Back Clinic Nerve Injury Team. Nerves are fragile and can be damaged by pressure, stretching, or cutting. Injury to a nerve can stop signals to and from the brain, causing muscles not to work properly and losing feeling in the injured area. The nervous system manages a great majority of the body’s functions, from regulating an individual’s breathing to controlling their muscles as well as sensing heat and cold. But, when trauma from an injury or an underlying condition causes nerve injury, an individual’s quality of life may be greatly affected. Dr. Alex Jimenez explains various concepts through his collection of archives revolving around the types of injuries and condition which can cause nerve complications as well as discuss the different form of treatments and solutions to ease nerve pain and restore the individual’s quality of life.
The information herein is not intended to replace a one-on-one relationship with a qualified healthcare professional or licensed physician and is not medical advice. We encourage you to make your own health care decisions based on your research and partnership with a qualified health care professional. Our information scope is limited to chiropractic, musculoskeletal, physical medicines, wellness, sensitive health issues, functional medicine articles, topics, and discussions. We provide and present clinical collaboration with specialists from a wide array of disciplines. Each specialist is governed by their professional scope of practice and their jurisdiction of licensure. We use functional health & wellness protocols to treat and support care for the injuries or disorders of the musculoskeletal system. Our videos, posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate to and support, directly or indirectly, our clinical scope of practice.* Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We provide copies of supporting research studies available to regulatory boards and the public upon request.
We understand that we cover matters that require an additional explanation of how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900.
Nerve Damage from Motor Vehicle Accidents: A Comprehensive Guide to Recovery with Chiropractic Care, Nurse Practitioners, Acupuncture, and Integrative Medicine
Motor vehicle accidents (MVAs) can leave lasting physical and emotional scars, often resulting in complex injuries like nerve damage, musculoskeletal issues, and chronic pain. Among the most significant consequences are nerve injuries, including radiculopathy, peripheral nerve damage, and spinal cord injuries, which can cause debilitating symptoms such as pain, numbness, and weakness. These injuries, along with musculoskeletal and ligamentous damage, frequently lead to back and neck pain that disrupts daily life. Fortunately, integrative approaches combining chiropractic care, nurse practitioner expertise, acupuncture, and functional medicine offer holistic solutions to address these issues, promote healing, and restore overall health.
This blog post examines the types of nerve damage resulting from MVAs, their effects on the body, and how integrative treatments can aid in recovery
. We’ll also highlight the expertise of Dr. Alexander Jimenez, DC, APRN, FNP-BC, a leading chiropractor and nurse practitioner in El Paso, Texas, whose dual licensure and innovative approach make him uniquely qualified to treat MVA victims. Written at a high school reading level, this guide aims to empower readers with clear, actionable information to navigate recovery.
Understanding Nerve Damage from Motor Vehicle Accidents
What Is Nerve Damage?
Nerves are like the body’s electrical wiring, carrying signals between the brain, spinal cord, and other parts of the body. When these nerves become damaged, it can cause problems such as pain, numbness, or weakness. Motor vehicle accidents often cause nerve injuries because of the sudden, forceful impact on the body. These injuries can affect various parts of the nervous system, resulting in different symptoms depending on the type and severity of the damage (Mayo Clinic, 2023a).
Types of Nerve Damage from MVAs
Peripheral Nerve Injuries
Peripheral nerves are those outside the brain and spinal cord, like the nerves in your arms, legs, and hands. These are the most common nerve injuries from car accidents because they’re vulnerable to trauma. For example, a sudden jolt can stretch, compress, or sever these nerves, leading to symptoms like:
Tingling or numbness in the limbs
Burning or shooting pain
Weakness or difficulty moving (Hoffmann Personal Injury, n.d.)
Common peripheral nerve injuries include damage to the brachial plexus, a network of nerves controlling the arm, shoulder, and hand. A crash can stretch or tear these nerves, causing pain or loss of function (Mayo Clinic, 2023b).
Radiculopathy
Radiculopathy happens when a nerve root near the spine gets compressed or irritated, often due to a herniated disc or whiplash from an MVA. This can cause sharp, piercing pain that radiates from the spine to other areas, like the arms or legs. For example, sciatica is a type of radiculopathy where the sciatic nerve is compressed, causing pain that radiates from the lower back down to the leg (Sally Morin Law, n.d.).
Spinal Cord Injuries
Spinal cord injuries are the most severe, as they can lead to partial or complete paralysis. The spinal cord, protected by the spine, carries signals to and from the brain. A crash can fracture vertebrae or dislocate the spine, damaging the cord and causing loss of sensation or movement below the injury site (McGowan Hood, 2025).
Pinched Nerves
A pinched nerve occurs when surrounding tissues, like bones or muscles, press on a nerve. This is common in MVAs due to whiplash or spinal misalignments, leading to pain, tingling, or weakness in areas like the neck or lower back (BWGLaw, n.d.).
How MVAs Cause Nerve Damage
Car accidents create sudden, violent forces that can harm nerves in several ways:
Impact Trauma: A collision can crush or stretch nerves, especially in the arms, legs, or neck.
Whiplash: The rapid back-and-forth motion of the neck in a crash can pinch nerves or damage the cervical spine, leading to radiculopathy or peripheral nerve issues (Mayo Clinic, 2023a).
Fractures or Dislocations: Broken bones or misaligned vertebrae can press on or sever nerves, causing severe damage.
Soft Tissue Injuries: Swelling or inflammation from muscle or ligament damage can compress nerves, leading to pain or numbness (Marks & Harrison, n.d.).
Symptoms of Nerve Damage
Nerve damage symptoms vary depending on the injury’s location and severity. Common signs include:
Sharp, shooting, or burning pain
Numbness or tingling (like pins and needles)
Muscle weakness or paralysis
Sensitivity to touch
Loss of reflexes or coordination (Baltimore Peripheral Nerve Pain, n.d.)
If you experience these symptoms after an accident, consult a healthcare provider immediately. Early diagnosis and treatment can prevent long-term complications.
Musculoskeletal and Ligamentous Injuries from MVAs
What Are Musculoskeletal and Ligamentous Injuries?
Musculoskeletal injuries affect the muscles, bones, joints, and connective tissues like ligaments and tendons. Ligaments are tough bands that connect bones, while tendons attach muscles to bones. MVAs often cause these tissues to stretch, tear, or break due to the force of the crash.
Common Musculoskeletal and Ligamentous Injuries
Whiplash
Whiplash is a neck injury caused by the head jerking forward and back, straining muscles and ligaments in the neck. It’s one of the most common MVA injuries, leading to neck pain, stiffness, and sometimes nerve damage (Mayo Clinic, 2023a).
Sprains and Strains
Sprains involve stretched or torn ligaments, while strains affect muscles or tendons. These injuries often occur in the back, neck, or shoulders during a crash, causing pain and limited movement.
Fractures
Broken bones are common in high-impact crashes, especially in the arms, legs, or spine. Fractures can also press on nerves, worsening nerve damage (Eckell Sparks, 2024).
