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Pinched nerve following hip replacement

Discussion in 'Concerns after hip surgery' started by Josephine, Aug 30, 2017.

  1. Josephine

    Josephine FORUM ADMIN, NURSE DIRECTOR Administrator
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    Re: pain after 4 months

    Let me explain the 'pinched' or 'trapped' nerve phenomenon, because it's a bit of a myth. I've heard of people having been given this as a diagnosis when it's only part of the issue. A pinched nerve can't be treated, only the thing that's pinching it.

    This is usually concerning the sciatic nerve (except in the neck but the same principles apply!). The sciatic nerve emerges from the spine and then travels through a maze of ligaments and muscles, often very close to bone. It's a big nerve and therefore very prone to suffering when adjacent muscles have problems. The problems they mostly have are going into spasm and/or being inflamed and swollen. When this happens, the nerve is pressed against bone or another muscle which may well be in spasm as well.

    Muscles in spasm are very hard, sometimes almost as hard as bone. Hardly surprising then that the nerve cannot function and the areas it supplies are rendered painful or even numb. But the real source of the pain is the muscle spasm, not the compressed nerve! Saying to a patient "You have a pinched (or trapped) nerve" is something of a fob-off. It's not addressing the real problem which is the muscle spasm.

    The Piriformis syndrome is a perfect example. The piriformis is a short but very strong muscle that goes from the top of the femoral trochanter across to the pelvis. It is responsible for the action of moving your leg outwards and to the side - abduction; hence it is part of the group of muscles called the abductor mechanism. The sciatic nerve passes underneath this group of muscles and underneath the sciatic nerve is the bone of the pelvis. The piriformis is the biggest, fattest muscle in this group so when it goes into spasm or swells with inflammation, the nerve is pressed down onto the bone. As a result of this the sufferer can experience numbness starting in the foot and gradually extending up the calf and even into the outside of the thigh. Pins and needles can also be experienced.

    Based upon the patient's description, the doctor is not completely wrong to say "oh, you have a pinched nerve" because that's essentially what has happened. But it's not really the cause of the pain. The muscle spasm is the real cause and often as not, that goes unidentified and therefore, unaddressed.
     
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