Shoulder
> Pinched Nerves
What is a Pinched Nerve?
he medical terminology
for a pinched nerve, or what is commonly referred to
as a "burner" or "stinger," is actually
a stretch injury to the nerves that are distributed
to the upper extremities. The condition affects primarily
the upper trunk of the brachial plexus, which is part
of the nerves that extend to the arms. These nerves
are responsible for the muscular function and sensation
of the arm and hand.
Pinched nerves are usually caused
by a forceful downward pulling of the shoulder one way
while the head is pulled in the opposite direction.
A pinched nerve can occurs when a football player makes
a tackle and there is a collision while his arm is reaching
one way and his head and neck all move in a different
direction. Herniated discs also can lead to pinched
nerves. Herniated discs are ruptures of the vertebral
ligaments that cause disc material to push into the
spinal canal. These can compress, or pinch, the nerve
roots. A herniated disc affects the spinal cord itself
as opposed to the peripheral nerves branching off the
spine. Other conditions that can cause a pinched nerve
are bulging discs, ligament problems where you have
an unstable spine, and spinal stenosis, a condition
where the bony canal structures that the nerves exit
are too narrow.
Physical therapy, neck braces, neck
strengthening and stretching exercises, and proper equipment
all play a role in both the treatment and prevention
of pinched nerves. The long-term prognosis for these
types of injuries is very good. Arthur
J. Ting, M.D. is team physician for the San Jose
Sharks and a member of Professional Team Physicians.
If an athlete reports burning or numbness
which later subsides, and the symptoms are not reproducible
by the team physician or trainer, it would be safe to
return that player to competition. If the stinger can
be reproduced or if there is residual weakness or numbness,
then the athlete should not return to competition until
the condition is resolved. If there is any paralysis
of an extremity, the nerve could be completely lacerated
or cut, which would result in an almost irreversible
condition. Paralysis may also result if the nerve is
stretched or severely bruised. Clinically, when someone
has paralysis or neurological deficit, it is difficult
to tell for sure whether that nerve has been momentarily
pinched or lacerated. If the injury is more severe than
tingling or numbness and there is shooting pain or paralysis
involved, it is vital to treat the injury as if it were
a laceration. If this proves to be true, the prognosis
is, unfortunately, not as good. There is a three- to
five-day window during which it is too early to tell
the severity of the injury. Even if a nerve is completely
cut, there can still be some conduction from one end
that could show a positive result. An electromyogram,
or nerve conduction study, will tell whether the nerves
are intact. A wait of seven days is necessary before
someone can be tested for complete laceration. If the
results are abnormal and show little or no nerve conduction,
you face a very low surgery-success rate. If the test
is normal and there is conduction and no laceration,
conservative treatment is advised, with rest, avoidance
of contact, and monitoring to see how much neurological
functioning returns. Herniated discs can predispose
someone to a pinched nerve, so in the diagnosis of repetitive
stingers or even in an initial stinger that is more
severe, there must be a thorough exam of the cervical
spine that would include X-rays and possibly MRI (magnetic
resonance imaging).
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