Herniated Discs
The spine’s discs act like cushions between vertebrae. A crash can cause these discs to bulge or rupture, pressing on nearby nerves and causing radiculopathy or sciatica (Jimenez, 2025a).
Impact on Back and Neck Pain
Musculoskeletal and ligamentous injuries often lead to chronic back and neck pain. For example:
Neck Pain: Whiplash or sprains can cause persistent soreness, stiffness, or radiating pain due to nerve irritation.
Back Pain: Herniated discs or strained muscles in the lower back can cause sharp or aching pain, especially when sitting or moving (El Paso Back Clinic, n.d.).
These injuries can limit mobility, disrupt sleep, and affect mental health, making comprehensive treatment essential.
Chiropractic care focuses on the spine and musculoskeletal system, utilizing hands-on techniques to enhance alignment, alleviate pain, and promote healing. Chiropractors are trained to treat injuries from MVAs, especially those affecting the spine and nerves (Mayo Clinic, 2024).
How Chiropractic Care Helps MVA Injuries
Spinal Adjustments
Chiropractors use precise movements to realign the spine, relieving pressure on nerves and reducing pain. A 2020 study found that spinal manipulative therapy significantly reduces pain and disability in patients with chronic low back pain (Rubinstein et al., 2020, as cited in Jimenez, 2025b).
Spinal Decompression
This non-surgical technique gently stretches the spine to relieve pressure on discs and nerves, helping to alleviate conditions such as herniated discs or sciatica (Jimenez, 2025b).
Soft Tissue Therapy
Chiropractors use massage or myofascial release to relax tight muscles and reduce inflammation, improving mobility and easing pain.
Nurse practitioners (NPs) are advanced practice nurses with extensive medical training, allowing them to diagnose and treat a wide range of conditions. In MVA care, NPs provide comprehensive assessments and coordinate treatment plans, often working alongside chiropractors (ChiroMed, 2023).
How NPs Help MVA Victims
Diagnostic Expertise
NPs perform thorough evaluations, ordering tests like MRIs or CT scans to identify nerve damage, fractures, or soft tissue injuries. Their medical training helps pinpoint the underlying causes of pain (Jimenez, 2025c).
Holistic Care
NPs address both physical and systemic issues, such as inflammation or metabolic imbalances, using evidence-based treatments, including medications and lifestyle changes.
Coordination of Care
NPs collaborate with chiropractors, acupuncturists, and other specialists to create personalized recovery plans, ensuring all aspects of health are addressed.
Why NPs Are Essential
NPs bridge the gap between medical and alternative therapies, offering a balanced approach that enhances recovery. Their ability to prescribe treatments and provide patient education empowers individuals to take charge of their healing (Jimenez, 2025c).
References
ChiroMed. (2023). Integrated medicine holistic healthcare in El Paso, TX. Retrieved from https://chiromed.com/
Jimenez, A. (2025c). Board certified nurse practitioner (FNP-BC) Dr. Alex Jimenez. Retrieved from https://dralexjimenez.com/
Acupuncture for MVA Recovery
What Is Acupuncture?
Acupuncture is a traditional Chinese medicine practice that involves inserting thin needles into specific points on the body to balance the flow of energy, or “qi.” It’s widely used to relieve pain and promote healing (ChiroMed, 2023).
How Acupuncture Helps MVA Injuries
Pain Relief
Acupuncture stimulates the release of endorphins, the body’s natural painkillers, thereby reducing discomfort associated with nerve damage or musculoskeletal injuries.
Reduced Inflammation
By improving blood flow, acupuncture helps reduce swelling around injured tissues, easing pressure on nerves.
Nerve Healing
Acupuncture may support nerve regeneration by enhancing circulation and reducing stress on the nervous system.
Stress and Anxiety Relief
MVAs can cause emotional trauma. Acupuncture promotes relaxation, helping patients manage stress and improve their sleep quality.
Benefits of Acupuncture
Non-Invasive: No surgery or drugs required.
Complementary: Works well with chiropractic care and medical treatments.
Customizable: Tailored to individual symptoms and needs (ChiroMed, 2023).
References
ChiroMed. (2023). Integrated medicine holistic healthcare in El Paso, TX. Retrieved from https://chiromed.com/
Integrative Medicine: A Holistic Approach
What Is Integrative Medicine?
Integrative medicine combines conventional medical treatments with complementary therapies, such as chiropractic care, acupuncture, and nutrition. It focuses on treating the whole person—body, mind, and spirit—to achieve optimal health (Jimenez, 2025d).
How Integrative Medicine Helps MVA Recovery
Functional Medicine
Functional medicine identifies the root causes of symptoms, such as inflammation or hormonal imbalances, using advanced diagnostics, including blood tests. Dr. Jimenez uses tools like the Neural Zoomer Plus to assess neurological health (Jimenez, 2019).
Nutrition and Wellness
Personalized diet plans help reduce inflammation, support tissue repair, and boost energy levels. NPs and nutritionists guide patients on anti-inflammatory foods and supplements.
Lifestyle Interventions
Stress management, exercise, and sleep optimization improve mental and physical resilience, aiding recovery.
Collaborative Care
Integrative medicine brings together chiropractors, NPs, acupuncturists, and other specialists to create comprehensive treatment plans.
Benefits of Integrative Medicine
Addresses Root Causes: Treats underlying issues, not just symptoms.
Promotes Long-Term Health: Focuses on prevention and wellness.
Patient-Centered: Tailored to individual needs and goals (Jimenez, 2025d).
References
Jimenez, A. (2019). Functional medicine – Neurological health. Retrieved from https://elpasobackclinic.com/
Jimenez, A. (2025d). Dr. Alex Jimenez chiropractor and injury recovery. Retrieved from https://dralexjimenez.com/
Dr. Alexander Jimenez: A Leader in MVA Care
Who Is Dr. Alex Jimenez?
Dr. Alexander Jimenez, DC, APRN, FNP-BC, is a board-certified chiropractor and family nurse practitioner based in El Paso, Texas. With over 25 years of experience, he leads Injury Medical & Chiropractic Clinic, specializing in MVA injuries. His dual licensure allows him to integrate chiropractic techniques with advanced medical diagnostics, offering a unique approach to healing (Jimenez, 2025e).
Clinical Justification for Treatment
Dr. Jimenez emphasizes the importance of enhanced imaging (e.g., MRI, CT scans) and dual-scope procedures (combining chiropractic and medical assessments) to accurately diagnose MVA injuries. These tools help identify nerve damage, herniated discs, or ligament tears that may not appear on standard X-rays. His diagnostic evaluations, including neurological tests and functional assessments, ensure precise treatment plans that address both symptoms and underlying causes (Jimenez, 2025f).
Unique Qualities for Personal Injury Cases
Dr. Jimenez’s dual expertise makes him exceptionally qualified to handle personal injury cases:
Medical and Chiropractic Knowledge: As a chiropractor, he restores spinal alignment and musculoskeletal function. As an NP, he manages systemic conditions and prescribes evidence-based treatments.
