A pinched nerve, medically known as nerve compression or entrapment, occurs when surrounding tissues—such as bone, cartilage, muscle, or tendon—apply pressure to a nerve. This pressure disrupts the nerve’s function, leading to uncomfortable symptoms. Common signs include sharp, aching, or burning pain that may radiate outward, along with tingling, numbness, or a “pins and needles” sensation in the affected area. Understanding the correct medical pathway is important for diagnosis and effective treatment.
Starting Point: Primary Care and Initial Diagnosis
The first step in addressing persistent nerve discomfort involves visiting a primary care physician (PCP), general practitioner, or internal medicine specialist. The PCP serves as the gateway to specialized care, performing a physical examination and taking a detailed medical history to narrow down the potential cause of the pain. They check for muscle weakness, changes in reflexes, and specific sensory deficits to confirm a preliminary diagnosis of nerve compression.
The PCP initiates the first line of conservative treatment, focusing on managing symptoms and promoting natural healing. This often includes rest, activity modification, and over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) to reduce local inflammation. If symptoms are severe or persist longer than a week without improvement, the doctor may order initial imaging, such as X-rays, to look for bone changes that could be compressing the nerve, like spinal narrowing or fractures.
If symptoms persist despite these initial conservative measures, the PCP coordinates the next phase of care by issuing a referral to a specialist. This referral indicates the condition requires more advanced diagnostic tests or targeted non-surgical interventions outside the scope of general practice. The goal is to establish a foundation for diagnosis and begin conservative treatments before escalating to specialized care.
Non-Surgical Treatment: Physiatrists and Neurologists
For pinched nerve cases that do not resolve with initial care, the next doctors consulted are physiatrists and neurologists, who specialize in non-surgical management and precise diagnosis. A physiatrist, or Physical Medicine and Rehabilitation (PM&R) physician, is an expert in the non-surgical treatment of musculoskeletal and nerve-related disorders. They create comprehensive, individualized rehabilitation plans aimed at restoring function and reducing pain.
Physiatrists commonly prescribe physical therapy and administer therapeutic injections, such as epidural steroid injections. These injections deliver anti-inflammatory medication directly to the irritated nerve root, reducing swelling and pain. This provides a window for the patient to engage in physical therapy and long-term recovery. Physiatrists also frequently perform diagnostic procedures, including Electromyography (EMG) and Nerve Conduction Studies (NCS).
A neurologist specializes in nervous system disorders and plays a primary role in detailed diagnostic testing. They often use Nerve Conduction Studies (NCS) and Electromyography (EMG) to pinpoint the exact location and severity of the nerve damage. The NCS measures how quickly electrical signals travel through a nerve, while the EMG assesses the electrical activity of muscles responding to nerve stimulation.
These neurodiagnostic tests help differentiate true nerve compression from other conditions that might mimic the symptoms, such as muscle disorders. The neurologist’s findings, often collaborating with the physiatrist, provide objective data on the nerve’s health. This data guides the non-surgical treatment plan or confirms the need for surgical consultation, ensuring all conservative options are explored.
Advanced Care: Orthopedic and Neuro Surgeons
If conservative treatments fail to provide adequate relief after six to twelve weeks, or if severe neurological deficits are present, the care path escalates to a surgical consultation. Urgent surgical evaluation is necessary if a patient experiences progressive muscle weakness or, in rare cases, a loss of bowel or bladder control, which indicates severe nerve compression. The two main types of surgeons who address pinched nerves are orthopedic spine surgeons and neurosurgeons.
An orthopedic spine surgeon specializes in the musculoskeletal system, focusing on conditions involving the bones, joints, ligaments, and discs that may be compressing a nerve. Their training emphasizes the mechanical and structural aspects of the spine, and they are well-versed in procedures that correct spinal alignment or stabilize the spine. They commonly treat pinched nerves resulting from disc herniation or spinal stenosis using procedures like laminectomies or spinal fusions.
A neurosurgeon is a specialist in the nervous system, including the brain, spinal cord, and peripheral nerves. While they perform many of the same spinal procedures as orthopedic surgeons, their focus is specifically on relieving pressure on delicate neural structures. Neurosurgeons often use microsurgical techniques for nerve decompression, making them suited for cases where the nerve root or spinal cord is the primary concern. The surgical goal for both specialties is decompression—creating more space for the irritated nerve to heal.