Common Causes of Pinched Nerves

Spine | Tuckahoe Orthopaedics
Walter N. Rabhan, MD | Tuckahoe OrthopaedicsBy Walter N. Rabhan, MD

Many patients, when they have a pinched nerve in the spine or neck, aren’t aware they have a pinched nerve. Instead, they talk about the associated symptoms without knowing the underlying cause. At Tuckahoe Orthopaedics, we use testing and medical knowledge to get to the root of the problem and find the cause of your pain.

Symptoms of Pinched Nerves

Common symptoms of a pinched nerve in the lower back or spine include:

  • Pain, burning, or stinging sensation in one or both buttocks, thighs, or calves
  • Hip pain
  • Pain or burning down to the toes or foot

Symptoms of a pinched nerve in the upper back neck usually include these same sensations, but the symptoms radiate into the upper extremities (arms, shoulders, scapula, hands).

Keep in mind, these are only symptoms, not conditions in and of themselves. A pinched or irritated nerve is really an indication of some other, underlying condition. If you have a pinched nerve, it’s a sign something else is going on in your body.

Causes of Pinched Nerves

Any one of these conditions can result in the symptoms described above.

  • Bulging of the disc.
  • Protrusion of the disc.
  • Ruptured disc
  • Degenerative disc disease (an early form of arthritis)
  • Bone spurs.
  • Fractures.
  • Inflammation of soft tissue from a severe sprain or strain

In rarer instances, pinched nerves may be caused by tumors, fractures, or what is called Piriformis Syndrome (an irritation of the sciatic nerve caused by muscle spasms).

Causes of a pinched nerve often vary by age. From ages 20 to 45, pinched nerves will most often occur as a result of disc or soft tissue problems. From ages fifty to eighty and onward, pinched nerves are most likely a result of degenerative arthritis, spinal stenosis, or other age-related causes.

Diagnosis and Treatment of Pinched Nerves

Diagnosis of a pinched nerve starts with a basic examination and X-ray. A physical exam will tell the doctor at what level of the spine the problem is occurring. Most of the time, barring extraordinary circumstances or significant abnormalities in the examination, the treatment for a pinched nerve is the same.

Routine treatment begins with anti-inflammatory medication, physical therapy, rest, and modified physical activity for three to four weeks. If the symptoms have not abated after this time, then further examination may be necessary, such as an MRI. This will show the doctor the disc, soft tissue, and the nerves to check for stenosis, bulging, protrusions, or other conditions that do not show up on an X-ray.

Beyond the non-invasive treatments are solutions such as cortisone shots and (as a last resort) surgery. However, most patients recover from a pinched nerve before even needing an MRI.

Are you experiencing ongoing neck or back pain that fits the symptoms above? Request an appointment with Tuckahoe Orthopaedics today so we can diagnose your options.

ACL Surgery Recovery: Expectations and Timeline

ACL, Tuckahoe Orthopaedics, orthopedic care

ACL Surgery Recovery: Expectations and Timeline

By Dustin C. Dyer, DO

If you are scheduled to have surgery for your ACL injury, or have recently undergone surgery, you may wonder how long it will take to recover. When can you run or play sports again? What will physical therapy be like?

The most important thing to remember about your recovery is to manage your expectations. For example, NFL athletes who suffer ACL injuries take eight months on average to fully recover. You should not expect a full recovery in just a few weeks. Instead, concentrate on performing every exercise and physical therapy activity correctly. It is also very important to follow all restrictions and recommendations from your surgeon and physical therapist. Do this and you’ll stand a much greater chance of an efficient, stable, and long-lasting recovery.

The Day of Surgery

These days, most ACL surgeries are outpatient, which means no overnight stay in the hospital. Before surgery, the anesthesiologist will administer a nerve block which numbs the nerves that send pain signals to the knee. This will give the patient a head start on the first twenty-four hours of pain control. You can start icing and elevating the knee right away — which will be critical for a proper recovery.

The First Two Weeks

For the first two weeks, you will most likely be using crutches and a hinged knee brace. This brace will initially be locked straight, because the quadriceps muscle tends to get weak after an ACL injury. If not braced, the knee may buckle, risking re-injuring the ACL. The knee can tolerate bearing weight, but must be kept straight when walking until the physical therapist or physician deems otherwise.

These first two weeks will focus on icing the knee (to reduce swelling) and range of motion activities. Heel slides and extension stretching are common activities. Obtaining full extension of the knee is important, because it is associated with a more complete recovery. The more you ice and elevate the knee throughout the first two weeks, the better your knee will feel (thus improving your recovery). A general goal is have range of motion from zero to 100 degrees by two weeks.

The First Three Months

At five to six weeks, the quadriceps muscle is likely recovered enough to support normal walking with your hinged knee brace unlocked. The decision to unlock or remove your brace will be made by your surgeon or physical therapist. From here, a good physical therapy routine and home exercise program are key. A patient that stays motivated and complies with restrictions will excel. Keep in mind that every patient is different, and recovery time and difficulty will vary depending on circumstances.