Legal Documentation: Dr. Jimenez provides detailed medical records and expert testimony, crucial for personal injury claims. His reports align with legal standards, ensuring accurate representation of injuries (Jimenez, 2025e).
Holistic Approach: He combines spinal adjustments, decompression, acupuncture, and functional medicine to promote comprehensive recovery, reducing the need for invasive procedures.
Community Impact
Dr. Jimenez is committed to expanding access to integrative care in El Paso through workshops, online resources, and outreach programs, such as the “Tell A Veteran” Project, which informs veterans about chiropractic treatment options (Jimenez, 2025g).
Motor vehicle accidents can cause devastating nerve damage, musculoskeletal injuries, and chronic pain, but recovery is possible with the right care. Chiropractic care, nurse practitioner expertise, acupuncture, and integrative medicine provide holistic solutions that address both symptoms and their underlying causes. Dr. Alexander Jimenez stands out as a leader in this field, combining advanced diagnostics, dual licensure, and a patient-centered approach to help MVA victims heal and thrive. By seeking comprehensive care and accurately documenting injuries, you can reclaim your health and quality of life.
For more information or to schedule an appointment with Dr. Jimenez, visit www.dralexjimenez.com or call (915) 850-0900.
Jimenez, A. (2025a). Comprehensive guide to ligamentous injuries and sciatica from motor vehicle accidents. Retrieved from https://ceb.elpasobackclinic.com/
Understanding Compression Injuries, Nerve Damage, and Whiplash from Car Accidents: A Comprehensive Guide
Car accidents, also known as motor vehicle accidents (MVAs), are a leading cause of injuries worldwide, often resulting in conditions that can significantly impact a person’s quality of life. Among the most common injuries are compression injuries, nerve damage, and indirect trauma like whiplash. These injuries can lead to chronic pain, mobility issues, and even long-term disabilities if not properly diagnosed and treated. In El Paso, Texas, where thousands of accidents occur annually, clinicians like Dr. Alexander Jimenez, a chiropractor and nurse practitioner, specialize in helping victims recover using advanced diagnostic tools and integrative care.
This blog explores the medical causes of compression injuries, nerve damage, and whiplash from MVAs; their connection to peripheral neuropathies; and the innovative approaches used by Dr. Jimenez to diagnose and treat these conditions. We’ll also discuss the impact of these injuries in El Paso’s personal injury cases and how accurate diagnostics bridge the gap between medical care and legal documentation. This guide aims to clarify and make complex medical concepts more accessible.
What Are Compression Injuries, Nerve Damage, and Whiplash?
Compression Injuries
The force of an MVA can squeeze or press parts of the body, such as bones, muscles, or nerves, resulting in compression injuries. For example, a sudden impact can compress spinal discs or vertebrae, leading to pain and restricted movement. These injuries often affect the spine, causing issues like herniated discs or fractures that may press on nerves.
Nerve Damage
Nerve damage, also called neuropathy, occurs when nerves are stretched, compressed, or torn. Nerves act like the body’s wiring, carrying signals between the brain and other parts. When damaged, they can cause symptoms like sharp pain, numbness, tingling, or weakness. In MVAs, nerve damage often results from trauma to the spine or limbs, disrupting normal function.
Whiplash
Whiplash is a common MVA injury, especially in rear-end collisions. The sudden jerking of the head forward and then backward strains the muscles, ligaments, and nerves of the neck. This rapid motion can cause inflammation or compression of nerves, leading to neck pain, headaches, and sometimes long-term issues. Research suggests that about 50% of whiplash patients experience neck pain for at least a year after the accident (Carroll et al., 2008).
Medical Causes of Compression Injuries and Nerve Damage in MVAs
MVAs can cause various injuries due to the sudden and forceful movements involved. Below, we examine the primary causes of compression injuries and nerve damage, drawing on clinical insights.
Whiplash and Nerve Compression
Whiplash occurs when the neck undergoes rapid acceleration and deceleration, often in rear-end collisions. This motion can inflame tissues around the cervical spine (neck) or compress nerves, leading to pain, stiffness, and numbness in the arms or hands. According to Houston Pain Specialists, whiplash is a primary cause of nerve pain in MVAs due to its impact on soft tissues and nerves.
Herniated Discs
The spine’s intervertebral discs act as cushions between vertebrae. In an MVA, the force of impact can cause these discs to shift or rupture, a condition known as a herniated disc. When the disc’s inner material protrudes, it can press on nearby nerves, causing pain, numbness, or weakness. The Russo Firm notes that herniated discs are a common cause of peripheral neuropathy, disrupting nerve signals to the limbs.
Spinal Cord Injuries
Severe MVAs can directly injure the spinal cord, the bundle of nerves running through the spine. These injuries may cause partial or complete loss of sensation and movement below the injury site. Spinal cord damage is less common but can lead to permanent nerve damage, affecting functions like walking or breathing.
Pinched Nerves
A pinched nerve occurs when surrounding tissues, such as bones or swollen muscles, compress a nerve. In MVAs, displaced vertebrae or inflamed tissues can pinch nerves, causing sharp pain or tingling. This is often observed in the neck or lower back, contributing to conditions such as radiculopathy.
Inflammation and Swelling
After an MVA, the body responds to trauma with inflammation, which can cause swelling around injured areas. This swelling may press on nerves, leading to pain and potential chronic nerve damage if untreated. Inflammation is a key factor in prolonged symptoms, as noted by Houston Pain Specialists.
Scar Tissue Formation
As the body heals, scar tissue can form around injured areas. This tissue may entrap or compress nerves, worsening pain over time. Scar tissue is a significant concern in cases of chronic nerve pain, as it can create lasting pressure on nerves.
Severe Stretching or Compression
The intense forces in an MVA can stretch or compress nerves beyond their normal range, causing immediate damage. This may lead to ongoing pain or neurological symptoms if the nerves don’t heal properly, as explained by Houston Pain Specialists.
Cause
Description
Common Symptoms
Whiplash
Rapid neck movement can inflame or compress nerves.
Neck pain, numbness, headaches
Herniated Discs
Disc rupture presses on nerves.
Pain, numbness, weakness in limbs
Spinal Cord Injuries
Direct trauma to the spinal cord.
Loss of sensation, paralysis
Pinched Nerves
Compression by bones or tissues.
Sharp pain, tingling
Inflammation and Swelling
Swelling presses on nerves.
Pain, reduced mobility
Scar Tissue Formation
Scar tissue entraps nerves post-healing.
Chronic pain, nerve irritation
Severe Stretching/Compression
Direct nerve damage from impact.
Persistent pain, neurological symptoms
Peripheral Neuropathies from MVA Injuries
Peripheral neuropathy refers to damage to the peripheral nerves, which connect the brain and spinal cord to the rest of the body. These nerves control movement, sensation, and autonomic functions, such as heart rate. Motor vehicle accidents (MVAs) can cause peripheral neuropathies through mechanisms such as nerve compression or trauma.
