What Happens if you Have a Pinched Nerve in Your Neck?

Introduction to Neck Problems

[00:00] All right, welcome back to our Hefflinger podcast. I'm here with my son, Kevin. Morning, Kevin. Morning, Dad. How are you doing? Good. So I thought today would be good to talk about neck problems because a lot of people have neck problems. But more specifically, I want to talk about people who get pain down their arm or numbness down their

[00:20] arm from a pinched nerve in the neck because it's a very common problem that I see in the office every day. Yeah. So what is it? So people who are getting pinched in their first thoughts start off with what is a pinched nerve in your neck and how does that come about? Yeah.

Understanding a Pinched Nerve

[00:40] So a pinched nerve in your neck is kind of like having sciatica in your lower back, how people talk about sciatica. So sciatica means pinching to a nerve in your lower back that causes pain or numbness or both down your leg. So this is kind of like the sciatica of your arm. So what happens is people get a pinched nerve in their neck and that can be due to a lot

[01:00] lot of things. It can be due to a herniated disc pinching your nerve. It can be due to arthritis in your neck or bone spur, like an arthritic overgrowth that pinches down on your nerve. So there's a lot of different reasons people can get pinched nerves in their neck. But the most common presentation or symptoms that people have

[01:20] they come into my office are they're going to say, you know, maybe for the past two or three months, six months, even a year, I've had pain that's in my neck and then that pain, you know, it radiates into my shoulder and my shoulder blade and it'll go all the way down my arm and then depending on which nerve is pinched, it will go into different parts of

[01:40] your arm and your hand. So is that how you kind of based on people if they saw you in the presentation and kind of this story they tell you like where the pain is is that how you kind of kind of make a guess of what nerve you think is pinched? Yeah because you know you know most people who have a pinched nerve it'll go along a certain nerve distribution. So say say your

Identifying the Affected Nerve

[02:00] fifth nerve is pinched. Well, the fifth nerve goes from your neck and shoulder area down to right here and it stops here. It doesn't go past your elbow. So if somebody comes in rubbing their arm here, I'm thinking their fifth nerve. The sixth and seventh nerve of the neck, they go all the way down the arm into the hand. So typically people who have a

[02:20] a Pint 6 nerve will have numbness or pain that goes into their thumb and if your 7th nerve is pinched you'll have symptoms that go into your middle finger and even if your C8 what's called your C8 nerve is pinched that will cause symptoms into your these two fingers out here. So every nerve goes in a different distribution and so

[02:40] when I ask people about their distribution, it gives me an idea of what nerve is pinched. How do you, beyond just hearing them say it, then seeing it on, you already kind of said it, but it's being pinched. How do you see that when you see someone's MRIs and kind of imaging scans?

Diagnostic Process

[03:00] Yeah, well, before we get into that, I kind of ask people what's the distribution? But then you also have to spend a little bit more time and ask them how long it's been going on. You have to talk to them about what brought it on. Did you fall and hit your neck? Or did you wake up with it and it was just there? Did you have a cold

[03:20] or an infection recently. So a lot of different questions I'll ask to try to get an idea of what caused this problem to come on. And then from there, you're right, you have to diagnose it. So how do you diagnose it? Well, after I do the history, I do an exam. And certainly when I do my exam, I can

[03:40] check the muscle group. So every muscle is controlled by a different nerve, right? So if I'm looking for a pinched fifth nerve, I check the deltoid. So you have people raise their arms up and I push against them. And if I can push that person's arm down, well, they have a weak deltoid and that indicates that maybe their fifth nerve is pinched.

