Symptoms of a Pinched Spinal Nerve
The primary symptoms of a pinched spinal nerve include pain radiating in a dermatomal distribution, sensory changes (numbness, tingling, burning), motor weakness in the affected nerve distribution, and reflex changes. 1
Cardinal Symptoms
Pain Characteristics
- Neuropathic pain with burning, electric, or shooting quality
- Pain that radiates along specific nerve pathways (dermatomal distribution)
- Pain that may worsen with certain positions or movements
- Pain that may be relieved by changing positions (especially with spinal flexion) 2
Sensory Disturbances
- Numbness or reduced sensation in the affected nerve distribution
- Tingling or pins-and-needles sensation (paresthesia)
- Dysesthesias (unpleasant abnormal sensations) 1
- Hypersensitivity to touch in the affected area (allodynia)
Motor Symptoms
- Muscle weakness in the distribution of the affected nerve
- Reduced reflexes in the affected area
- Possible muscle atrophy with chronic compression
- Flaccid loss of tendon reflexes in the affected region 1
Location-Specific Symptoms
Cervical Spine (Neck)
- Pain radiating into shoulder, arm, or hand
- Numbness/tingling in fingers or hand
- Weakness in specific arm or hand muscles
- Neck pain that may worsen with certain movements
Lumbar Spine (Lower Back)
- Pain radiating into buttock, leg, or foot (sciatica if involving sciatic nerve)
- Numbness/tingling in leg or foot
- Weakness in leg muscles
- Lower back pain that may worsen with standing or walking 2
- Symptoms that improve with sitting or spinal flexion 2
Special Considerations
Cauda Equina Syndrome
This is a medical emergency requiring immediate attention when a pinched nerve is severe:
- Urinary retention or incontinence
- Bowel incontinence
- Saddle anesthesia (numbness in groin/genital area)
- Bilateral leg weakness or paralysis 1
Differential Diagnosis
It's important to distinguish a pinched spinal nerve from other conditions:
- Plexopathy (symptoms occur in multiple peripheral nerve distributions) 1
- Peripheral neuropathy (typically bilateral and symmetrical) 1
- Vascular claudication (pain with walking that improves with rest but doesn't require position change)
- Musculoskeletal pain (typically doesn't follow dermatomal patterns)
Clinical Assessment
When evaluating for a pinched spinal nerve, clinicians should assess:
- Sensory function using pinprick, light touch, vibration testing
- Motor strength in key muscle groups
- Deep tendon reflexes
- Special tests like straight-leg raise for lumbar nerve compression 1
Diagnostic Pearls
- A pinched spinal nerve typically causes symptoms in a specific dermatomal distribution
- Symptoms often worsen with certain positions that increase nerve compression
- Relief with positions that decrease nerve compression (like spinal flexion) is characteristic
- The presence of both sensory and motor symptoms increases diagnostic certainty
Remember that symptoms of a pinched spinal nerve can mimic other conditions, so correlation with imaging findings and clinical examination is essential for accurate diagnosis 1, 3.