. More than one nerve root affected is a red flag for medical referral.
After the examination the surgeon will have a clear idea of which nerve root is the likely culprit and will order an MRI scan to image the segment of the neck responsible. If a large disc protrusion is evident on the scan then a surgical removal of the disc prolapse is possible although this is less commonly performed than in the lumbar spine. After the recovery period it is useful for patients to keep themselves fit and try to return to as normal activity as possible in order to forestall any chances of developing consequences from the syndrome.
About the Author:
Jonathan Blood Smyth, editor of the Physiotherapy Site, writes articles about Physiotherapy, back pain, orthopaedic conditions, neck pain, injury management and physiotherapists in Kent. Jonathan is a superintendant physiotherapist at an NHS hospital in the South-West of the UK.
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