Median Nerve

What is radiculopathy?

Radiculopathy, commonly known as a pinched nerve, is irritation to a nerve from the surrounding tissue or structures. This can happen both on the upper part of our body (think neck and arm), and the lower part of the body (think low back, butt, and back of your thigh). 

Some people suffering with this condition might not know who to see for a pinched nerve and might never think to contact a physical therapist to treat it. The good news is that physical therapy does help a pinched nerve. Physical therapists can utilize back nerve tests to help diagnose left and right upper extremity radiculopathy and recommend specific pinched nerve exercises to treat the condition.

Pathways

One of the upper body nerves most commonly impacted by entrapment sites and irritation is the median nerve. Let’s take a look at the pathway of this nerve:

Median nerve: 

Armpit → bicep → front of elbow → front of the forearm (palmar side) → first three digits (thumb + pointer + middle)

Entrapment sites

Now that we know where each of these nerves run, let's think about each of the most common entrapment sites for these nerves. 

Cervical spine: Hypomobile vertebrae 

Herniated disc

First rib

Scalenes

Bicep: Arcade of Struthers

Elbow: Bicipital fascia

Forearm: Pronator teres

Wrist: Carpal tunnel

How do I know if I have radiculopathy?

Who is at risk of a pinched nerve?

Whereas anyone has the potential for developing a radiculopathy, there are certain groups of people who are at a higher risk. In short, those who are sedentary and not getting much movement may be at a higher risk  for developing radiculopathy. 

How can radiculopathy be presented?

The most common and expected symptom will be a shooting or radiating pain, paresthesia, or weakness that is exacerbated during some positions and alleviated during others. If on the left side, it is known as a left upper extremity radiculopathy, if on the right side, a right upper extremity radiculopathy.

Some more specific presentations are as followed:

→ Weakness in the wrist flexors 

→ Paresthesia and and weakness in the wrist flexors

→ Dull ache in the hand and forearm

→ Tingling in the thumb, pointer, and middle finger

Sciatica is another common radiculopathy that runs down the back of the leg, along the sciatic nerve. Move Strong PT offers physical therapy for sciatica pain as well as for radiculopathy in the upper extremities.

Self tests

*This test may put tension on the nerve and should be performed in search of familiar symptoms (i.e. the symptoms that have led you to continue to read this article).*

Median Nerve

**At each step, stop just short of any signs or symptoms to prevent injuring yourself**

1. Seated with your arm flexed to 90’ at your side, elbow flexed to 90’ (field post position) with the palm facing the ceiling and forearm facing you

   • You should feel like you’re a server carrying a tray

2. Slowly extend your elbow maintaining the same posture 

3. Bend your head bringing your opposite ear to the opposite shoulder 

4. Stop short of symptoms 

→ A (+) test would be an increase in your familiar symptoms as you extend your elbow and/or side bend the head away.

What to do about it?

Work environment 

Symptoms can be aggravated by staying in certain positions -  lots of time spent in position, sitting as an example, can potentially increase the symptoms you are feeling. Additionally, not moving around enough throughout the day can also contribute to symptom aggravation.  

Setting up your work environment to promote movement can be key to reducing symptoms and irritation. This entails having a work environment that allows you to be able to change positions frequently. If this is not an option, going for short walks throughout the day can also be helpful to loosen things up and decrease symptoms. 

What should my next steps be?

While you wait on your physical therapy appointment, there are a few exercises you can do to alleviate some of the symptoms. 

Median Nerve Glide: 

Starting with the head in neutral and the arm positioned just shy of reproducing symptoms (wrist extended, arm flexed up to 90’, elbow extended), slowly side bend your head away as you flex your elbow (causing less of a stretch). As you extend the arm back out, side bend the ear towards the testing side. Repeat these sets with 3 second holds in each position for 10 sets. 

Side lying armbar 

Starting side lying on the floor or a mat, grab a kettlebell or a dumbbell in the affected arm (arm with symptoms). Hold the weight directly up over the shoulder and reach, avoiding shrugging your shoulder. Keep your head and neck relaxed, look up towards that arm / the weight. Driving with your arm, rotate the weight in and out (twisting the arm) in a slow continuous rhythmic motion.  Hold at each end range for 2-3 seconds, completing 10 rotations. 

Get Started With Physical Therapy

Our team can help you get out of pain and back to what you love to do. Contact our Hudson, MA physical therapy clinic to get started.