You may be referred to a neurologist for evaluation of neck (cervical) or back (thoracic) or low back (lumbar) pain. Many different types of medical conditions can cause cervical, thoracic or lumbar pain. Evaluation of these complaints to assess for the possibility of cervical, thoracic or lumbar radiculopathy (pinched nerves) would be conducted. Numerous symptoms may indicate that cervical, thoracic or lumbar pain is secondary to a pinched nerve.
To evaluate for the possibility of a pinched nerve an electromyography/nerve conduction study (EMG/NCS) may be performed. The test consists of two parts that include an evaluation of peripheral nerves by sending electrical impulses through those nerves. The second part examines muscles in either the limb or along the spine by placing a small needle electrode into the muscle to evaluate electrical activity in the muscles. This study helps to distinguish between a nerve issue in the limb or a pinched nerve coming from the spine. The EMG/NCS helps to determine which level of the spine is involved as well as the severity of involvement. It can provide useful information in evaluating the need for cervical or lumbar surgeries. Other testing could include CT scan, MRI or x-ray studies of the appropriate spinal level. The MRI study demonstrates the anatomy of the cervical, thoracic or lumbar spine to determine what may be causing the pinched nerve and to evaluate for other causes of pain. Test results will help determine the most probable cause and type of treatment to recommend.
In addition to neurological issues that can occur as a result of pinched nerves in the cervical, thoracic or lumbar spine, there may also be neurological issues related to spinal stenosis of the cervical, thoracic or lumbar spine. Spinal stenosis refers to compression of the cervical, thoracic or lumbar spinal cord as a result of external compression, which in the vast majority of cases is due to a combination of arthritis and “wear and tear” in the spine. Cervical spinal stenosis could compress the cervical spinal cord and cause symptoms in both the arms and legs.
The evaluation of spinal stenosis may include EMG/NCS of the upper or lower limbs and/or CT scan or MRI studies of the appropriate spinal level.
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- Inflammation and muscle spasm
- Walking related stiffness
- Difficulty standing up from a sitting position
- Pain and numbness in the legs after walking a distance
- Localized or radiating pain
- Numbness – reduced sensation or tingling, pins and needles sensations
- Physical therapy
- Surgical correction
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