Sciatica as a Peripheral Neuropathy
Sciatica, a common peripheral neuropathy, occurs when the sciatic nerve, running from the lower back to the legs, is compressed. This type of injury often results from herniated discs or spinal misalignment caused by MVAs. Symptoms include radiating pain, numbness, and muscle weakness in the legs. Dr. Jimenez’s website highlights that ligamentous injuries, such as tears in the annulus fibrosus, can lead to disc herniation and sciatica (Jimenez, n.d.).
Symptoms and Diagnosis
Symptoms of peripheral neuropathy include:
Sharp, burning, or shooting pain
Numbness or tingling
Sensitivity to touch
Muscle weakness or coordination issues
Autonomic issues like blood pressure changes
Diagnosis often involves imaging, such as MRI, to detect nerve compression, as well as clinical assessments to evaluate symptoms. Early diagnosis is crucial in preventing chronic conditions, as noted by The Russo Firm.
Dr. Alexander Jimenez’s Clinical Insights
Dr. Alexander Jimenez, DC, APRN, FNP-BC, is a leading clinician in El Paso, Texas, recognized for his integrative approach to treating motor vehicle accident (MVA) injuries. With over 30 years of experience, he holds certifications in chiropractic care, functional medicine, and nursing, allowing him to address both musculoskeletal and systemic issues.
Background and Expertise
Dr. Jimenez’s practice focuses on holistic healing, combining chiropractic techniques with functional medicine. His clinic, Injury Medical Clinic, offers treatments for chronic pain, personal injury, and complex conditions like sciatica and herniated discs. Awards such as the Top Rated El Paso Chiropractor Award from 2015 to 2024 (Three Best Rated) recognize his work.
Diagnostic Approach
Dr. Jimenez uses advanced diagnostic tools to assess MVA injuries:
MRI: Detects soft tissue injuries like ligament tears and disc herniations, which may not appear on X-rays. A case study on his website describes a 49-year-old female with a 9 mm disc bulge causing radicular pain, diagnosed via 1.5 Tesla MRI (Jimenez, 2017).
Computerized Radiographic Mensuration Analysis (CRMA) assesses how the spine moves to determine if the ligaments are loose, a condition known as Alteration of Motion Segment Integrity (A.O.M.S.I.). The diagnosis is crucial for deciding impairment ratings, which can significantly influence insurance claims (Jimenez, 2017).
Treatment Strategies
Dr. Jimenez employs chiropractic adjustments, physical therapy, and functional medicine to restore mobility and reduce pain. His integrative approach addresses both immediate injuries and underlying causes, such as inflammation or biomechanical issues, to prevent the development of chronic conditions.
Impact of El Paso’s Personal Injury Cases
El Paso experiences a high number of motor vehicle accidents (MVAs), with 19,150 reported in 2021, of which 25–27% resulted in injuries (Make Roads Safe). Common injuries include whiplash, herniated discs, and nerve damage, which can lead to long-term issues like peripheral neuropathy. Dr. Jimenez’s clinic plays a vital role in treating these victims, offering personalized care plans to restore health and support legal claims.
Case Study Example
A 49-year-old female patient involved in an MVA experienced radicular pain due to a 9 mm disc bulge, detected via MRI. Dr. Jimenez’s treatment plan, combining chiropractic care and physical therapy, helped alleviate her symptoms and provided documentation for her personal injury case (Jimenez, 2017).
Linking Diagnostic Tests and Imaging to Patient Injuries
Accurate diagnosis is crucial for effective treatment and legal documentation in motor vehicle accident (MVA) cases. Dr. Jimenez’s use of advanced imaging and diagnostic tests ensures precise identification of injuries, which is crucial for both medical and legal outcomes.
Importance of Diagnostics
Standard X-rays may miss soft tissue injuries, with 12% of spinal cord injuries showing no radiographic abnormality (Jimenez, 2017). MRI and CRMA provide detailed insights:
MRI: Visualizes ligament tears, disc herniations, and nerve compression.
CRMA: Measures spinal instability, with specific criteria for A.O.M.S.I. (e.g., >3.5 mm motion in the cervical spine). Such injuries can result in a 25–28% impairment rating, which can influence insurance settlements (Jimenez, 2017).
Legal Documentation
Insurance companies reserve significant funds (e.g., $60,000) for ligament laxity diagnoses, as they indicate serious injury. Dr. Jimenez’s detailed documentation, supported by CRMA and MRI, helps patients secure fair compensation for medical bills, lost wages, and pain and suffering.
Diagnostic Tool
Purpose
Impact on Treatment and Legal Claims
MRI
Detects soft tissue and nerve damage
Guides treatment; provides evidence for legal claims
The term “dual-scope procedures” may refer to Dr. Jimenez’s use of multiple diagnostic approaches, such as combining MRI and CRMA, to assess injuries comprehensively. This dual approach ensures a thorough understanding of both structural and functional damage, which enhances treatment plans and legal documentation.
Conclusion
Motor vehicle accidents can cause severe injuries, like compression injuries, nerve damage, and whiplash, often leading to peripheral neuropathies such as sciatica. These conditions require prompt and accurate diagnosis to prevent chronic pain and disability. In El Paso, Dr. Alexander Jimenez stands out for his expertise in treating MVA victims, using advanced tools like MRI and CRMA to link injuries to effective treatment and legal outcomes. His integrative approach ensures patients receive holistic care while supporting their pursuit of fair compensation.
If you have been involved in a motor vehicle accident (MVA), please consider seeking a medical evaluation promptly to address any potential injuries. Contact specialists like Dr. Jimenez at Injury Medical Clinic (915-850-0900) for expert care and support.
Should individuals experiencing nerve pain or various sensations get a nerve conduction velocity study to examine nerve health and function?
Nerve Conduction Velocity
A nerve conduction velocity (NCV) is a noninvasive test that measures the speed and strength of nerve stimulation using electrical probes placed on the skin. It’s used to diagnose nerve damage or disease, often alongside an EMG (electromyogram) to differentiate between nerve and muscle problems. It can also evaluate sensory issues, pain, and weakness of the extremities.
This test involves safe electrical shocks that can be slightly uncomfortable but not painful.
Nerve conduction velocity (NCV) measures the speed at which electrical impulses travel along a nerve fiber, which measures how quickly electrical signals travel through a nerve.
This information indicates nerve health and function.
Electromyography (EMG) is a nerve test that involves placing tiny needles into the muscles.
A slower NCV can indicate nerve injury or dysfunction.
Test Uses
Generally, the test is ordered to assess peripheral nerve diseases, those that connect from the muscles, organs, and skin to the spinal cord or brain. It can help identify the type and location of nerve damage.
Peripheral nerve conditions typically cause pain, sensory loss, tingling, or burning.
Mild weakness and diminished reflexes can be detected during a neurological examination.
Conditions
Nerve conduction studies are performed to help diagnose conditions.
Nerve damage (neuropathy), such as from diabetes, chemotherapy, or autoimmune disorders
Charcot-Marie-Tooth disease
Nerve compression
Many different conditions, including trauma, inflammation, and tumors, can compress one or more nerves.
Radiculopathy
Often described as a pinched nerve, radiculopathy can affect an arm or a leg, causing pain and weakness.
