Cervical Radiculopathy (Pinched Nerve in the Neck)

How cervical radiculopathy happens

Eight pairs of nerve roots (C1 to C8) leave the cervical spine through small openings called foramina, then form the nerves of the arm. If a disc bulges or bone spurs narrow the opening, the nerve root is squeezed and inflamed. The pain is felt along the nerve's path rather than only in the neck.

Symptoms

• sharp, burning or electric pain spreading from the neck to the shoulder blade, arm or hand
• tingling or pins and needles in part of the arm or fingers
• numbness in a specific area
• weakness in particular muscles, such as the triceps or grip
• reduced reflexes
• pain worse when tilting or turning the head toward the affected side, or looking up
• relief from lifting the arm and resting the hand on the head (shoulder abduction relief sign)

Which nerve root is affected

Causes

• Herniated disc: the soft center of a disc pushes out and presses on the nerve. More common in people aged 30 to 50, sometimes after lifting or a sudden movement.
• Cervical spondylosis: age-related disc degeneration and bone spurs narrow the foramen. The most common cause after 50.
• Less common causes: injury, tumors, infection, cysts and inflammatory arthritis.

Risk factors include heavy lifting, driving, operating vibrating equipment, smoking and previous neck injury.

Conditions that can mimic it

• carpal tunnel syndrome: numbness in the thumb, index and middle fingers, worse at night, without neck pain
• ulnar nerve entrapment at the elbow: numbness in the ring and little fingers
• thoracic outlet syndrome
• shoulder problems such as rotator cuff disease
• shingles before the rash appears
• heart pain, which can spread to the left arm

Diagnosis

A doctor will ask where the pain travels and test strength, sensation and reflexes in both arms. The Spurling test, gently tilting and pressing down on the head toward the painful side, reproduces arm pain in many people with radiculopathy.

Imaging is not needed at first unless there are red flags. It is used when symptoms persist beyond 6 weeks or surgery or injection is considered:

• MRI: shows discs, nerves and the spinal cord.
• CT or CT myelogram if MRI is not possible.
• X-rays: show bone spurs and alignment.
• Nerve conduction studies and EMG: help separate radiculopathy from nerve entrapment in the arm.

Treatment

Non-surgical treatment

Most people recover without surgery.

• Activity modification: avoid positions that provoke pain, such as looking up for long periods, but stay generally active.
• Medicines: NSAIDs such as ibuprofen or naproxen, following the label dose; a short course of oral steroids is sometimes prescribed. Nerve pain medicines such as gabapentin have mixed evidence.
• Physical therapy: posture correction, neck and shoulder strengthening, nerve gliding exercises and, in some cases, traction.
• Soft collar: short-term use only, if at all.
• Epidural or selective nerve root steroid injection: can relieve severe arm pain for weeks to months.

Surgery

Surgery is considered for progressive weakness, signs of spinal cord compression, or severe pain that does not improve after 6 to 12 weeks of non-surgical care. Options include:

• Anterior cervical discectomy and fusion (ACDF): the disc is removed through the front of the neck and the vertebrae fused.
• Cervical disc replacement: an artificial disc preserves movement.
• Posterior foraminotomy: widens the nerve opening from the back of the neck.

Surgery relieves arm pain in most well-selected patients.

Outlook

About 75% to 90% of people improve with non-surgical treatment. Numbness may take longer than pain to resolve. Symptoms can recur, so keeping up exercises and good posture helps.

Frequently asked questions

What are the symptoms of cervical radiculopathy?

The main symptoms are neck pain that shoots down one arm, along with tingling, numbness or weakness in a specific part of the arm or hand. Pain often worsens when tilting or turning the head and may improve when you rest your hand on top of your head.

How long does a pinched nerve in the neck take to heal?

Most people improve significantly within 6 to 12 weeks with conservative treatment. Pain usually settles first, while numbness and weakness can take several months. If symptoms do not improve or weakness worsens, further assessment is needed.

What is the best treatment for a pinched nerve in the neck?

Most people do well with a combination of staying active, NSAIDs, and physical therapy. Steroid injections can help severe arm pain. Surgery is reserved for persistent pain, progressive weakness or spinal cord compression.

Can a pinched nerve in the neck cause hand numbness?

Yes. Depending on the nerve, it can cause numbness in the thumb and index finger (C6), middle finger (C7) or ring and little fingers (C8). Carpal tunnel syndrome can cause similar numbness, so testing may be needed to tell them apart.