Mark: Hi, it's Mark from Remarkable Speaking. I'm here with the Iyad Salloum of Insync Physio in North Burnaby, BC, Canada. And we're gonna talk about radiculopathy, which is as funny name for when you have pins and needles in your shoulder. Maybe going down your arm, even a dull ache in your arm, and it's coming from your neck. What the heck is going on Iyad?
Iyad: Yeah, radiculopathy, it's a bit of a mouthful and a lot of people use different terms to describe it. That's the medical term. The general population sometimes calls it a pinched nerve, which might or might not be accurate because nerves get sore for lots of reasons beyond just pinching.
So, basically people with this present with, usually we tend to see them quite acutely in the clinic. Either in physician's offices or in physio practices, if they've had this before, so they'll kinda come to us directly. And it presents with them being, you know, suddenly over like a very short time, being unable to move their head and neck because of quite intense pain.
And they report sometimes that the pain's actually worse in the arm and in the shoulder blade, then it is in the actual neck. But they can't move so well. They get fuzzy sensations in their arm. And then one of the things that we are trying to look for in the clinic is to try to figure out, does this person actually have just a sore nerve, let's say a nerve that's quite sensitive or is it something that actually has a bit of loss of conduction?
Because you can actually impact the nerve to a point where you lose a bit of its ability to send electricity through. So we would do a pretty thorough assessment with these and try to figure out what we're dealing with. But yeah, pins and needles is a common complaint. You sometimes can get dull aching. You can sometimes get burning sensations. Some people tell you, I feel like I've just left the dentist here. You know, like it's kind of completely numb. So it depends, I guess, on what nerve from the neck has been sensitized or affected. And then, you know, that kind of can manifest in a multitude of ways for symptoms.
Mark: What causes this?
Iyad: So lots of different things. You can have a cumulative, it's like a bunch of stuff can actually make a nerve sore. So for example, your general health is quite significant here. And your overall kind of I guess overall health is quite significant. And in determining whether you develop symptoms or not.
So give an example, somebody who is potentially like a longtime diabetic with type two diabetes can have an easier time to kind of synthesize the nerve because of that condition. Meanwhile, somebody else who might not have that might need a bit more, let's say of an attack on that system before they can kind of experience symptoms or loss of function.
So most of the time it tends to be either chemical irritation from inflammation in the neck or a direct pressure. So it could be things like disc bulge, could be a bunch of other things that could just kind of directly put pressure on it. So the compression can happen and that can cause symptoms.
And there are other less understood things like, let's say gradual narrowing of the spaces in the spine that seem to sometimes matter. And sometimes don't matter at all. And that's kind of where it's a bit confusing. If we just follow, for example, x-rays to diagnose this and MRIs because lots of people have these abnormal findings and have completely fine necks and no arm pain or loss of function.
So it really seems to be an unnecessarily complicated area, but the diagnosis tends to be a mix of clinical, which is basically what we would assess in clinic. And we do a physical exam along with sometimes we would do something called a nerve conduction study where our physician colleagues would trying to figure out which areas specifically is affected by testing how well that nerve is conducting electricity. And usually we would do that when we were expecting some kind of loss of function in that system.
Mark: And would this be from sleeping wrong? Would this be from picking up somebody the wrong way, like your grandkids?
Iyad: I think that would be an oversimplification to say that one can cause it, you know, these things tend to happen gradually over a long period of time. And then, you know, just because something happened, let's say the one night you slept wrong or like the time you picked up your grandkid and they kind of kicked out at you, doesn't mean that specific thing was caused. But yeah, it seems to be kind of a gradual process over time. And then eventually you become aware of it and some people go on to develop really debilitating symptoms and other people somehow can shrug it off quite easily and never really even know that something's there. Even when we scan them and we see something, and then they say, Hey, I've never had neck pain.
So that's usually what happens, but if it's progressed to the point where we're getting symptoms down the arm, usually yeah, most people will kind of report that it's been happening, you know, in the last week or so. And it's just kinda started outta the blue. That's most of the time. I've had somebody who said one time, they were reaching over to their phone to turn off their alarm and then they felt this. So I'm pretty sure that they've done that every day for the last 20 years as a working professional and it can't be that this one time was the one that they did it wrong. So it's kind of happens.
And that's probably the most confusing part of these injuries is that you're kind of wondering why did this happen? It just seems to happen over time from an accumulation probably of stresses on the body.
Mark: What's a typical course of treat?
Iyad: Great question. So, first thing we wanna do is figure out what we're dealing with. So if you're dealing primarily with a painful nerve versus an actual nerve that's lost function, we would kind of do things a bit differently but not also that differently. So if a nerves lost function, we wanna kind of monitor for any other signs that we would warrant a referral out.
We just wanna make sure that that person is progressing in the right direction and not kind of losing more function. If somebody has, let's say a painful condition only where we assess the conduction ability and they'll have normal strength, they have a little more sensitivity in the skin where the area's hurting, but everything else seems to be fine. The reflexes are fine. We would treat them with a multitude of things. We have lots of things that we could do. Our most important thing seems to be at this point is just telling them what to do at home, because it can take quite a bit of time for it to resolve fully. But if you know how to control certain symptoms and to actually move through some things and maybe avoid certain things for a temporary period of time, you do a lot better.
So that's what we would do on the education side. Try to identify those provocative movements, the things that feel good and getting people to just stay, you know, as active as they can be to help the healing. The other thing is, we would counsel them on, like, for example, sleeping positions and things like that.
Those are all really important because if you're not sleeping, you could do everything right. And that's gonna just basically be the equivalent of running to stay healthy and then smoking a pack of cigarettes after, it's just gonna cancel each other out kind of thing. And then we would do a bunch of stuff in the clinic.
So we have lots of tools from manual therapy. We would do anything from mobilizations on the neck to help desensitize it. There's nerve mobilization that can also desensitized nerve. And then we also can work on the affected soft tissues. We could do certain taping, embracing that can actually help certain things.
Again, it would just depend on what area and how bad their symptoms are in the beginning. And maybe if it's just that thing in isolation, or if they have five other things going on, that would probably change the course of treatment. But that's kind of the stuff we would do. And it would take, usually most people will see kind of a bit of an improvement after first four to six weeks, but then the full recovery process can be quite a bit longer.
And that's something that's really important for people to know. Because sometimes they think they're not recovering if it takes them three to six months. But that's actually what a typical recovery can be sometimes. It's just the body needs time to adapt back to normal.
And I guess I'll give you an example, if you are wanting to go back to wrestling, as a sport versus wanting to go back just to walking your dog every day. I think your recovery's gonna be quite different. We'd need to build you up a lot more if we want you to be able to handle the stresses of wrestling versus just walking around the block a few times. So all of that stuff kind of factors into the planning of the treatment and the timelines and all that stuff.
Mark: So if you want some expert treatment, if you've been diagnosed or feel like you have some issues with radiculopathy or numbness, burning pain, pins and needles in your shoulder and arm and you want to get back to jumping off the top rope and giving the people's elbow to people. The guys to see are Insync Physio in North Burnaby. You can reach them at their website, insyncphysio.com. Or you can call in book (604) 566-9716 is the Cambie office. Burnaby is (604) 298-4878. You have to call and book ahead. They're always busy. Thanks Iyad.
Iyad: Thank you.