[04:00] And then if I want to check for a pinched sixth nerve, I check the biceps. So I have them pull towards me and then I see if they can pull towards me with resistance. If they have any weakness of their biceps, that would indicate a pinched sixth nerve. The seventh nerve is the triceps. So I have them push against me. So I have people

[04:20] push out against me and if their triceps is weak, that will indicate their seventh nerve is pinched. And then lastly, I check their hand muscles. These are called the hand intrinsic. So I'll have them open their hand and I push against them. And if they're weak, then that would indicate their eighth nerve is pinched. So then after

[04:40] speaking to them and getting the distribution, then I can test their muscles and find out if there's any weakness. And often people have weakness. And then the last thing you look at is this muscle. I mean, some people have wasting of their muscles and that gives you another idea if there's a problem. So then once you use all that and you have an idea, yeah, there's a problem with the nerve in the neck,

Initial Management and Treatment Options

[05:00] The next thing to do is get imaging. So there's a lot of different things you can do. If someone's had trauma to their neck, I'll start with plain X-rays to check for a fracture and I'll have them bend their neck forward and backwards to see if there's any evidence of instability. We'll often get a CAT scan.

[05:20] of the neck, which is a more specific way to look at the bone to make sure that if there's not been a fracture of the bone. Then we use MRIs to look for herniated discs and arthritic changes that can pinch the nerve. So yeah, we typically use X-rays, a CAT scan, and MRIs of the neck to diagnose the problem.

[05:40] So at this point you know all these people a lot of times if they're by the time they're seeing you they probably had the pain for a couple months or issues for a couple months. If someone first kind of starts if they're listening and they they recognize any of the kind of symptoms you're talking about what would what should be their first step of kind of progressing.

[06:00] through the motions? Well, I think first of all, a lot of people just wake up with a stiff neck sometimes in the morning and if that happens, it may have been you did too much the day before or something along that line, but I would just simply use like a Motrin or Advil medication. If you did too much the day before, I would just give

[06:20] it a little bit of time and give it at least two or three days to see if it gets better. As long as you have normal strength and you don't have any problems with your walking or any other problems like that. But if it persists, then you should definitely go see your doctor, your primary doctor. And then often your primary doctor may have you get into physical therapy to

[06:40] start with or they may just have you see me. I mean it just depends on the doctor. They may get an MRI already at that point and if they do and it shows a problem, they'll have you see me. So your first step really is to go see your primary doctor who will then often refer you to me if he suspects that you have a pinion or he's found a pinion

[07:00] nerve on a test like an MRI. Alright, so if someone has then indeed that they've noticed it's not just a couple days they've been having some issues for weeks, they go to their primary care doctor, they get referred to you, they explain all the symptoms and kind of their story and what's happened. You get the imaging, it's all confirmed that you think they

[07:20] possibly have or they do or they most likely have a pinched nerve or something that could be treated for that matchup with the symptoms. What would be the next step? What are the treatment options? So a lot of it goes into how long they've had it and what their symptoms are and what they're examined. So say for instance someone comes in with

[07:40] Often I'll see people with a one or two week history of pain down the arm, suspicious for a pinched nerve, they've been sent to me, I talk to them, there's no trauma, they didn't hit their neck, their exam is completely normal. Then at that point, often I'll treat those people just with medications like steroids can be very helpful, what's called

When Surgery Becomes Necessary

[08:00] Medrol dose pack. It's a five-day course of steroids by mouth that can help ease the pain, muscle relaxants for their neck. Sometimes early on I'll get them into physical therapy. Sometimes I don't. It just depends how short the symptoms have been. If someone comes in my office say with six weeks of pain

[08:20] down the arm. Again, they have a normal exam. I don't find any deficits in their exam. And maybe they have an MRI that shows moderate narrowing of a space where a nerve goes out. Then I'll often get them into physical therapy and I like doing water and land therapy combinations. It works very well for people

[08:40] neck and lower backs and so I'll try therapy. And then I'll always see the patient back. So I mean after I have a person go to physical therapy, I see him back in six to eight weeks. And then at that point, we have to talk about what are other treatment options and a lot of it is based on what your MRI shows on honestly because

[09:00] your MRI shows a pinched nerve and you failed physical therapy, then I think surgical intervention is probably a better option for you than going through something like pain management where you're just going to get temporary injections to your neck. If someone doesn't have a pinched nerve on their MRI and they failed physical therapy and I can't help

