Nerve compression, often called a pinched nerve, occurs when surrounding tissues—such as bone, cartilage, tendons, or muscle—exert excessive pressure on a nerve. This mechanical irritation disrupts the nerve’s ability to transmit signals, leading to symptoms in the area the nerve serves. The resulting discomfort can manifest as pain, a burning sensation, tingling, numbness, or muscle weakness. Conditions like carpal tunnel syndrome and sciatica are common examples. Finding the correct medical specialist is the first step toward effective treatment and recovery.
How Nerve Compression is Identified
The diagnostic journey for nerve compression often begins with a primary care physician (PCP) who performs an initial physical and neurological examination. This exam typically involves assessing reflexes, muscle strength, and sensory perception to determine a potential pattern of nerve involvement. If the initial assessment suggests nerve compression, the patient is usually referred for specialized diagnostic testing to pinpoint the exact location and severity of the injury.
Electrodiagnostic studies, collectively known as Nerve Conduction Studies (NCS) and Electromyography (EMG), are considered the gold standard for confirming nerve function. The NCS measures how quickly and strongly an electrical signal travels along a nerve, revealing if the signal is slowed or blocked at a specific point. The complementary EMG involves inserting a fine needle electrode into muscles to evaluate their electrical activity both at rest and during contraction. This test helps determine if the nerve damage has resulted in chronic changes to the muscles it supplies.
Imaging studies are often used in conjunction with electrodiagnostic testing to identify the underlying structural cause of the compression. Magnetic Resonance Imaging (MRI) is particularly valuable because it excels at visualizing soft tissues, unlike X-rays, which primarily show bone. While the MRI does not typically image the nerve itself in high detail, it clearly reveals the compressing structures, such as a bulging or herniated spinal disc, bone spurs from arthritis, or spinal stenosis. Specialized imaging techniques like MR neurography can further enhance the visualization of the nerve and surrounding inflammation.
The Role of Non-Surgical Specialists
The first line of care for most nerve compression issues is conservative, non-surgical treatment, led by specialists who focus on rehabilitation and pain management. Physiatrists, who are physicians specializing in Physical Medicine and Rehabilitation (PM&R), play a central role in this process. Their focus is on restoring function and improving the patient’s quality of life without surgical intervention.
A physiatrist often designs a comprehensive treatment plan that heavily features targeted physical therapy, prescribing specific exercises to strengthen supporting musculature and improve flexibility. They also specialize in interventional procedures, such as precise image-guided injections to deliver anti-inflammatory medication directly to the site of compression. For instance, an epidural steroid injection is a common procedure they perform to reduce swelling around an irritated nerve root in the spine.
Neurologists are physicians who specialize in disorders of the nervous system and are often involved in diagnosing the condition and managing nerve-related pain. They are experts in interpreting the results of NCS and EMG tests to determine the precise nature and extent of the nerve damage. Neurologists typically manage symptoms using medications that specifically target nerve pathways, which are often ineffective with standard over-the-counter pain relievers.
These specialists frequently prescribe anticonvulsant medications, such as gabapentin or pregabalin, to calm the hyperactivity of damaged nerves. They may also utilize certain classes of antidepressants, like tricyclics (e.g., amitriptyline) or Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs, e.g., duloxetine), because these drugs can modulate the chemical signals involved in chronic nerve pain. The neurologist’s treatment plan is centered on dampening the nerve’s distress signals, working in tandem with the physiatrist’s functional approach.
The Role of Surgical Specialists
When conservative management, including medication and rehabilitation, fails to relieve pain or if the patient experiences progressive neurological deficit, surgical intervention becomes necessary. The type of surgeon consulted depends on the location of the compression and the underlying cause. Two primary surgical specialties manage these conditions: orthopedic surgeons and neurosurgeons.
Orthopedic surgeons are specialists in the musculoskeletal system, which includes bones, joints, ligaments, and tendons. Their scope often includes nerve compression in the extremities or caused by bony or soft tissue structures outside the spinal cord. Procedures like carpal tunnel release, which relieves pressure on the median nerve in the wrist, or cubital tunnel surgery for the ulnar nerve at the elbow, are typically performed by an orthopedic surgeon.
Neurosurgeons specialize in the entire nervous system, including the brain, spinal cord, and peripheral nerves. While often associated with complex brain surgery, they are also highly trained in delicate procedures involving the spinal column and nerve roots. They commonly perform procedures like microdiscectomy, which removes a small piece of a herniated disc pressing on a spinal nerve, or laminectomy, which enlarges the spinal canal to relieve pressure on the spinal cord and nerves.
Both surgical specialists work toward the common goal of decompression—the physical removal of the pressure source to allow the nerve to heal. The decision to proceed with surgery is made after careful consideration of the diagnostic imaging, the electrodiagnostic findings, and the patient’s response to non-surgical care. Neurosurgeons often manage the more centrally located compressions, particularly those involving the spinal nerve roots, while orthopedic surgeons frequently handle peripheral nerve entrapments in the limbs.