Conditions · Carrollwood · Tampa Bay
Pinched Nerve
What nerve root impingement, foraminal narrowing, and radiculopathy mean on your report, why a problem at your spine shows up in your fingers or your foot, and how a doctor trained in spinal MRI interpretation connects the picture to the person.
A radiology report is written for other doctors, not for you. So when yours says nerve root impingement at C6-C7, or foraminal narrowing, or radiculopathy, the words land without a translator, and you read them at 11pm with your phone in one hand. This page is the translator. Dr. Bobby Koser, DC, chiropractic physician, completed post-doctoral training in spinal MRI interpretation and clinical correlation, and reviewing the report with the person it belongs to is part of the examination here. Bring yours.
Pinched Nerve Overview
What the words on your report mean
A nerve root is the branch that leaves the spinal cord and passes out through a small doorway between two vertebrae. Nearly every phrase on this page describes the same situation: something next to that root taking up room. It might be disc material, a bone spur, called an osteophyte, thickening of the small joints at the back of the spine, or a narrower doorway. If your report also names a protrusion or an extrusion, the herniated and bulging disc page translates the disc words.
Pinched nerve
The everyday name for pressure on a nerve root: something beside the nerve pressing against it, or crowding the space it travels through. In practice people use the phrase for a lot of different things: a stiff joint, a muscle in spasm, a trigger point referring pain somewhere else, and sometimes an actual compressed nerve. Which one you have is what the examination works out.
Also written as: compressed nerve, nerve compression, spinal nerve compression, impinged nerve, trapped nerve, or nerve entrapment. Patients also search it by where they feel it, as a pinched nerve in the neck, the shoulder blade, the low back, the arm, the hip, or the leg.
Radiculopathy
The medical word for a nerve root under pressure or irritated, from radix, Latin for root. Cervical means the neck, thoracic the mid back, lumbar the low back, so cervical radiculopathy names a root in the neck. Radicular pain travels along the path one nerve serves instead of staying at the spine, and monoradiculopathy means a single root is involved.
Also written as: radiculitis, cervical radiculitis, lumbar radiculitis, lumbosacral radiculopathy, radicular symptoms, or nerve root irritation.
Nerve root compression, impingement, abutment, contact
Radiologists use these for how much of the nerve root the scan shows being touched. Contact and abutment mean something is up against it. Impingement, compression, effacement, and mass effect mean the nerve’s shape or position on the image has changed. Each describes one picture, from one angle, with you lying still. Which word appears is not a ranking of what it means for you; that is what the examination is for.
Also written as: neural impingement, nerve root contact, nerve root effacement, nerve root displacement, mass effect on the nerve root, or neural encroachment.
Foraminal narrowing, or foraminal stenosis
The foramen is the small doorway on each side of the spine where a nerve root leaves, one pair at every level. Foraminal narrowing means that doorway measures smaller than usual on the scan. Lateral recess narrowing describes the same thing a little deeper in, in the channel a nerve passes through before it exits.
Also written as: neuroforaminal narrowing, neural foraminal narrowing, foraminal stenosis, neuroforaminal stenosis, neuroforaminal encroachment, lateral recess stenosis, or subarticular recess narrowing.
Exiting root, traversing root, and the level names
Every level has a numbered nerve root leaving it on each side, which is why a report names both, like C6-C7 or L5-S1. C numbers are the neck, L numbers the low back, counted from the top down. The exiting root is on its way out at that level; a traversing root is passing through to leave a level lower down, which is how a finding at L4-L5 ends up named alongside the L5 root.
Also written as: C5-C6 or C6-C7 pinched nerve, C6 or C7 nerve root, L4-L5 or L5-S1 pinched nerve, L5 or S1 nerve root.
Dermatome, myotome, paresthesia, and what a nerve test measures
Each nerve root carries two kinds of traffic: feeling from one strip of skin, its dermatome, and signals to one set of muscles, its myotome. Paresthesia is the medical word for pins and needles. A sensory deficit means feeling measures reduced on examination; a motor deficit means strength does. An EMG, short for electromyography, and a nerve conduction study measure the electrical traffic through those nerves and muscles.
A finding is not a diagnosis
In one study, 148 people who had not had low back pain in the previous four months had an MRI of the low back. One or more bulging discs, meaning a disc that extends past its normal border, showed up in 64% of them, and at least one protrusion, a more focused version of the same thing, in 32%: about a third of people with no recent back pain had a protrusion on the scan, and about two thirds did not. The people in that study were Veterans Affairs outpatients rather than a cross-section of the community, and the imaging covered the low back rather than the neck. The authors also concluded: the less common findings, including nerve root compression, meaning pressure on a nerve where it exits the spine, are the ones likely to be diagnostically and clinically relevant. A finding common in people who have no pain does not by itself tell us what is producing your symptoms, and your pain is not less real because the same words appear on other people’s reports.1
Whether a finding explains your symptoms depends on where it sits, which nerve it could reach, and whether that matches what you feel. Treating the picture instead of the person can mean treating the wrong thing, and pressure on a nerve root deserves to be examined rather than waved off. The report is the starting point. The examination connects it to you.