[09:20] them with surgery, often I'll refer people to pain management to try to give them some symptomatic relief. And then lastly, you have to realize sometimes people come in and they have deficits. I saw a person the other day who came in who over two or three weeks has trouble walking. He's using a cane now. His arms are weak. When I test his muscles,

[09:40] He's weak, he has numbness in his arms and legs. His MRI showed that he had a pinched spinal cord. So for that person, he has the risk of going paralyzed because he has a pinched spinal cord. So I don't do physical therapy. I didn't recommend pain management. I recommended surgery quickly. And the point of that

[10:00] is because there are certain things that you can have when it comes to the world of your spinal cord and your pinched nerve that it's not in your best interest to try therapy, to go through pain management. You want to get the pressure off your spinal cord or get that pressure off your nerve as soon as possible so you have a chance for a good outcome. Definitely. So it's all really in

Surgical Procedures and Outcomes

[10:20] that you've been practicing full time plus all your neurosurgery training, but you've been practicing full time for 25 plus years plus the imaging plus what they tell you. You're using all of that to kind of make what you think is the best choice for their natural, for their next progression in the treatment plan. You're meshing everything together. You're taking their history, how long they've had it, their exam.

[10:40] are their deficits, what their studies show. And then based upon that and having seen all these people through 26 years of doing this, it gives you an idea what's the best course of action and how long should you wait before you recommend surgery to somebody. So what does the surgery actually entail and kind of how do you go through the process?

[11:00] patient does need surgery. Yeah. So specifically, let's talk about a pinched nerve in your neck. So a pinched nerve in your neck, basically it's a structural problem. Something is pinching the nerve. And so I kind of put these problems in the category. So a person that has a pinched nerve from a herniated disc that's pinched

[11:20] the nerve. Often that tends to be in younger people and when I say younger I mean people usually like 60 years or less in age and so I'll often recommend surgery from the front of the neck because when I do surgery from the front of the neck I can actually take that disc out, pull that disc away from the pinched nerve and

[11:40] and that will unpinch the nerve. And so these are called ACDFs. They're one level single fusion surgeries, but they're excellent. They work very well. They're not painful surgeries and people have great outcomes. And people worry about having one level of their neck fused or sometimes

[12:00] do two or three levels of their neck being fused. And most people don't notice any perceivable, loss of range of motion. They still have good flexibility. So I think it's a great procedure. Nowadays, you can do artificial discs as well. A lot of surgeons will put an artificial disc in. And the purpose for that is to try to preserve the motion, all the

[12:20] of your neck. So sometimes that can be recommended. And so that's when somebody has a herniated dyspinching in the nerve, often I'll recommend surgery from the front of the neck. And then there's another category of people who have a pinched nerve from arthritis. They get an overgrowth of the joint. It pinches down on the nerve and so often I'll

[12:40] I'll recommend surgery from the back of the neck to do what's called a laminectomy. And so a laminectomy just means removing bone off the top of the nerve to open up that space for the nerve to unpinch the nerve. And so with a laminectomy, you just take a little bit of bone off the top of the nerve and you don't have to do a fusion or have any hardware

[13:00] put in your neck. It preserves your full range of motion. You do have to cut through the muscles of the back of the neck so it can be a little bit more sore of a surgery than coming from the front. But it's also an excellent surgery. And often when people come in, I'll talk about both procedures, but surgery from the back

[13:20] neck. Often we do on older people because that's where the arthritis builds up and people who are in their late 60s, 70s, and 80s often will have surgery from the back of the neck, at least in my practice. But there's always people, I've had younger people who you could do surgery either from the front or from the back of the neck and what I do is I sit

[13:40] down and I talk to the patient, I explain both surgeries, explain the MRI to them, show them what's happening, and then I give them the choice. And they just need to know that if you have surgery from the front of your neck, it doesn't mean that someday you might need surgery from the back of your neck and vice versa. It just kind of benefits versus risk and there's differences.

