Cervical Radiculopathy

What is cervical radiculopathy?

Cervical radiculopathy, sometimes called a pinched nerve in the neck, happens when a nerve is irritated or compressed as it leaves your spine in your neck. This can cause pain, numbness, tingling or weakness that spreads from your neck into your shoulder, arm or hand, usually on one side only.

Symptoms of cervical radiculopathy

• Neck pain, and sometimes pain between your shoulder blades
• Sharp, burning or 'electric' pain that spreads down one arm, sometimes as far as the hand
• Numbness, or a 'pins and needles' tingling feeling
• Heaviness or weakness in the arm or hand
• Weakened reflexes.

Symptoms are often worse when you extend or turn your neck towards the affected side, or reach your arm overhead. Some people find that resting their hand on top of their head temporarily eases the pain, by taking pressure off the affected nerve.

Causes of cervical radiculopathy and who's at risk

• Age-related wear and tear in the discs, joints and ligaments of the neck (cervical spondylosis), which can lead to bony growths that narrow the space a nerve passes through
• A bulging or herniated disc pressing on a nerve, which is more common in adults under 50
• An injury to the neck, such as a whiplash-type injury
• Tightness in the neck and shoulder muscles.

It can happen to anyone, but you may be more at risk if: your work involves heavy lifting, operating vibrating equipment or prolonged driving; if you smoke; or if you've previously had similar nerve pain affecting your leg. Interestingly, playing golf has also been identified as a risk factor.

Are there different types of cervical radiculopathy?

Cervical radiculopathy is usually described by which specific nerve is affected, since this determines exactly where in your arm and hand you notice symptoms. The nerve most commonly affected, called C7, accounts for more than half of cases, followed by C6, in around a quarter of cases. Nerves higher or lower in the neck are affected less often.

How is cervical radiculopathy diagnosed?

Cervical radiculopathy is usually diagnosed from your symptoms and a physical examination alone. Your doctor or physiotherapist will ask how your symptoms started, examine how your neck moves, and test the strength, sensation and reflexes in your arm, comparing one side against the other.

Scans aren't usually needed early on. An X-ray won't show the discs, nerves or ligaments that are actually causing the problem, so it's only useful after a fall or direct injury. An MRI scan is generally only arranged if you're not improving after 6 to 8 weeks, or if your doctor wants to check for another cause.

How is cervical radiculopathy treated?

The great majority of cases settle without specialist treatment, so most initial treatment focuses on managing symptoms while your body heals.

Self-care and staying active

Prolonged rest can make things worse by stiffening the neck, so it's important to stay as active as your symptoms comfortably allow, alongside these general measures:

• Support your arm on a pillow if it feels heavy at rest, and adjust your sleeping position and pillow height for comfort
• Avoid staying in one position, such as sitting rigidly upright, for long periods
• Gentle heat over the neck muscles for 5 to 10 minutes can ease pain in the short term
• Low-impact activity, such as walking or a static bike, can help – although breaststroke swimming can sometimes aggravate symptoms because of the head position it requires
• Take regular breaks during activities like driving, or if holding your arm at or above shoulder height.

Medication and physiotherapy

Anti-inflammatory painkillers can help, and your GP or pharmacist can advise on what's suitable for you. A physiotherapist can guide you through an exercise programme that progresses gradually, usually starting with gentle postural awareness exercises and building up to strengthening as your pain allows, adjusting the pace if any exercise increases your arm symptoms.

A soft neck collar can sometimes help for brief periods, but isn't usually recommended for more than a week or two, since prolonged use can weaken the neck muscles. Forceful neck manipulation is best avoided, as it can occasionally worsen nerve symptoms, though gentler hands-on physiotherapy techniques are generally considered safe.

Injections and surgery

If symptoms persist, a steroid injection around the affected nerve can help settle pain for some people, though the benefit isn't always long-lasting.

Surgery is generally only considered if severe pain, or symptoms of nerve damage such as weakness, haven't improved after around 6 to 12 weeks of the treatments above, or if nerve problems are significant or getting worse.

Surgery aims to give the nerve more room by removing the piece of bone or disc pressing on it, using an approach through either the front or back of the neck, and both give similarly good results. Surgery tends to relieve arm pain more reliably than numbness, which can take longer to settle.

When should I see a doctor?

See your GP if your pain hasn't started to ease after several weeks of self-care, or if it's significantly affecting your daily life.

Seek urgent medical advice, or call NHS 111, if you experience any of the following:

• Vertigo (a spinning sensation)
• Changes to your eyesight, such as double or blurred vision
• Difficulty speaking or swallowing
• A metallic taste in your mouth, or numbness of your face
• A severe headache
• A change in your walking pattern, or an unexplained trip or fall
• Loss of fine hand control, or a significant loss of grip strength
• Numbness or tingling affecting both hands or both feet, or a change in your bladder or bowel control.

These can very rarely signal pressure on the spinal cord itself, called myelopathy, and need same-day assessment to avoid permanent symptoms.