1. Jarvik JJ, et al. The Longitudinal Assessment of Imaging and Disability of the Back (LAIDBack) Study: baseline data. Spine (Phila Pa 1976). 2001;26(10):1158-1166. PubMed
Where the symptoms travel is the map the examination reads
A root in the lower neck can put numbness in two fingers. A root in the low back can put a numb patch on the outside of your foot. The pressure is at the spine. The symptom is wherever that nerve was going.
So the pattern is information, not noise. Which fingers or which toes, which movement gives way, which reflex answers and which stays quiet: an examination reads that against the level your report names.
In one population-based study, researchers identified 561 people diagnosed with cervical radiculopathy, an irritated or compressed nerve root in the neck, in a single Minnesota county between 1976 and 1990. Adjusted for age, new diagnoses averaged 83.2 a year for every 100,000 people, and in the 50 to 54 age group the rate was 202.9 per 100,000.2 Those figures count new diagnoses in one year, in one county, decades ago: in every age band, the large majority of people were not diagnosed in a given year, and this is not a Tampa number or a present-day number. One more finding speaks directly to the level names on your report: when a single nerve root was involved, the C7 root was involved most often, followed by C6. Those are levels in the lower neck. Whether the level named on yours explains what you feel is what the examination works out.
The spinal cord and a nerve root are different structures: the cord is the main cable in the spinal canal, the roots are the branches leaving it. Pressure on the cord itself produces a different picture and belongs on the warning list below, referred rather than managed as a pinched nerve.
2. Radhakrishnan K, et al. Epidemiology of cervical radiculopathy. A population-based study from Rochester, Minnesota, 1976 through 1990. Brain. 1994;117(Pt 2):325-335. PubMed
Symptoms, and the warning signs we screen for
Nerve symptoms have a texture people recognize once it is named: burning, electric, shooting, numb, pins and needles, or a limb that has gone to sleep and will not wake up. They follow a line rather than sit in a spot, and they can be louder in the arm or leg than at the spine. When the traveling pain runs down the back of a leg, many people call it sciatica. When it stays at the spine without traveling, start with neck pain or low back pain.
Common, and examined here
- Pain, tingling, or numbness that travels down one arm or one leg
- Pins and needles in particular fingers or toes
- Neck or back pain that changes with position, coughing, or sneezing
- A report that reads nerve root impingement, foraminal narrowing, or radiculopathy
- Arm or leg symptoms that started after a car accident
Emergency, not an appointment
- New loss of bowel or bladder control, or trouble starting or stopping urination
- New numbness in the groin, buttocks, or inner thighs, the area a saddle would touch
- Weakness in an arm or leg that is getting worse over hours or days, or spreading to another limb
- Weakness or numbness in both legs, or in both arms, at the same time
- New trouble walking, unsteadiness on your feet, or legs that give way
- New clumsiness in the hands: dropping things, or trouble with buttons, keys, or handwriting
- New weakness or numbness after a fall, a crash, or a blow to the head or neck
- Spine pain with nerve symptoms alongside fever, chills, unexplained weight loss, or a history of cancer
Some of these point to pressure on the spinal cord, or on the cauda equina, the bundle of nerve roots at the bottom of the spinal canal. Go to the emergency department now. Screening for these is part of the examination here.
How we approach a pinched nerve
The examination comes first: your history, a physical and neurological examination that measures strength, sensation, and reflexes side to side, and your imaging report read with you, not at you. Dr. Koser’s post-doctoral training in spinal MRI interpretation and clinical correlation exists for exactly this conversation, and years of helping flag potential surgical spine cases for referral, alongside neurosurgeons, came before this practice. The question the visit answers: does the finding on the report explain the person in the room? That visit is the Pain Source Exam.
When conservative care fits, it is built from the examination rather than the report: gentle techniques including flexion-distraction, which stretches the spine slowly with no thrust, instrument adjusting, soft-tissue work and dry needling for the muscles guarding the area, and a plan for movement you can follow. What was measured at the first visit gets measured again, so the plan changes if you do not.
Strength is the finding that changes the conversation. Grip that keeps failing, a foot that catches on a stair, a muscle weaker than last week: when the examination points there, we say so, refer you to the right physician, and send your records with you. The same is true when symptoms do not match any single nerve root, which can point away from the spine, toward the shoulder or hip joint itself or a nerve compressed at the elbow or wrist. Surgery decisions belong with surgeons; making sure you are in the right room is part of the job here.
Hurt in a car accident? Nerve symptoms after a crash run through a different door: Florida’s PIP law requires care to begin within 14 days. Start at our auto accident page.
What the research shows
Both studies below are randomized trials, studies in which patients are assigned by chance to one approach or another so the results can be compared fairly.