[14:00] But those are both very common, those are some of your most common surgeries you do, right? It is, yep. And my sister, when she was 38, had surgery done from the front of her neck and had one level of fuse and she's been great for 20 years now. And one of my best friends, I did surgery from the back of the neck. He was younger, but we just did a laminectomy and he's

[14:20] been great for probably 10, 15 years. So there's not a right or wrong way to do things. Well, because there's other surgeons that do stuff that even within the field of neurosurgery and spine surgeries, there's people that do it different ways too. People do like exelives and the different areas of approach aren't there other ways that people

[14:40] people have that do in the there's lots of different w the neck, you know, the ways are just from the fr know, for that guy who had over multiple levels, yo who needs bone taken off the back of the spine and probably even need rods and scru

Post-Surgery Recovery and Rehabilitation

[15:00] stabilize the spine. So every problem a person has has a unique set of considerations and then there's different options surgery wise. Yeah. So going by both of these either from the front of the neck or the back of the neck, what are the kind of recovery plans

[15:20] This is kind of what you tell people about the recovery, what they should do, are there differences there, kind of go through both those maybe? So I think, you know, obviously, every surgeon is different. This is the way I practice over the past 26 years of doing this. But I think the recovery from my perspective for just single level surgery from the front or the back is very

[15:40] very similar. Obviously, you want to just take it easy on your neck the first month. So I tell my patients to keep their lifting to like 5 or 10 pounds, very light for the first month. They can do routine things around the house. I just don't want them to do any heavy lifting or painting a ceiling or staring at a computer for hours on end.

[16:00] that would strain your neck, you don't want to do that first month. But I tell my patients they can be up walking around, they can go up and down stairs. If they go home the same day, they can go up the stairs that day, they can sleep in any position in bed they want, side stomach back, it doesn't matter. In a few days if they want to go out for walks or you can go out to dinner or the grocery store and they're filling up

[16:20] to it, I think it's fine to do. So it just depends. If you get into a more complex surgery where you have more muscle dissection and maybe you do a multi-level fusion from the front or a multi-level laminectomy and fusion from the back with rods and screws, those people are going to have more neck pain so I'm going to limit their activity more.

[16:40] I won't have them out going out to dinner, you know two days after surgery because they're probably not gonna feel like it. Yeah. Do you have any like recommendations for people or like is there anything you tell your patients for like long term of stuff to potentially if there is anything kind of protect your neck? I think a lot of different people sometimes

[17:00] get stiff like you talked about earlier stiff necks. Is there different things you can try to do? Or is it kind of just one of those things? Just like avoid kind of trauma to your neck and stuff? I think I haven't found any rhyme or reason like the most common person that I see in the office that comes up with a pinched nerve will be somebody who said I just woke up with the pain in my neck and down my arm. They didn't do anything

[17:20] thing. They just woke up and the pain was there. Or they might be even just sitting at the coffee table in the morning, having coffee and the pain comes on. So most times when people come with a pinched nerve, I don't find a history that correlates to some traumatic incident or something that they specifically did. So I don't really tell people, should

[17:40] do this and not do this. I mean, I think I tell people it's kind of like more random and some people might just, you know, you just get sometimes it can just happen versus it's something you can, it's not something people are specifically doing something wrong and kidding. But I mean, sometimes I'm having more conversations that as I get older, I want to be healthier and I tell people, I mean, I

[18:00] It's the little things like just try to be healthy as you can. So try to do strengthening of your muscles as you grow older and get some kind of workout routine down. I mean, it's important. And try to eat as healthy as you can. Your body only gets the nutrients that you put into it and all that lends into how healthy your body is.

[18:20] trying to get good sleep and use the right pillow and not trying to overdo it depending on what age you're at. So all those little things that you can do every day that will keep your health to where you want it to be, you have to do because your health is your greatest commodity and once you lose your health, you can't buy it back.

