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Dr. Bob
Dr. Bob, Neurologist (MD)
Category: Neurology
Satisfied Customers: 5431
Experience:  Neurology & Int Medicine (US Trained): 20 yrs experience
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I have been diagnosed with what they call a compressed nerve

Customer Question

i have been diagnosed with what they call a compressed nerve in the neck area. I do not experience any pain, but i have symptoms of weakness in both of my hands. Physiotherapy seems to be helping but i'm still suffering these symptoms.
Submitted: 1 year ago.
Category: Neurology
Expert:  Dr. Bob replied 1 year ago.

If both of your hands are affected, you would have to have 2 pinched nerves (one on each side) or a pinched spinal cord. Have you had an MRI of the cervical spine?

Customer: replied 1 year ago.
I did but I'm not sure if it indicated a pinched nerve
Expert:  Dr. Bob replied 1 year ago.

So you've lost strength in both hands? Have you had nerve conduction tests (NCV/EMG)?

Expert:  Dr. Bob replied 1 year ago.

The important questions, Peter, include is there nerve damage and if so where is it originating from?

Expert:  Dr. Bob replied 1 year ago.

If it's originating from the cervical spinal cord (i.e cord compression, or spinal stenosis) you need to see a neurosurgeon to assess whether the cord is at risk of further injury and if the compression can be fixed surgically. The MRI should show this. In such a scenario, chiropractic adjustments of the neck could be dangerous. If it's originating from peripheral nerves, either at the neck region (i.e. radiculopathies) or further down the course of the nerves at the wrists, for example, (e.g. carpal tunnel) you would need to see either a neurosurgeon or a hand specialist to see if the nerves can be released from the pressure that is causing the weakness. If surgery was not needed, physical therapy might be helpful.

Expert:  Dr. Bob replied 1 year ago.

Let me know if you have any follow up questions. I would be happy to help you further.

God bless.

Customer: replied 1 year ago.
Can injections help? Like corticosteroids?
Customer: replied 1 year ago.
It's weird what I'm feeling the weakness can shift from left hand to right hand at any moment
Expert:  Dr. Bob replied 1 year ago.

Corticosteroid injections are used to reduce inflammation leading to pain. They are not generally helpful in terms of weakness, especially weakness that comes and goes.

In such a scenario you would have to consider other diagnoses such as myasthenia gravis, a condition in which muscles fatigue with repeated use, then regain strength slowly with rest. Your family doctor can look for this by ordering a blood test.

Expert:  Dr. Bob replied 1 year ago.

Do you have any additional questions? Let me know if there is anything else I can help you with.

Customer: replied 1 year ago.
I have yet to get an mri done. I've only had X-rays taken by a chiropractor of my neck I believe the best course of action is to visit a neurosurgeon. I also do experience occasionally like a pin or needle like sensation on the affected area
Expert:  Dr. Bob replied 1 year ago.

Yes, I would suggest you see a neurosurgeon or a neurologist if the weakness is affecting both hands. If you can get an MRI first that would be very helpful. If not, see if you can get nerve conduction tests done on the upper extremities (i.e. NCV/EMG). This test will tell you if there is nerve damage and if so where it is coming from.

Customer: replied 1 year ago.
does nerve damage require surgery or are there alternatives other than physio?
Expert:  Dr. Bob replied 1 year ago.

It depends on what is causing the nerve damage and how severe it is. Nerve conduction testing can be very helpful in this regard. Surgery is usually the last resort for nerve damage that is worsening or for spinal compression that puts one at risk for other complications.

Expert:  Dr. Bob replied 1 year ago.

If an MRI shows no cord or nerve root compression, you would likely not need surgery. In this case, physiotherapy and medications would likely be the best approach.

Customer: replied 1 year ago.
What type of medications? I don't believe a simple ibuprofen will do the trick
Customer: replied 1 year ago.
I've tried Advil. Seems useless
Expert:  Dr. Bob replied 1 year ago.

Ibuprofen is sometimes helpful. If not, you might need to use a cox-2 inhibitor such as celecoxib or meloxicam. If there is evidence of a lot of inflammation, you might need to be on a course of prednisone. Your doctor can help you decide the right medication based on your exam and the results of testing.