In one trial, 205 patients whose cervical radiculopathy, a pinched nerve in the neck, had started less than one month earlier were assigned to one of three groups: a semi-hard collar with rest for three to six weeks, twice weekly physiotherapy with home exercises for six weeks, or a wait and see approach, with results measured over the first six weeks only. The wait and see group improved too: arm pain eased by 19 mm over six weeks on a 100 mm pain scale, a line where patients mark how much it hurts. The collar group and the physiotherapy group each averaged an extra 12 mm of arm pain reduction beyond that, on the same 100 mm scale. Neck pain fell by 17 mm with the collar and 14 mm with physiotherapy while not decreasing significantly with wait and see, and on a neck disability measure the collar showed a significant change while physiotherapy did not. The authors concluded that in the early phase of the condition, either treatment reduced neck and arm pain substantially compared with waiting.3 Neither arm was chiropractic care; what the trial speaks to is how treating early compared with waiting, in the first six weeks of a recent-onset pinched nerve in the neck.
The second trial is about the low back, where a pinched nerve often announces itself as sciatica, pain traveling down the back of the leg. In that trial, 283 patients who had had severe sciatica for 6 to 12 weeks were randomly assigned to early disc surgery or to conservative treatment with surgery only if it became needed. Relief of leg pain and the sense of being recovered came faster for those assigned to early surgery. In the conservative group, 39%, about four in ten, went on to have surgery after a mean of 18.7 weeks. Even so, disability scores showed no significant overall difference over the first year, and after one year the probability of reporting recovery was 95% in both groups, which still leaves about one person in twenty who did not.4 Two limits matter when you read that next to your own report: the trial compared the timing of surgery, not surgery against no surgery, and it enrolled only low back cases whose symptoms had already lasted 6 to 12 weeks, so it says nothing about a recent-onset pinched nerve or about the neck.
Where your symptoms sit in any of this, neck or low back, recent or long-standing, is what the examination works out, and that conversation starts with the Pain Source Exam.
3. Kuijper B, et al. Cervical collar or physiotherapy versus wait and see policy for recent onset cervical radiculopathy: randomised trial. BMJ. 2009;339:b3883. PubMed
4. Peul WC, et al. Surgery versus prolonged conservative treatment for sciatica. N Engl J Med. 2007;356(22):2245-2256. PubMed
Common questions about a pinched nerve
Is a pinched nerve the same thing as sciatica?
They overlap in everyday speech, but they are not the same word. Sciatica names a pattern: pain traveling down the back of the leg along the sciatic nerve. Pinched nerve means pressure on a nerve root anywhere along the spine, neck included. If your symptoms run down a leg, start with the sciatica page.
Why are my fingers numb and tingling when the problem is in my neck?
Because that is where the nerve was going. Each nerve root in your neck carries feeling from one strip of skin, and for the lower neck those strips run down the arm to specific fingers. The pressure is at the root; you feel it at the far end. Which fingers are involved is what the examination reads.
My MRI says nerve root impingement. Does that mean I need surgery?
That phrase is not a surgical recommendation. Impingement describes what the picture showed at the moment it was taken: something up against the nerve root, or the root’s shape changed on the image. Whether that is producing your symptoms is what the examination works out, and if it says you need a surgeon, we refer you.
How long does a pinched nerve last, and what gets measured along the way?
No honest number fits everyone, and a timeline you read online is a guess about a stranger. What can be tracked is your examination: strength, sensation, and reflexes recorded at the start and measured again. Findings that hold or improve say the plan is working; findings that measure worse are a reason to change it or refer you.
Do I need an MRI or a nerve test to find out which nerve is pinched?
Not before your first visit. The examination decides whether imaging, or an electrodiagnostic test such as an EMG or nerve conduction study, is worth ordering, and if a test belongs with another physician we refer you for it. If you already have images or a report, bring them: reading them with you is part of the visit.
Can a chiropractor treat a pinched nerve, or will getting adjusted make it worse?
The examination decides the technique, before anything is done. Nerve presentations are where the gentler tools earn their place: flexion-distraction, instrument adjusting, and soft-tissue work. Some presentations should not be adjusted at all, and if yours is one of them, we tell you and treat differently or refer. The four techniques used here are described on the chiropractic care page.
My hand keeps dropping things and my grip feels weak. What does that mean?
Dropping objects, or new trouble with buttons, keys, or handwriting, is on the warning list above, because alongside neck symptoms it can point to the spinal cord rather than a single nerve root. Weakness that is getting worse over hours or days is an emergency department visit now, not an appointment. Weakness that is not changing still needs strength measured, written down, and measured again.
I was in a car accident and now my arm burns and tingles. What should I do?
Get examined early and get it on the record. Florida’s PIP law requires care to begin within 14 days of the crash, and nerve symptoms are better documented while they are happening than from memory months later. Our auto accident page covers what to bring. If weakness is getting worse, or symptoms are on both sides at once, that is an emergency department visit now.
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This page is general health information and is not medical advice for any individual. The studies summarized describe groups, not any one person’s outcome, and whether any finding on your imaging explains your symptoms can only be determined by examination. Talk to Dr. Bobby Koser, DC, about your own situation, and seek emergency care immediately for the warning signs listed above.
Bring the report. Have the words explained.
A complete examination with Dr. Bobby Koser, DC, your report read with you, and your findings explained the same day.