Radiculopathy

Radiculopathy, commonly called a pinched nerve, occurs when a spinal nerve root is compressed or irritated as it exits the spinal column through the neural foramen. The most common causes are herniated disc (disc material pressing on nerve), foraminal stenosis (bony narrowing of nerve exit canal), or bone spurs from arthritis. Cervical radiculopathy (pinched nerve in neck) causes arm/hand pain, while lumbar radiculopathy (pinched nerve in lower back) causes leg/foot pain (sciatica is lumbar radiculopathy affecting the sciatic nerve specifically). At Mountain Spine & Orthopedics, we use precise diagnostic imaging and targeted treatments including epidural steroid injections, Physical Therapy, and surgical nerve decompression to restore function. Learn more about radiculopathy from the American Academy of Orthopaedic Surgeons.

Symptoms depend on which nerve root is compressed. Cervical radiculopathy (neck) causes radiating arm/hand pain, numbness, tingling, or weakness in a specific dermatome pattern (e.g., C6 - thumb/index finger, C7 - middle finger, C8 - ring/pinky fingers). Lumbar radiculopathy (lower back) causes radiating leg/foot pain (sciatica when L5 or S1 nerve roots affected), often described as sharp, shooting, burning, or electric. Numbness, tingling, or weakness in specific leg muscles may occur. Pain often worsens with certain neck/back positions, coughing, sneezing, or straining.

Risk factors include age 30-50 (peak for disc herniation), occupations involving heavy lifting or repetitive neck/back motions, smoking (accelerates disc degeneration), obesity, sedentary lifestyle with poor posture, family history of disc disease, prior spine injury or trauma, and degenerative changes (Degenerative Disc Disease, Spinal Stenosis, arthritis). Acute radiculopathy can occur with sudden disc herniation from trauma or lifting injury.

Diagnosis begins with neurological examination testing strength, sensation, and reflexes in affected limb to identify which specific nerve root is compressed. MRI is the gold standard imaging, showing disc herniations, foraminal stenosis, and nerve root compression (complimentary MRI review available). EMG/nerve conduction studies (electrodiagnostic testing) confirm nerve damage and help differentiate radiculopathy from peripheral nerve problems. Spurling's test (cervical) or straight leg raise (lumbar) reproduce radicular symptoms on physical exam. Selective nerve root blocks can confirm which specific nerve root is the pain generator when multiple levels show abnormalities on MRI.

Conservative Non-Surgical Management

Most radiculopathy cases (70-90%) improve with conservative treatment over 6-12 weeks. Initial management includes:

• Activity modification - avoiding aggravating positions (prolonged sitting, neck extension)
• Physical Therapy - nerve gliding exercises, posture correction, core/neck strengthening
• Medications - anti-inflammatories (NSAIDs), neuropathic pain medications (gabapentin, pregabalin), muscle relaxants, oral corticosteroids for acute severe cases
• Cervical or lumbar traction (when appropriate)

Epidural Steroid Injections

Epidural steroid injections (ESI) deliver corticosteroid directly to the inflamed nerve root, reducing swelling and pain. This allows participation in physical therapy and may avoid surgery. ESI is highly effective for radiculopathy from disc herniation or stenosis when conservative measures alone provide insufficient relief. Relief typically lasts weeks to months and can be repeated if symptoms recur.

Surgical Nerve Decompression

Surgery is considered when:

• Progressive weakness develops (dropping objects, foot drop, muscle atrophy)
• Severe pain unresponsive to 6-12 weeks of comprehensive conservative care including ESI
• Large disc herniation with significant nerve compression on MRI
• Cauda equina syndrome (emergency) - loss of bladder/bowel control, saddle numbness

Surgical options include:

• Cervical: ACDF, posterior foraminotomy, disc replacement
• Lumbar: microdiscectomy, endoscopic discectomy, laminectomy, foraminotomy

These procedures remove the compressive structure (disc, bone spur) to decompress the nerve root. Most are minimally invasive with high success rates (80-90% good-to-excellent outcomes).

Radiculopathy pain patterns follow specific nerve root distributions (dermatomal patterns):

• C5 - shoulder, lateral arm
• C6 - thumb, index finger, radial forearm
• C7 - middle finger
• C8 - ring/pinky fingers
• L4 - anterior thigh, medial shin
• L5 - lateral leg, top of foot, big toe
• S1 - posterior leg, lateral foot, bottom of foot

Pain is typically sharp, shooting, or burning, radiating from spine down limb. Unlike muscular pain (dull, diffuse), radiculopathy follows a clear nerve distribution. Red flags requiring urgent evaluation include progressive or sudden weakness (drop foot, hand weakness), loss of bladder/bowel control (cauda equina syndrome), saddle anesthesia (numbness in groin/inner thighs), or bilateral leg symptoms with difficulty walking, which may indicate severe spinal cord compression requiring emergency surgery.

Preventing radiculopathy includes maintaining good posture and ergonomics (especially with desk work), regular exercise focusing on core and neck strength, proper lifting technique (bending at knees, keeping loads close to body), maintaining healthy weight to reduce spinal stress, avoiding smoking (accelerates disc degeneration), taking breaks from prolonged sitting or repetitive motions, and addressing early neck/back pain before it progresses. For those with prior episodes, continuing strengthening exercises and maintaining flexibility reduces recurrence risk.

Radiating arm or leg pain, numbness, or weakness suggesting pinched nerve? Schedule your consultation today at Mountain Spine & Orthopedics for radiculopathy evaluation. Complimentary MRI review and second opinion available. Same-day and next-day appointments often available. Car accident or trauma causing nerve compression? We treat accident-related radiculopathy.