Duration
The acute case of nerve root inflammation usually lasts between one week and half a year, depending on its severity and manifestation. With adequate therapy, the pain should improve rapidly. Persistent irritation or other impairment of the nerve root can become chronic and result in pain that is difficult to treat. These can then accompany patients throughout their lives.
Nerve root irritation of the cervical spine
Less frequently than complaints of the lumbar spine, but significantly more frequently than those of the thoracic spine, nerve root irritation of the cervical spine (cervical spine) occurs. The relatively small cervical vertebrae with their associated intervertebral discs are more sensitive to irritation due to their nature and size alone. Nevertheless, they naturally carry much less weight than the lumbar spine, for example, and are therefore less subject to stress.
Depending on the exact location of the irritation, nerve root irritations of the cervical spine can lead to tingling sensations and numbness in the arm and/or in the area of the hands. These sensory disturbances can be felt on one side, but in the case of severe irritation they can also be felt simultaneously on both sides. Here too, reflex failures and functional weaknesses of certain characteristic muscles can provide clinical indications of the location of the nerve lesion or irritation.
Nerve root irritation of the thoracic spine
As the middle section of the spine, the thoracic vertebrae are much less frequently affected by herniated discs or contusions than the lumbar spine. In those cases where this occurs nevertheless, the picture of an intercostal neuralgia is usually presented. This is a belt-like pain in the upper body with sudden pain radiating along the ribs.
In addition, other symptoms can also occur. Sensory disturbances with nerve root irritation in the thoracic spine usually also run analogous to the corresponding pain in the form of a belt or ring around the rib cage. It is not uncommon for an acute herniated disc in the thoracic spine to be mistaken for a heart attack at first sight because of these very symptoms.
In contrast to a heart attack, however, the pain of nerve root irritation is classically intensified by deep inhalation or rotation of the upper body to the left and right. Rotational movements in particular then further irritate the already sensitive nerve roots, so that all symptoms become significantly worse. The diagnosis of intercostal neuralgia can therefore usually be made by questioning the patient.
Only in the case of untypical or long-lasting pain should imaging techniques and further examinations be used. The lumbar spine, often abbreviated as the lumbar spine, is the most common site of nerve root irritation. This is also where most of the herniated discs occur.
The intervertebral discs between the vertebral bodies L4 (i.e. the fourth lumbar vertebral body) and L5 as well as between L5 and the first sacral vertebral body (S1) are particularly at risk. The reason for this is the biomechanically induced higher load on the lower back section. The lumbar spine carries a large part of the body weight, enables the patient to stand upright and performs at its best when lifting heavy objects.
The best known nerve root irritation of the lumbar spine is lumbo-ischalgia – commonly known as sciatica – caused by a herniated disc in the lumbar spine. It is accompanied by very characteristic burning or stabbing back pain in the area of the lumbar spine, which may be carried on into the leg of the affected side, as well as sensory disturbances and paralysis. The so-called characteristic muscle of the nerve root L5 is the muscle extensor hallucis longus, which is responsible for pulling the toes towards the nose (= dorsal extension of the foot).
An identification muscle identifies a specific nerve, since it is supplied by this very nerve and receives its commands.If the signature muscle can no longer perform its actual function sufficiently while surrounding muscles are completely unaffected, it is suspected that it could be a nerve problem. The same applies to certain reflexes, which is why the tibialis posterior reflex should be tested carefully and side-by-side for nerve root irritation in the L5 region. This reflex can be triggered by a targeted blow to the tibialis posterior muscle, which should cause the inner edge of the foot to react by lifting.
In addition to muscular weakness and reflex disorders, sensory disturbances can occur on the outside of the knee, via the outside of the lower leg and the back of the foot to the back of the big toe. A characteristic muscle can also be tested in the case of nerve root irritation of the S1 nerve root; this is the gastrocnemius muscle, i.e. the calf muscle. The large pomus muscle (M. gluteus maximus) can also be affected.
In addition, the Achilles tendon reflex is also important, which causes the tip of the foot to slacken as soon as the Achilles tendon is tapped. Sensory disturbances occur when nerve root irritations of the S1 area occur mainly on the outer back of the entire leg as well as above the heel and on the lower outer edge of the foot.
