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).