Peripheral Neuropathy
This nerve damage begins in the most distal nerves, those farthest from the center of the body, such as the toes and fingers. It is often due to chronic alcohol misuse, uncontrolled diabetes, nutritional deficits, and inflammatory diseases. (Ferdousi M. et al., 2020)
Carpal Tunnel Syndrome
Commonly caused by inflammatory diseases or overuse of the wrists, such as from assembly line work, carpal tunnel syndrome causes numbness, pain, and weakness of the fingers and hands. (Tada K. et al., 2022)
Ulnar neuropathy
This common condition causes arm pain and sensory changes, usually due to repetitive movements or a prolonged position that causes pressure on the ulnar nerve.
Guillain-Barré syndrome (GBS)
This inflammatory condition causes demyelination, or loss of the insulating covering around nerves, which results in leg weakness.
It begins in the motor nerves, which send signals to muscles in the legs. (Shibuya K. et al., 2022)
The inflammation travels to nerves of the upper body, often affecting the muscles that control breathing.
Respiratory support is necessary until the condition improves.
Chronic Demyelinating Polyneuropathy (CIDP)
This condition is a chronic, recurrent form of GBS that usually affects the legs and causes episodes of weakness.
ICU neuropathy
Metabolic changes, severe illness, and not moving enough can cause nerves to develop a pattern of weakness and sensory loss.
Myasthenia gravis (MG)
This autoimmune condition affects the junction between the nerves and the muscles.
Myasthenia gravis causes drooping eyelids and weakness of the arms and shoulders.
Amyotrophic lateral sclerosis (ALS)
ALS is a serious, degenerative disease affecting the spinal cord’s motor neurons.
Amyotrophic lateral sclerosis progresses rapidly, resulting in substantial weakness of muscles throughout the body.
How it’s Done
Surface electrodes are placed on the skin over nerves, and a small electrical current is applied to stimulate the nerve.
The time it takes for the electrical signal to travel between the electrodes is measured, and this time is used to calculate the NCV.
Values
Normal NCV values are generally between 50 and 70 meters per second. However, these values can vary depending on the nerve and the individual.
NCV Factors
Various factors can influence NCV.
Age
Sex
Medical conditions like diabetes
Interpretation
A slower NCV can indicate nerve damage or demyelination (loss of the myelin sheath, which insulates nerve fibers), while an EMG can help determine if the problem is with the nerve or the muscle.
Results
The results of NCV testing can be used to determine the type, severity, and location of nerve damage. The results will be ready in report form about a week after the test.
The test measures velocity (how fast a nerve transmits signals) and amplitude (how many nerve fibers were activated). (Tavee J. 2019)
The measurements are transmitted to a computer and shown as waves and numerical values.
The values are compared to a standard measurement based on the tested nerve.
The distance between the electrodes.
The person’s age.
Compared to the standard, the NCV results can identify certain patterns of nerve damage. (Tada K. et al., 2022) Outcomes include: (Tavee J. 2019)
If one or more nerves are affected.
If motor nerves (control movement), sensory nerves (transmit sensory signals), or both are affected.
Whether a nerve is blocked or damaged.
The severity of the damage.
The type of nerve damage
Axonal (damage to the nerve itself)
Demyelination (damage to the protective fatty layer around the nerve)
The results can help point to certain diagnoses.
Preparation Before the Test
Individuals will not need to change their diet before having an NCV. However, patients will be asked to avoid lotions or creams on their skin before the test. Individuals who are also having an EMG at the time of their NCV might be asked to stop taking medications or supplements that increase the risk of bleeding and bruising. If a healthcare provider says not to stop taking the medicines for health reasons, the patient might be warned that they could have some bruising after the EMG test.
NCV may advise against getting the test for those with electrical device implants.
Make sure your healthcare providers are aware of your whole medical history.
Injury Medical Chiropractic & Functional Medicine Clinic
Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop an optimal health and wellness solution. We focus on what works for you to relieve pain, restore function, and prevent injury. Regarding musculoskeletal pain, specialists like chiropractors, acupuncturists, and massage therapists can help mitigate the pain through spinal adjustments that help the body realign itself. They can also work with other medical professionals to integrate a treatment plan to resolve musculoskeletal issues.
Peripheral Neuropathy and Chiropractic Care
References
Ferdousi, M., Kalteniece, A., Azmi, S., Petropoulos, I. N., Worthington, A., D’Onofrio, L., Dhage, S., Ponirakis, G., Alam, U., Marshall, A., Faber, C. G., Lauria, G., Soran, H., & Malik, R. A. (2020). Corneal confocal microscopy compared with quantitative sensory testing and nerve conduction for diagnosing and stratifying the severity of diabetic peripheral neuropathy. BMJ open diabetes research & care, 8(2), e001801. https://doi.org/10.1136/bmjdrc-2020-001801
Tada, K., Murai, A., Nakamura, Y., Nakade, Y., & Tsuchiya, H. (2022). In Carpal Tunnel Syndrome, Sensory Nerve Conduction Velocities Are Worst in the Middle Finger Than in the Index Finger. Frontiers in Neurology, 13, 851108. https://doi.org/10.3389/fneur.2022.851108
Shibuya, K., Tsuneyama, A., Misawa, S., Suzuki, Y. I., Suichi, T., Kojima, Y., Nakamura, K., Kano, H., Ohtani, R., Aotsuka, Y., Morooka, M., Prado, M., & Kuwabara, S. (2022). Different patterns of sensory nerve involvement in chronic inflammatory demyelinating polyneuropathy subtypes. Muscle & Nerve, 66(2), 131–135. https://doi.org/10.1002/mus.27530
Tavee J. (2019). Nerve conduction studies: Basic concepts. Handbook of Clinical Neurology, 160, 217–224. https://doi.org/10.1016/B978-0-444-64032-1.00014-X
Can physical therapy help individuals with a pinched nerve in the neck?
Pinched Nerve In The Neck
A pinched nerve in the neck can cause pain, numbness, and weakness that extends through the neck, shoulder, and arm. (American Academy of Orthopaedic Surgeons, 2024) Over-the-counter pain medications, resting the muscles, and gentle stretching can help. However, if you’re still in pain after a few days, see a healthcare provider. Common treatments include:
Rest
Over-the-counter (OTC) pain meds
Physical therapy
Steroid injections
Wearing a neck collar
Surgery is rarely needed, but it can provide relief if other treatments don’t help. Most of the time, a pinched nerve resolves within days or weeks.
Sharp pain that extends into the shoulder and arm.
The pain worsens, or there is a shooting sensation when turning the head.
Tingling or feeling of pins-and-needles in the fingers or hand.
Weakness in the arm, shoulder, or hand.
Numbness or loss of feeling.
Often, these symptoms occur only on one side. Some find their pain less when they lift their hand onto their head, which can relieve pressure on the nerve.