Customer: replied 1 year ago.
I was told that the compression was mild based on a physiotherapists observation. The medications you listed in your prior message, can they also be prescribed through a general practioner, if he or she believes that this is the case?
Expert:  Dr. Bob replied 1 year ago.

Yes.

Expert:  Dr. Bob replied 1 year ago.

If the compression is mild, the medications are more likely to be effective and you might not need the tests we discussed...so that would be a reasonable place to start.

Customer: replied 1 year ago.
Although I've been under the care of my family doctor since birth, I do not feel confident enough in him to be able to treat this efficiently. I'm simply going to ask him for a referral for a neurosurgeon and have an MRI done. I believe this might be the best thing. I have yet to get an MRI done actually, it was simply x-rays done through a chiropractor.
Expert:  Dr. Bob replied 1 year ago.

That would be ideal. Weakness is not something you want to wait too long to address...especially if it is getting worse.

Expert:  Dr. Bob replied 1 year ago.

Hi there. Were you able to be evaluated by your primary doctor for your hand weakness? Has it gotten any better or any worse? Let me know if there is anything else I can help you with.

Customer: replied 1 year ago.
Hi there I visited my general practitioner who has prescribed me meloxicam. He also booked an appointment to see a neurologist for next Wednesday. i was wondering how long does it take for meloxicam to kick in? Also does meloxicam interfere with any anti depressants?
Expert:  Dr. Bob replied 1 year ago.

That's great. This is a first important step in getting the proper diagnosis and treatment before things progress. As for the meloxicam, it is an excellent anti-inflammatory and you should begin to see improvement within a couple weeks if there is an inflammatory component to this.

Expert:  Dr. Bob replied 1 year ago.

In terms of possible interactions, it is generally considered to be a safe medication. If taken with meloxicam, certain antidepressants, particularly the SSRI class, can increase the risk of stomach and gut bleeding.

  • Citalopram
  • Escitalopram (Lexapro)
  • Fluoxetine (Prozac)
  • Fluvoxamine Maleate
  • Paroxetine (Paxil)
  • Sertraline (Zoloft)
  • Venlafaxine (Effexor)
Customer: replied 1 year ago.
I take Paxil so thank you for providing me with this info. i was afraid that the meloxicam wouldn't work with Paxil
Customer: replied 1 year ago.
I didn't know that an anti inflammatory can also help with weakness
Expert:  Dr. Bob replied 1 year ago.

Yes. Sometimes, inflammation can affect motor neurons. This affects their ability to function properly. If the inflammation recedes with anti-inflammatories, the symptoms often gradually improve. Your neurologist should be able to determine if there is nerve damage, where it is located, and whether there is an inflammatory component. Similarly, if you begin to improve while taking the anti-inflammatory, this is pretty good indirect evidence of inflammation.

Customer: replied 1 year ago.
Well I just started taking the meloxicam yesterday so I don't expect anything till at least a couple of weeks. I'm hoping the neurologist can perform an MRI next Wednesday. The physiotherapist claims that the compression is mild. If that's the case, there's no reason that this can't be dealt with
Expert:  Dr. Bob replied 1 year ago.

I agree. I think you will do well once you get the diagnosis pinned down and start on treatment. Be sure to ask the neurologist if nerve conduction testing (i.e. NCV/EMG) is warranted. This may be more valuable than an MRI at this point.

Customer: replied 1 year ago.
Thank you I will be sure to ask him that!
Expert:  Dr. Bob replied 1 year ago.

You're welcome. Hope all works out for the best for you.

Expert:  Dr. Bob replied 1 year ago.

Do you have any additional questions?

Customer: replied 1 year ago.
I think the meloxicam is starting to help
Expert:  Dr. Bob replied 1 year ago.

That's terrific. Give it a couple more weeks if tolerated, and continue with the physiotherapy as this should help you regain the strength you have lost.

Expert:  Dr. Bob replied 1 year ago.

Hi there. How are your hands today? Did you have any follow up questions for me?

Let me know if you do and I would be happy to help further. If you have no additional questions, please don't forget to provide a rating. This is the only way I get credit for helping you.

Thank you.