[18:40] it's gone. Yeah, definitely. I agree. Your health is so important and I think what it sounds like, it's for a lot of things. Just being as healthy as you possibly can gives you as much buffer against almost any disease or potential problems you could have, whether it's directly linked

Lifestyle and Prevention Strategies

[19:00] are not, especially if it's not trauma based. Well think about, yeah, just think about like all these things that we can do, eat healthy, sleep, exercise, that all helps our immune system, which your immune system is important in fighting off disease. And there's so many little things that you can do for yourself that will help prevent inflammation in all the foods that we talk

[19:20] about that inflammatory, all that adds up to conditions in your body that need treatment. So you got to take care of your body. I think an interesting conversation for another podcast episode would be talking about, I really wonder, and something I think about a lot is they call it, they've already kind of called it like

[19:40] Phone neck or something I think but this idea of people constantly at computers and looking at their phones and like how your next constantly like Tilted downwards kind of and stuff like that It'd be interesting to do a deep dive on all of that and obviously there's still it's still relevantly new so like decades over the decades

[20:00] There'll be a lot more research on it, but that'd be very interesting. When people used to just be out working in the fields all day in the past or out actively doing stuff compared to, we already know, sedentary lifestyle is not good for us over the long term. It causes back problems and neck problems. So it'll be interesting now with the smartphones.

[20:20] Some people will use these smartphones 10 plus hours a day. I think our bodies are meant to move. Having your body in one position, that's why you feel stiff when you get up. But I think that'd be very helpful if it is, again, this isn't specific medical advice. And if you

[20:40] You think after listening to this episode that you might have something or someone you know might have some of the problems described, your first step would be see if it's been going on for more than just a couple days or it's been a week plus long. Just summarizing here that you should definitely go consult your primary care physician

[21:00] go figure something out because you shouldn't have long term pain like that. It's usually an indication that you might have an issue. Yeah, and the worst thing you can do, I would warn people, is that don't ignore it. I have so many people who ignore the pain. They just live with it.

[21:20] maybe they did therapy for years and years and went to the chiropractor and they did pain management. So they come to my office after three or four or five years of having pain in their neck and down their arm. All along they've had a pinched nerve, they didn't want to have surgery and then they get to the point where nothing else works. They said I'm ready to have surgery. Well at

[21:40] At that point, the nerve made me damaged. There are people who have surgery done who don't get better from surgery and then a lot of people say, yeah, that's why I never want to have neck surgery or back surgery because it doesn't work, people just don't get better. Well, people do get better when you address it when you need to. If you wait years and years and then have your surgery and leave the pensioner

[22:00] leave the nerve pinched, you can end up damaging the nerve and then it won't get better after surgery. So I always, for my patients, I usually let it go up to three to six months and if conservative measures haven't worked and they have a pinched nerve, by that point I recommend surgery because I think waiting for years, you're just letting the nerve sit there squeezed and it

[22:20] and it gets potentially damaged and then you have chronic pain that won't respond to anything including surgery. So there's a time when surgery works and a time when surgery doesn't work and you just don't want to wait too long and you shouldn't be scared of surgery. I mean surgery is if you can see all the patients that come into my office after I operate on both in their neck and their lower back and how it changes

Conclusion and Key Takeaways

[22:40] their life and how the pain is gone and how much better they feel. I just did three surgeries the other day. The first patient had a neck surgery, went home the same day. His arm pain was already better in the recovery room. The other two people had surgery on their lower back for spinal stenosis. And in the morning when I saw them, they had both been up walking

[23:00] the halls and they both said their leg pain was already almost gone. So surgery can work wonders for people. Don't be afraid of it. But you only want to have it when you need it. But don't ignore your symptoms. That's what I'm telling you, please. I think that's very good advice because I think some people just kind of go into the mantra of like, just they live with the pain or like it's

[23:20] It's about a toughness or yeah, they're scared of something. But obviously, what you're saying too is that you don't have all the options the longer you wait. And what if you're the person who has something that's much worse than a pinched nerve and you didn't catch that. So it's important. Take advantage of modern medicine.

[23:40] I think that was a really good kind of dive into your world and something you do on a routine basis and see all the time. So hopefully some people gain something from that. Yeah, it's a very specific topic, but a lot of people have it. A lot of people have a pinched nerve in their neck and pain and symptoms down their arms. So I hope you guys learned a little bit about it and it makes a little more sense.

[24:00] sense to you and if you ever have those symptoms make sure you see your doctor to get some better information about it or treatment.