Treating a Pinched Nerve in Neck or Shoulder

Between radiating neck pain and tingling sensations to your arm, dealing with a pinched nerve in your neck or shoulder can be a nuisance. If you are one of the many Americans who suffer from this spinal issue, the good news is there are many approaches to help reduce discomfort and speed up healing. 

“Neck, shoulder and arm pain can be very debilitating,” acknowledges Charles Steger, a physical therapist with INTEGRIS Health Jim Thorpe Rehabilitation in Oklahoma City. “Nerve pain can be especially confusing and irritating due to the variability of its presentation. Your physical therapist can help you verify if you are experiencing a pinched nerve and provide you with specific treatments to help your body heal and feel better.” 

From conservative approaches such as exercises and stretches to more advanced surgical treatments, in this blog we explore how to effectively manage a pinched nerve.

What is a pinched nerve?

There are 31 pairs of nerves and roots in the spine. These nerves control both motor and sensory functions.

Spinal nerves exit the spinal canal to the rest of the body through a small opening called foramen. This opening is near muscles, vertebral discs, ligaments, tendons and joints, and any excessive pressure in these areas can “pinch” the nerve. For example, a tight muscle in the neck can shrink a nerve’s exit space, which squeezes and compresses the nerve and disrupts its ability to function. 

A pinched nerve can cause radiating pain, numbness, weakness or a tingling sensation in whichever area is affected. The feelings can range from a constant, dull pain to a sudden, intense pain.

Most pinched nerves occur in one of three areas:

• Neck (cervical radiculopathy): This can cause stiffness in the neck that radiates to the arm or shoulder.
• Middle back (thoracic radiculopathy): This can cause pain or stiffness in the chest area.
• Lower back (lumbar radiculopathy): This typically causes localized back pain along with pain that radiates to the hips, glutes or legs.

A pinched nerve can occur for many reasons, including a herniated disc, bone spurs, narrowing of the spine (spinal stenosis), injury or engaging in a repetitive motion. Age-related degenerative changes account for 70 to 90 percent of all cases.

Pinched nerve in neck

There are seven small vertebrae that make up the cervical spine. These bones help support the head and allow it to move in various directions. The cervical spine is home to eight cervical nerves. The cervical nerves play a key role in transmitting signals between the brain and body, which helps us perceive our surroundings and move our muscles.

Of the eight cervical nerves, three aid in movements and sensations of the neck. Cervical nerves C1, C2 and C3 allow the head and neck to move side to side, forward and backward. Nerve compression to any of these nerves can cause symptoms anywhere in the head or neck area.

Pinched nerve in shoulder

When people refer to nerve pain in their shoulder, they typically have compression in the cervical spine that is causing pain in the shoulders or arms.

Cervical nerve 4 allows the shoulder to move upward and cervical nerve 5 allows the deltoid muscles to move. These two nerves also provide sensory information for the shoulders and upper arms. For example, C5 provides sensation from the upper arm to elbow, which explains why pain from a pinched nerve in this area can radiate to your elbow.

That said, the shoulder does have many nerves that can also become compressed. The axillary nerve, which helps lift your arm and rotate it away from the body, is one of five nerves that runs through the shoulder.

How long does a pinched nerve last?

The recovery time for a pinched nerve depends on the severity (how compressed the nerve is). In most cases, it may only take days for symptoms to improve. Other times, the pain and discomfort can last weeks or even longer. Without treatment (rest alone), symptoms may improve in four to six weeks.

Will a pinched nerve heal on its own?

A pinched nerve can heal on its own simply with rest. Minor overuse injuries are a prime example. If a nerve becomes compressed due to repetitive overhand motions, simply resting and avoiding the movements altogether will help clear up your symptoms.

You can also combine rest with over-the-counter medications and ice/heat therapy to reduce swelling and inflammation. However, if home treatments don’t provide relief, this should signal you to contact a doctor or physical therapist for further examination.

How to relieve a pinched nerve

Treatment for a pinched nerve almost always starts with conservative methods such as rest, medications and physical therapy.