Causes
The cervical spine is the spinal cord area around the neck. It’s made up of seven vertebrae. Nerves branch off the spinal cords in the spaces between the vertebrae. Nerve compression occurs when the space between two vertebrae is reduced, putting pressure on the nerve, pinching it, and causing pain. Pinched nerves develop from age because the spinal discs between the vertebrae become compressed over time. Age causes about 70% to 80% of nerve compression. Other factors that cause pinched nerves include: (Harvard Health Publishing, 2021)
Degenerative disc disease
A herniated disc
Injuries like car accidents falls, or other trauma to the spine
Find a comfortable position and try to allow the muscles in your neck to relax and rest.
Heat or Ice
Warmth and coolness can relieve pain and inflammation.
Use a warm or cool compress for 15 minutes at a time.
Over-The-Counter Pain Medications
Pain medications, including nonsteroidal anti-inflammatory drugs (NSAIDs), can help bring relief.
Treatment for Severe Symptoms
If pain doesn’t resolve within a few days, or if it is so bad that you can’t go about daily activities, it’s recommended to see a healthcare provider. They can diagnose a pinched nerve after a physical exam and may also recommend imaging, including an X-ray, CT scan, MRI, or EMG, to reveal what’s causing the symptoms. After diagnosing the condition, the healthcare provider will develop a personalized treatment plan, which may include the following (Harvard Health Publishing, 2021)
Physical Therapy
Physical therapy can help build strength and flexibility in the neck.
This is especially important if there is frequent nerve pain in the same spot.
Cervical Collar
A soft cervical collar is a brace that fits around the neck.
It supports your head so the neck muscles can relax, facilitating healing.
The collar can also keep the head from turning in painful ways.
Oral Corticosteroids
Oral steroids like prednisone can help reduce inflammation.
If inflammation or swelling in the neck puts more pressure on the nerve, they can help.
Steroid Injections
Steroid shots right into the painful tissue reduce inflammation right away.
Muscle Relaxers
These medications keep the muscles in the neck from seizing up.
As the muscles relax, this brings pain relief.
Narcotic Pain Medications
Narcotic pain medications can be used short-term by individuals who have severe pain.
A healthcare provider will inform the patient of the benefits and drawbacks of these medications, which include opiates.
Hold for 20 seconds, then return to a neutral position.
Do this five times.
Eyes to Sky
Lean your head back and look toward the sky.
Hold for 20 seconds, then return to your starting position.
Do this five times.
Side to Side
Turn your head to the right as far as possible, bringing your chin in line with your shoulder.
Hold for 20 seconds, then turn as far as possible toward the left.
Repeat four times.
Ear to Shoulder
Bring your ear down toward your shoulder.
Hold for 20 seconds, then repeat the exercise on the other side.
Alternate between the right and left, stretching each side five times.
While it’s normal for exercises to hurt from stretching the muscles, they should never hurt more than a five on a pain scale of 1 to 10. If they do, stop exercising (National Health Service, 2025)
Healing Time
Healing and recovery depend on the severity of the injury. Some individuals find that the pain from a pinched nerve goes away in days, while for others, it can last for weeks. The pain goes away and then returns. If pain doesn’t go away with the conservative treatments or lasts more than a few days, talk with a healthcare provider or return for a second visit. Rarely do individuals need surgery to bring pain relief. The healthcare provider will discuss whether surgery is the best option and what to expect regarding pain relief. (American Academy of Orthopaedic Surgeons, 2024)
Injury Medical Chiropractic and Functional Medicine Clinic
Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to build optimal health and wellness solutions. We focus on what works for you to relieve pain, restore function, prevent injury, and mitigate issues through adjustments that help the body realign itself. The clinic can also work with other medical professionals to integrate a treatment plan to resolve musculoskeletal problems.
Revitalize and Rebuild with Chiropractic
References
American Academy of Orthopaedic Surgeons. OrthoInfo. (2024). Cervical radiculopathy (pinched nerve). https://orthoinfo.aaos.org/en/diseases–conditions/cervical-radiculopathy-pinched-nerve/
Harvard Health Publishing. Publishing, H. H. (2021). Treating a pinched nerve. https://www.health.harvard.edu/pain/treating-a-pinched-nerve
National Institute of Neurological Disorders and Stroke. (2025). Pinched Nerve Definition. Retrieved from https://www.ninds.nih.gov/health-information/disorders/glossary-neurological-terms#-P-
National Health Service. Service, N. H. (2025). Exercises for neck problems. https://www.nhsinform.scot/illnesses-and-conditions/muscle-bone-and-joints/neck-and-back-problems-and-conditions/exercises-for-neck-problems
Excessive alcohol consumption: what is alcoholic peripheral neuropathy?
Alcoholic Peripheral Neuropathy
Alcoholic peripheral neuropathy (ALN) is a condition that damages the nerves in the body due to chronic alcohol consumption. It can cause sensory, motor, and autonomic dysfunction, which can lead to disability. This damage prevents the nerves from communicating information. Most symptoms generally start as mild but typically worsen over time as the neuropathy progresses. The most common symptoms are: (National Library of Medicine, 2023)
Numbness or tingling sensation in the extremities
Pain or a burning sensation in the extremities
Difficulty walking
Difficulty urinating
Difficulty talking or swallowing
Affected nerves include the peripheral and autonomic nerves, which help regulate internal body functions. Around 46% of chronic alcohol users will eventually develop the condition. (Julian T., Glascow N., Syeed R., & Zis P. 2019)
Causes
The exact cause of alcoholic neuropathy is unclear. But it is directly related to heavy and long-term alcohol consumption. (Julian T., Glascow N., Syeed R., & Zis P. 2019) It is believed overconsumption of alcohol can directly harm and hinder the nerves’ ability to communicate information. Unhealthy nutritional habits are often associated with it as well. Research shows that decreased thiamine/B vitamin plays a role, while others suggest an overall dietary deficiency may play a role. (Julian T., Glascow N., Syeed R., & Zis P. 2019) However, alcoholic neuropathy can also occur without the presence of malnutrition. (Julian T., Glascow N., Syeed R., & Zis P. 2019)
Neuropathy Development and Progression
Alcoholic peripheral neuropathy develops depending on many factors, including the amount of daily/nightly alcohol consumed, age and overall health, nutritional intake, and other individual factors. In most cases, the neuropathy takes several years or decades to develop, depending on the amount of alcohol consumed.
Pain or burning sensation in the arms, legs, or feet.
Symptoms that occur in the arms and legs typically affect both sides.
Cramps, aches, or weakness of the muscles.
Constipation or diarrhea.
Nausea and vomiting.
Difficulty urinating or incontinence.
Difficulty walking.
Difficulty talking or swallowing.
Heat intolerance.
Erection difficulties.
Most symptoms begin as mild and usually worsen over time as the neuropathy progresses. Alcoholic neuropathy affects individuals who consume excessive amounts of alcohol over a long time. (Julian T., Glascow N., Syeed R., & Zis P. 2019)
Healthcare providers will collect data involving past medical history and all current symptoms.
Physical Exam
This exam looks at other medical conditions contributing to symptoms, like diabetes or high blood pressure.
Neurological Exam
This is a noninvasive exam to determine the location and extent of neurological damage.
Healthcare providers may ask patients several questions and have them complete a series of small movements to check neurological function.