At this point, the physical therapist will continue to teach closed chain exercises, in which the the foot is planted and the patient works on strengthening the muscles around the knee. Strengthening the quadriceps muscle can help with normal ambulation, while strengthening the hamstring muscle can play a protective role for the healing ACL. Core strengthening, stretching and maintaining excellent range of motion are all vital to the rehab process as well.

Around the three-month mark, you may be able to start running in-line, though you likely will not be performing any cutting or pivoting exercises yet. Sports-specific cutting and pivoting exercises are likely to start five to six months after surgery.

Six to Eight Months

After six months (or longer), the physical therapist may administer a series of functional tests: agility tests, vertical jump tests, hop tests, etc. These tests are designed to determine the level of recovery and see if further physical therapy is necessary. The full recovery may take six months, eight months, or longer. It depends on the patient.

Many patients wonder if they will require an ACL brace after their surgery when they return to their sport or activity. While there is no definitive evidence that all ACL injury sufferers need a brace, there are certain athletes that prefer to wear them. Especially athletes that will be participating in contact sports. The best course of action is to consult with your physician and physical therapist regarding this matter.

If you have questions about ACL injury, surgery, or the recovery process, reach out to Tuckahoe Orthopaedics to request an appointment and get your questions answered.

Keep Shoulder Pain from Ruining Your Workout

Shoulder Pain, Shoulder Injury

Dr. Paul E. Caldwell, Arthroscopy and Sports Medicine, Tuckahoe Orthopaedics, Ortho, OrthopaedicsBy Paul E. Caldwell, MD 

Whether you’re in the gym or taking part in an active sport, the last thing you want to be worried about is feeling pain. This is especially true for shoulder pain, because of how much you use your shoulders when you are working out.

Let’s take a look at shoulder pain, how it affects you, and how careful adjustments to your workout routine can help alleviate the pain.

You Should Take Shoulder Pain Seriously

Unresolved shoulder pain can lead to larger problems, or be due to structural issues, such as a rotator cuff tear. This is another reason why you should always pay attention to your body rather than fighting through the pain.

Your shoulder pain should not linger for more than a day or two after a workout. It is especially concerning if it is a sharp pain, versus general soreness. A good rule of thumb is that if the pain keeps you up at night, it’s pain you can’t work through.

The mistake many people make is that they continue to be active and therefore continue to do further damage. After all, it’s one thing if a muscle is sore. But it is another thing entirely if the joint is sore or you’re dealing with a structural issue.

Be mindful of what your body is telling you. If the pain doesn’t go away soon after a workout, it could be problematic.

The Causes of Shoulder Pain

The majority of shoulder injuries that occur during workouts happen to those who are deconditioned, meaning they aren’t in good enough shape to do those exercises.

Typically, these people make the mistake of jumping into an exercise program that they bought online or saw on TV. While it is great that they have a desire to be healthier, their bodies are not ready for an intense workout yet.

There are also those who injure their shoulders when they lifting weights over their heads while using an improper form. This is common among beginners who do not know that they are doing the exercises incorrectly.

Overhead presses and behind the neck pull downs are the most common exercises that cause shoulder injuries. That’s why doctors recommend that beginners work with a trainer or other professional to learn how to do these exercises correctly.  Before you start an upper extremity workout program, make sure you’re getting assistance on your form.

Shoulder Pain Can Arrive in Different Ways

It’s very common for pain in the shoulder to worsen at night, with patients noticing they’re unable to sleep on that shoulder or arm.

The pain subsides during the day but it aches at night and often radiates down toward the elbow. This may make it easy to misinterpret as biceps/triceps or deltoid muscle pain.

It’s important to note that your experience may differ depending on your age. For example, some younger patients might report a pop or snap in their shoulder when a structural issue arises. For many older patients, it’s through repetition of a movement that they start to feel shoulder pain.

Either way, if it’s a structural issue like a torn rotator cuff, the patient will experience a loss of strength in the shoulder. While the patient’s hand usually responds normally, the issues are felt in the shoulder itself. It’s very difficult for a patient to differentiate between the small and larger muscles in the shoulder and know what the issue is without seeing a doctor.

Ways to Protect Yourself From Shoulder Injuries

The best way to make sure that you’re not putting your shoulder at risk is to talk to a doctor before starting a specific exercise program. You should avoid jumping into something that may be beyond your ability.

It’s also important to have professional guidance as far as your form. Start out with low weights and high repetitions and move up gradually. Next, make sure that you are warming up and stretching before any workout. This should include dynamic warm ups, which include more motion than just static stretching.

Lastly, if you start to feel pain in your shoulders, you should modify your activity. If it persists, stop working out altogether. If pain continues, try anti-inflammatory medications but do not use them to work through the pain.

You should always see a doctor if you experience continued pain for several days. If you’ve been dealing with ongoing pain in your shoulder, contact Tuckahoe Orthopaedics today.