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.
As the severe pain begins to settle the treatments can be stepped up with the careful watching for intervention interfering with the natural history of the pain and flaring it again. Sleeping can be improved by wearing a soft collar to limit the positions attained by the neck joints at night. Helpful mechanical inputs to the neural pain systems can be provided by performing regular gentle range of motion neck exercises. Painkillers are best maintained for somewhat longer than thought necessary as pain control is so important to the disability associated with this syndrome and patients need to cope with increased activity.
Resolution of this kind of severe arm pain is very likely with time, but sometimes the time is too great to allow the patient to go on suffering for so long so a referral for consideration of operation by a spinal surgeon may be appropriate. The examination will require a history of the neck and arm pain and whether previous episodes have occurred, what brought it on, the areas of the arm affected and the easing and aggravating factors. It is wise to limit the physical examination to easy ranges of joint movement, reflex testing, sensory testing and an assessment of muscle power to avoid aggravating the pain.
One nerve root is the most likely affected structure and this means that all the symptoms will be related to the functions which this nerve has. Reflex loss, loss of feeling, weakness of muscle groups and the distribution of the pain in the arm should all fit in terms of being attributable to the compression of this one nerve. If more than one root is affected the patient should be referred for a medical opinion.
A magnetic resonance imaging scan is typically ordered once the surgeon feels a nerve root lesion is the likely diagnosis, in order to indicate the nature of the compression. If a disc protrusion consistent with the examination findings is found on the MRI scan then a cervical discectomy is an option although this is more commonly performed in the lumbar spine. Management after operation is straightforward and patients should return to normal. Maintenance of physical fitness over the long term and a speedy return to normal activities is the best management of this problem and may protect against complications. - 14130
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.
As the severe pain begins to settle the treatments can be stepped up with the careful watching for intervention interfering with the natural history of the pain and flaring it again. Sleeping can be improved by wearing a soft collar to limit the positions attained by the neck joints at night. Helpful mechanical inputs to the neural pain systems can be provided by performing regular gentle range of motion neck exercises. Painkillers are best maintained for somewhat longer than thought necessary as pain control is so important to the disability associated with this syndrome and patients need to cope with increased activity.
Resolution of this kind of severe arm pain is very likely with time, but sometimes the time is too great to allow the patient to go on suffering for so long so a referral for consideration of operation by a spinal surgeon may be appropriate. The examination will require a history of the neck and arm pain and whether previous episodes have occurred, what brought it on, the areas of the arm affected and the easing and aggravating factors. It is wise to limit the physical examination to easy ranges of joint movement, reflex testing, sensory testing and an assessment of muscle power to avoid aggravating the pain.
One nerve root is the most likely affected structure and this means that all the symptoms will be related to the functions which this nerve has. Reflex loss, loss of feeling, weakness of muscle groups and the distribution of the pain in the arm should all fit in terms of being attributable to the compression of this one nerve. If more than one root is affected the patient should be referred for a medical opinion.
A magnetic resonance imaging scan is typically ordered once the surgeon feels a nerve root lesion is the likely diagnosis, in order to indicate the nature of the compression. If a disc protrusion consistent with the examination findings is found on the MRI scan then a cervical discectomy is an option although this is more commonly performed in the lumbar spine. Management after operation is straightforward and patients should return to normal. Maintenance of physical fitness over the long term and a speedy return to normal activities is the best management of this problem and may protect against complications. - 14130
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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