A pinched nerve, or radiculopathy, occurs when surrounding tissues like bone, cartilage, muscle, or tendon place pressure on a nerve. This compression disrupts the nerve’s ability to transmit signals, resulting in symptoms such as pain, numbness, and tingling sensations. The pain often manifests as a sharp, burning feeling that radiates outward from the area of compression, such as from the neck down the arm or the lower back down the leg. Addressing this condition involves a sequence of specialized consultations to ensure an accurate diagnosis and effective treatment plan.
The Initial Consultation: Primary Care
The journey toward treating a pinched nerve begins with a Primary Care Physician (PCP), General Practitioner, or Family Medicine doctor. This initial consultation focuses on differential diagnosis, where the doctor rules out other potential causes of pain, such as muscle strain, joint arthritis, or vascular issues. The PCP conducts a thorough physical examination, testing reflexes, sensation, and muscle strength, while also taking a detailed medical history.
During this initial phase, the PCP may recommend conservative treatments, including rest, activity modification, and over-the-counter anti-inflammatory medications. If symptoms do not resolve, the physician may order preliminary imaging, such as X-rays, to look for bone alignment issues or signs of arthritis. This approach determines if the condition requires specialized care, at which point the PCP provides a referral to the appropriate specialist.
Specialists for Non-Surgical Treatment
The majority of pinched nerve cases resolve without surgery, relying on specialized non-surgical expertise for diagnosis, pain management, and rehabilitation. Several specialists typically manage this conservative treatment path.
Physiatrists (PM&R)
A physiatrist, or doctor of Physical Medicine and Rehabilitation (PM&R), specializes in restoring function and managing musculoskeletal and nerve-related pain through non-operative means. They design comprehensive treatment plans integrating medication, therapeutic exercises, and interventional procedures like targeted steroid injections or nerve blocks. Physiatrists may use electrodiagnostic studies, such as EMG and NCS, to identify the location and severity of nerve damage and guide effective injection placement.
Neurologists
Neurologists specialize in disorders of the nervous system, including the brain, spinal cord, and peripheral nerves. They primarily use sophisticated electrodiagnostic testing, specifically Nerve Conduction Studies (NCS) and Electromyography (EMG). These tests measure the electrical activity of nerves and muscles, confirming the presence of a pinched nerve and mapping its exact pathway. Their role is to ensure symptoms are caused by nerve compression and not by another neurological condition.
Physical Therapists
Physical therapists (PTs) implement rehabilitation programs to decompress the irritated nerve, often working under the direction of a physiatrist or neurologist. They use specific manual techniques and prescribe therapeutic exercises designed to improve posture, strengthen supporting muscles, and increase flexibility. PTs also employ modalities like heat, ice, or traction to alleviate muscle spasms and create more space for the nerve. This approach focuses on alleviating mechanical pressure while restoring the patient’s normal movement patterns.
When Surgical Intervention Is Needed
Surgical intervention is reserved for patients whose severe symptoms persist after a dedicated course of conservative treatment, typically lasting six to twelve weeks. A surgical consultation is also warranted if the patient develops signs of severe neurological compromise, such as progressive muscle weakness or the loss of bowel or bladder control. The goal of surgery is to physically remove the structure, such as a fragment of a herniated disc or a bone spur, that is compressing the nerve.
Two distinct specialists perform these procedures: neurosurgeons and orthopedic spine surgeons.
Neurosurgeons
A neurosurgeon specializes in the diagnosis and surgical treatment of disorders affecting the entire nervous system, including the brain, spinal cord, and peripheral nerves. Their training emphasizes the delicate handling of neural tissue, making them skilled in procedures that involve directly decompressing the spinal cord or nerve roots.
Orthopedic Spine Surgeons
An orthopedic spine surgeon specializes in the musculoskeletal system, focusing on the bones, joints, ligaments, and tendons of the spine. For common conditions causing a pinched nerve, such as a herniated disc or spinal stenosis, both types of surgeons frequently perform similar decompression surgeries. The choice between them often depends on their specific fellowship training, experience with the spinal segment involved, and the referral network.