Non-surgical options

• NSAIDs: Non-steroidal anti-inflammatory drugs, such as aspirin, naproxen and ibuprofen, provide pain relief by reducing inflammation at the site of the affected nerve.
• Steroids: Corticosteroids, either oral or via injection, reduce swelling at the site of the pinched nerve. A pain management specialist is able to inject a combination of corticosteroids and a local anesthetic, which reduces inflammation in the spinal canal.
• Ice/heat: Ice helps reduce and relax muscle tension around the pinched nerve. Heat can also stimulate blood flow to help the healing process.
• Immobilization: A padded ring called a soft cervical collar can be placed around the neck to minimize movement and irritation of the neck.
• Physical therapy: The goal of physical therapy is to create space to decrease compression of the nerve. Your therapist will use specific stretches, exercises and hands-on manual therapy techniques to loosen muscles, ligaments and tendons that put pressure on the nerves. Stretching reduces muscle tension to make them more flexible, and the exercises help strengthen muscle groups.

Cervical radiculopathy surgery

Surgery is typically a last resort option after other conservative treatments have failed. Surgical options include discectomy (disc removal), Laminectomy/foraminotomy (a combination procedure that both removes bone spurs and widens the opening in the spine where nerve roots travel) and spinal fusion. The goal of each procedure is to take pressure off the area around the nerve that causes compression.

• Anterior cervical discectomy and fusion (ACDF): This surgical procedure is a two-step process, first removing the herniated or degenerative disc in the neck, then using a bone graft to fuse the vertebrae together. By introducing a bone graft, the vertebrae heals into a single bone to eliminate movement and therefore reduce pain. The tradeoff is you lose flexibility in that part of the spine, which can lead to stiffness.
• Artificial disk replacement (ADR): This surgical procedure uses an artificial prosthesis to replace the damaged disc causing the compressed nerve. An ADR is similar to a knee or hip replacement. The implant is either made of metal or a combination of metal and plastic.
• Posterior cervical laminoforaminotomy: This surgical procedure thins down the lamina (a bone that protects and supports the back part of the spinal cord) and widens the foramina, the opening in the spine in which the spinal nerves and blood vessels pass. If bone spurs or a herniated disc are the cause of the compression, your surgeon will also remove them.

Cervical radiculopathy stretches and exercises

Stretching helps treat a pinched nerve by reducing muscle tension, promoting flexibility and improving blood flow. Exercises can then help by building up strength in the muscles, joints, tendons and ligaments around the affected area to reduce the risk of a future injury occurring.

Neck

• Chin tuck: In a standing or sitting position, tuck your chin towards your chest. Hold for a few seconds and repeat.
• Head turn: In a standing or sitting position, look over your shoulder and turn your head to the right. Hold for a few seconds. Then look over your left shoulder and turn your head to the left. Repeat several times.
• Neck bend: In a standing or sitting position, bring your ear to your shoulder and tilt your head to one side. Hold for a few seconds, then repeat on the other side.
• Nerve glide: While sitting in a chair, squeeze your shoulder blades together and bring your chin towards the chest. Hold for a few seconds, then relax. Repeat several times.
• Side bends: With your feet shoulder-width apart, clasp your hands over your head and gently tilt your body from side to side. Be sure to keep your head and neck straight. Repeat several times.
• Thoracic extension: While sitting on a chair, put your hands behind your head and lean back, arching your upper back. Hold for a few seconds and repeat several times.
• Trapezius stretch: In a standing or sitting position, reach your right arm over your head and place your hand on the left side of your head. Gently pull your head towards your right shoulder. Hold for a few seconds, then switch sides.

Shoulder

• Pendulum stretch: Lean over with your arm on a chair or bench. Dangle the other arm straight down and swing it back and forth like a pendulum. Perform this movement for a few minutes.
• Shoulder retraction: Stand or sit up with your arms by your sides. Pull your shoulder blades toward your spine. Think about squeezing them together. Hold for a few seconds and repeat several times.
• Shoulder rolls and shrugs: Shrug your shoulders up and down for about 30 seconds. Rest for a few seconds, then roll your shoulders in a circular motion (toward your chest and up toward your ears). Repeat this sequence a few times.
• Side bends: With your feet shoulder-width apart, clasp your hands over your head and gently tilt your body from side to side. Be sure to keep your head and neck straight. Repeat several times.

Before performing any exercise, consult a physical therapist for guidance on what specific stretches and exercises can improve your symptoms. In addition, contact an orthopedic physician who can assist you in diagnosing neck and shoulder ailments.

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