Blood and Urine Tests
These tests can detect diabetes, liver and kidney problems, infections, vitamin deficiencies, and other conditions that can cause neuropathic conditions.
Chronic alcohol use can also affect how the body stores and uses vitamins necessary for healthy nerve function. Vitamin levels that a healthcare provider may check include: (National Library of Medicine, 2023)
Vitamin A
Biotin
Folic acid
Niacin, or vitamin B3
Pyridoxine, or vitamin B6
Pantothenic acid
Liver Disease
Individuals with chronic liver disease often have neuropathy. The severity and stage are associated with a higher incidence of neuropathy. (Pasha MB, Ather MM, Tanveer MA, et al. 2019)
Treatment
Alcoholic neuropathy is not reversible, even when quitting drinking. However, individuals with the condition can make healthy changes to minimize symptoms and receive help for chronic alcohol use. The first step is stopping alcohol consumption. (Chopra K., & Tiwari V. 2012) Talk to a healthcare provider about what options are available. Treatment can include:
In-patient or outpatient rehab
Therapy
Medication
Social support from groups like Alcoholics Anonymous
A combination of treatments will likely be utilized. Other treatment options involve symptom management and preventing further injuries and may include:
Physical therapy
Keeping the head elevated while sleeping.
Orthopedic splints to maintain limb function and positioning.
Wearing compression stockings.
Adding vitamins and supplements.
Eating extra salt for those without hypertension
Medications to reduce pain and discomfort.
Intermittent catheterization or manual expression of urine for those with difficulty urinating.
Individuals with neuropathy may have reduced sensitivity in the arms and legs. If this occurs, additional steps need to be taken to prevent other injuries, that include (National Library of Medicine, 2023)
Wear special footwear to prevent foot injuries.
Checking feet daily for wounds.
Prevent burns by ensuring that bath and shower water is not too hot.
Injury Medical Chiropractic and Functional Medicine Clinic
Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to build optimal health and wellness solutions. We focus on what works for you to relieve pain, restore function, prevent injury, and help mitigate issues through adjustments that help the body realign itself. They can also work with other medical professionals to integrate a treatment plan to resolve musculoskeletal problems.
Peripheral Neuropathy Myths and Facts
References
National Library of Medicine. (2023). Alcoholic neuropathy. Retrieved from https://medlineplus.gov/ency/article/000714.htm
Julian, T., Glascow, N., Syeed, R., & Zis, P. (2019). Alcohol-related peripheral neuropathy: a systematic review and meta-analysis. Journal of Neurology, 266(12), 2907–2919. https://doi.org/10.1007/s00415-018-9123-1
National Institute of Neurological Disorders and Stroke. (2024). Peripheral neuropathy. Retrieved from https://www.ninds.nih.gov/health-information/disorders/peripheral-neuropathy
Pasha MB, A. M., Tanveer MA, et al. (2019). Frequency of peripheral neuropathy in chronic liver disease. Med Forum Monthly, 30(8), 23-26. https://medicalforummonthly.com/index.php/mfm/article/view/3761
Chopra, K., & Tiwari, V. (2012). Alcoholic neuropathy: possible mechanisms and future treatment possibilities. British journal of clinical pharmacology, 73(3), 348–362. https://doi.org/10.1111/j.1365-2125.2011.04111.x
Can understanding how nociceptors function and their role in processing pain signals help individuals who are managing injuries and/or living with chronic pain conditions?
Nociceptors
Nociceptors are nerve endings that detect harmful stimuli, such as extreme temperatures, pressure, and chemicals, and signal pain. They are the body’s first defense against potentially damaging environmental inputs.
Nociceptors are in the skin, muscles, joints, bones, internal organs, deep tissues, and cornea.
They detect harmful stimuli and convert them into electrical signals.
These signals are sent to the brain’s higher centers.
The brain interprets the signals as pain, which prompts the body to avoid the harmful stimulus.
Nociceptors, often called pain receptors, are free nerve endings all over the body. They play a pivotal role in how the body feels and reacts to pain. The main purpose of a nociceptor is to respond to damage to the body by transmitting signals to the spinal cord and brain. (Purves D, Augustine GJ, Fitzpatrick D, et al., editors. 2001) If you bang your foot, the nociceptors on the skin are activated, sending a signal to the brain via the peripheral nerves to the spinal cord. Pain resulting from any cause is transmitted this way. Pain signals are complex, carrying information about the stimuli’s location and intensity. This causes the brain to fully process the pain and send communication back to block further pain signals.
Thermal nociceptors respond to extreme hot or cold temperatures.
For instance, when touching a hot stove, the nociceptors, which signal pain, are activated immediately, sometimes before you know what you’ve done.
Mechanical
Mechanical nociceptors respond to intense stretching or strain, such as pulling a hamstring or straining a tendon.
The muscles or tendons are stretched beyond their ability, stimulating nociceptors and sending pain signals to the brain.
Chemical
Chemical nociceptors respond to chemicals released from tissue damage.
For example, prostaglandins and substance P or external chemicals like topical capsaicin pain creams.
Silent
Silent nociceptors must be first activated by tissue inflammation before responding to a mechanical, thermal, or chemical stimulus.
Most visceral nociceptors are located on organs in the body.
Polymodal
Polymodal nociceptors respond to mechanical, thermal, and chemical stimuli.
Mechano-thermal
Mechano-thermal nociceptors respond to mechanical and thermal stimuli.
Pain Transmission
Nociceptors are also classified by how fast they transmit pain signals. Transmission speed is determined by the type of nerve fiber known as an axon a nociceptor has. There are two main types.
The first type is A fiber axon, fibers surrounded by a fatty, protective sheath called myelin.
Myelin allows nerve signals/action potentials to travel rapidly.
Because of the difference in transmission speed, the pain signals from the A fibers reach the spinal cord first. As a result, after an acute injury, an individual experiences pain in two phases, one from the A fibers and one from the C fibers. (Ngassapa D. N. 1996)
Pain Perception Phases
When an injury occurs, the stimulated nociceptors activate the A fibers, causing a person to experience sharp, prickling pain.
This is the first phase of pain, known as fast pain, because it is not especially intense but comes right after the stimulus.
During the second phase of pain, the C fibers are activated, causing an intense, burning pain that persists even after the stimulus has stopped.
The fact that the C fibers carry burning pain explains why there is a short delay before feeling the sensation.
The C fibers also carry aching, sore pain caused by organs within the body, such as a sore muscle or stomachache. (Ngassapa D. N. 1996)
Injury Medical Chiropractic and Functional Medicine Clinic
Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to build optimal health and wellness solutions. We focus on what works for you to relieve pain, restore function, prevent injury, and help mitigate issues through adjustments that help the body realign itself. They can also work with other medical professionals to integrate a treatment plan to resolve musculoskeletal problems.
