Cervical radiculopathy (pinched nerve in the neck)

Cervical radiculopathy is irritation or compression of a nerve root in the neck where it branches off the spinal cord. Because these nerves travel to the shoulder, arm, and hand, a pinched nerve in the neck often causes symptoms that are felt down the arm rather than in the neck alone.

• Pain that starts in the neck and spreads into the shoulder blade, shoulder, or arm
• Sharp, burning, or electric pain, usually on one side
• Numbness or tingling in the arm, hand, or fingers
• Weakness in the shoulder, arm, or hand, or a weaker grip
• Pain that worsens with certain neck positions, such as looking up or turning toward the painful side

Some people find that lifting the arm and resting the hand on the head eases the arm pain.

In middle-aged and older adults, the most common cause is gradual wear in the neck (cervical spondylosis). As discs lose height and bone spurs form, the openings where the nerves leave the spine narrow. In younger adults, a herniated disc is the more typical cause, sometimes after lifting, pulling, or twisting, although often there is no clear injury.

Age, a previous neck injury or surgery, and work that involves heavy or repetitive strain raise the chance of these changes. Wear-related findings in the neck are very common on imaging and often cause no symptoms at all.

A clinician checks strength, sensation, and reflexes in the arms and may use neck movements that reproduce or relieve the pain. The pattern of symptoms often points to which nerve root is involved.

X-rays show alignment, disc height, and bone spurs. An MRI shows the discs, nerves, and spinal cord and is used when symptoms persist, when there is weakness, or before an injection or surgery; a CT scan gives more bone detail. Nerve studies (EMG and nerve conduction studies) can confirm nerve involvement and help rule out look-alike problems such as carpal tunnel syndrome or a nerve trapped at the elbow. Shoulder problems, and occasionally heart problems, can also cause arm pain, which is one reason an evaluation matters.

Most people improve over time with non-surgical care, although symptoms can come back. Options include a short period of activity changes, physical therapy with stretching, strengthening, and sometimes gentle traction, and anti-inflammatory or other medications when appropriate. A short course of oral steroids may be used for a severe flare, and a soft collar may be worn briefly for comfort. An image-guided steroid injection can ease arm pain for some people. Opioid pain medicines, if used at all, are limited to short periods for severe pain.

Surgery may be considered when arm pain remains significant despite non-surgical care, or when weakness is present or worsening. Common procedures include anterior cervical discectomy and fusion (removing the disc from the front of the neck and joining the bones), artificial disc replacement for selected patients, and posterior foraminotomy (enlarging the nerve's opening from the back of the neck). The right operation depends on the cause and the level involved.

With non-surgical care, arm pain often eases gradually, while numbness and strength may take longer to return. Physical therapy and a home exercise program help maintain neck motion and posture.

After surgery, many people go home the same day or the next day. Your surgeon will advise when to resume driving, work, and lifting, and physical therapy may follow.

Wear-related changes cannot be fully prevented, but these habits reduce strain on the neck:

• Keep a neutral neck posture at desks and screens, with screens raised to eye level
• Take regular breaks from looking down at phones or tablets
• Strengthen the neck, shoulder, and upper back muscles
• Use proper lifting technique