From Injury To Recovery With Chiropractic Care
References
Purves D, A. G., Fitzpatrick D, et al., editors. (2001). Nociceptors. In Neuroscience. 2nd edition. (2nd ed.). Sunderland (MA): Sinauer Associates. https://www.ncbi.nlm.nih.gov/books/NBK10965/
University of Texas McGovern Medical School. (2020). Chapter 6: Pain Principles. https://nba.uth.tmc.edu/neuroscience/m/s2/chapter06.html
Ngassapa D. N. (1996). Comparison of functional characteristics of intradental A- and C-nerve fibres in dental pain. East African medical journal, 73(3), 207–209.
Can understanding the anatomy and function of the long thoracic nerve help individuals make informed healthcare decisions after an injury to the nerve?
Long Thoracic Nerve
Also referred to as the posterior thoracic nerve, the long thoracic nerve/LTN is a thin superficial nerve that runs from the cervical spine to the chest wall side of the trunk. It supplies motor function to the thorax’s serratus anterior muscle, helping stabilize the shoulder blade. Injury to this nerve can cause limited or abnormal shoulder and shoulder blade motion, including difficulty raising the arm during overhead reaching.
Anatomy
The long thoracic nerve originates from the ventral rami of cervical nerves C5, C6, and C7. (Waxenbaum JA, Reddy V, Bordoni B. 2023) In some individuals, the root from C7 is absent; in others, a small nerve root branches from C8. The nerve roots from C5 and C6 go through the medial scalene muscle to join the C7 nerve. It travels behind the brachial plexus axillary artery and vein and courses down the lateral side of the thorax. The long thoracic nerve terminates at the lower portion of the serratus anterior muscle, sending small nerve tendrils to each muscle’s projections, which attach to the ribs. Because the long thoracic nerve is located on the lateral side of the chest, it is vulnerable to injury during sports or surgical procedures. The nerve also has a smaller diameter than other cervical and brachial plexus nerves, which increases its potential for injury.
Function
The long thoracic nerve attaches to the underside of the shoulder blade and inserts as muscular slips into the ribs. It supplies motor function to the serratus anterior muscle, essential for normal shoulder motion. When it contracts, it pulls the shoulder blade against the ribs and thorax, helping to move and stabilize the arm as it moves forward and up during shoulder motions. Injury to the long thoracic nerve causes a condition called scapular winging. This occurs when the serratus anterior muscle becomes weakened or paralyzed after injury. (Lung K, St Lucia K, Lui F. 2024)
Susceptibility to Injury
The LTN is relatively unprotected and can be damaged by several things, including:
Heavy backpacks
Sports
Activities the body is not used to, like digging
Using crutches
Conditions
Injury to the long thoracic nerve may occur as a result of trauma, lifting heavy weights above the shoulder, or a surgical procedure. Surgical procedures that may place the nerve at risk for injury may include: (Lung K, St Lucia K, Lui F. 2024)
Axillary lymph node dissection
Improperly placed intercostal drains
Chest tube placements
Mastectomy
Thoracotomy
The long thoracic nerve is protected during these procedures by the surgeon and proper surgical technique, but occasionally, difficulties arise during surgery, and the nerve may become injured. Individuals may also have an anatomical variance that places their nerves in varying positions. The surgeon may not see it and accidentally injure their nerves during surgery.
The superficial long thoracic nerve may also be injured during sports or trauma to the trunk. A blow to the side or a sudden overhead stretch to the shoulder may be enough to damage the nerve, paralyzing the serratus anterior muscle.
Weakness or paralysis of the serratus anterior muscle will result in a winged scapula. To test for this:
Stand about two feet from a wall, facing it.
Place both hands on the wall and gently push against it.
If one of the shoulder blades sticks out abnormally, it could be a winged scapula.
Have a family member or friend stand behind you and check the shoulder blade position.
If you suspect a winged scapula, visit a physician who can assess the condition and determine if there is a long thoracic nerve injury.
Winging the scapula may result in difficulty lifting the arm overhead. The serratus anterior muscle works with other scapular stabilizers, such as the upper trapezius and levator scapula, to properly position the shoulder blade when lifting the arm. Failure of the serratus to stabilize the shoulder blade may make lifting the arm impossible.
Clinical examination is usually used to diagnose a long thoracic nerve injury. X-rays and MRIs cannot show the nerve injury directly, although an MRI can show some secondary signs to help confirm the diagnosis. An electromyographic or EMG test may also be performed to examine the function of the long thoracic nerve.
Treatment and Rehabilitation
Treatment for LTN pain and reduced movement may include:
Rest
Heat or ice
Anti-inflammatory pain medication
Neck support or a pillow
Avoiding strenuous activity and driving
If the long thoracic nerve is severely injured and the serratus anterior is completely paralyzed, the best course of action is to be active and monitor the condition. Full recovery of arm function can take one to two years. If permanent nerve injury has occurred, surgery may be an option to restore shoulder motion and function. Several different kinds of surgery can be used to address winged scapula. (Vetter M. et al., 2017)
One involves transferring the pectoralis major tendon to the scapula (Vetter M. et al., 2017) so it functions as the serratus.
Often, the tendon has to be lengthened, which may be done using part of the hamstring tendon.
After surgery, individuals will likely wear a sling on their arm for a few weeks, and then gentle range-of-motion exercises will be initiated.
After eight to ten weeks, gentle progressive strengthening of the new tendon can begin.
Full shoulder motion and strength recovery are expected six to 12 months after surgery.
Lie on your back and raise both arms toward the ceiling.
Make a fist and punch up toward the ceiling.
Ensure the motion is steady and deliberate, and keep the elbow straight.
Hold the position for three seconds, then slowly lower the arm to the starting position.
Perform 10 to 15 repetitions.
Holding a small dumbbell in your hands can make the exercise more challenging.
Pushup
Lie on your stomach and place your hands flat on the ground by your shoulders as if you were going to perform a pushup.
Perform a pushup and press further, allowing the shoulder blades to wrap around the thorax.
Hold this position for three seconds, and slowly release.
Perform 10 to 15 reps.
If this is too difficult, perform the pushup against a wall to reduce the effect of gravity on the exercise.
Scapular Winging in Depth
References
Waxenbaum, J. A., Reddy, V., & Bordoni, B. (2024). Anatomy, Head and Neck: Cervical Nerves. In StatPearls. https://www.ncbi.nlm.nih.gov/pubmed/30844163
Lung, K., St Lucia, K., & Lui, F. (2024). Anatomy, Thorax, Serratus Anterior Muscles. In StatPearls. https://www.ncbi.nlm.nih.gov/pubmed/30285352
Vetter, M., Charran, O., Yilmaz, E., Edwards, B., Muhleman, M. A., Oskouian, R. J., Tubbs, R. S., & Loukas, M. (2017). Winged Scapula: A Comprehensive Review of Surgical Treatment. Cureus, 9(12), e1923. https://doi.org/10.7759/cureus.1923
Berthold, J. B., Burg, T. M., & Nussbaum, R. P. (2017). Long Thoracic Nerve Injury Caused by Overhead Weight Lifting Leading to Scapular Dyskinesis and Medial Scapular Winging. The Journal of the American Osteopathic Association, 117(2), 133–137. https://doi.org/10.7556/jaoa.2017.025
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