What is Cervical Radiculopathy?

Cervical radiculopathy is irritation or compression of a cervical nerve root in the neck. It is commonly called a pinched nerve in the neck. The cervical nerve roots exit the spine and travel into the shoulder, arm, hand, and fingers.

When a cervical nerve root is compressed or inflamed, symptoms may travel from the neck into the shoulder blade, arm, forearm, hand, or fingers. Cervical radiculopathy may involve pain, numbness, tingling, weakness, or changes in reflexes. The exact symptom pattern depends on which nerve root is affected.

De Novo Brain & Spine evaluates adult patients with suspected or confirmed cervical radiculopathy to help determine the appropriate next step. Evaluation may include neurological examination, cervical spine imaging, EMG and nerve conduction studies when appropriate, conservative care recommendations, pain management options, or surgical treatment planning in selected cases.

Common Signs and Symptoms

Cervical radiculopathy symptoms depend on which cervical nerve root is affected and how severe the nerve irritation or compression is.

Common signs and symptoms may include:

• Neck pain with pain traveling into the shoulder, arm, hand, or fingers
• Sharp, burning, aching, or electric-like arm pain
• Pain around the shoulder blade
• Numbness or tingling in the arm, hand, or fingers
• Pins-and-needles sensation in the upper extremity
• Weakness in the shoulder, arm, wrist, hand, or grip
• Reduced reflexes in the arm
• Pain that worsens with certain neck positions, turning, or looking upward
• Symptoms that improve when resting the hand on top of the head in some cases
• Muscle tightness or spasms in the neck or upper back
• Difficulty lifting, gripping, typing, writing, or handling small objects when weakness is present

Seek urgent medical evaluation for progressive arm or hand weakness, worsening numbness, balance problems, trouble walking, loss of hand coordination, bowel or bladder changes, fever, unexplained weight loss, history of cancer, severe pain after trauma, or symptoms that suggest spinal cord compression. Seek emergency medical care or call 911 for sudden weakness, sudden speech difficulty, facial drooping, loss of consciousness, or other stroke-like symptoms.

What Causes This Condition?

Cervical radiculopathy occurs when a cervical nerve root becomes irritated, inflamed, or compressed as it exits the spine. The cause may involve the spinal disc, joints, bones, or nearby soft tissues.

Possible causes and related conditions may include:

• Cervical herniated disc, when disc material presses on or irritates a nerve root
• Cervical foraminal stenosis, which is narrowing of the opening where a nerve exits the spine
• Cervical degenerative disc disease, involving wear or breakdown of spinal discs
• Cervical spondylosis, or arthritis-related degenerative change in the neck
• Bone spurs, also called osteophytes
• Facet joint disease or uncovertebral joint arthritis
• Spinal stenosis, when narrowing affects the spinal canal or nerve roots
• Cervical spinal instability in selected cases
• Whiplash or traumatic neck injury in selected cases
• Spinal tumor, infection, inflammatory disease, or fracture in less common cases
• Prior cervical spine surgery or recurrent nerve compression in selected patients

These causes and risk factors do not mean every patient with neck or arm pain has cervical radiculopathy. Treatment planning depends on symptoms, neurological examination, imaging findings, response to prior care, and overall health.

How It Is Diagnosed?

Cervical radiculopathy is diagnosed through medical history, physical examination, neurological examination, and imaging or nerve testing when appropriate. The evaluation also helps distinguish cervical radiculopathy from carpal tunnel syndrome, ulnar neuropathy, peripheral neuropathy, shoulder disease, or other conditions.

Common diagnostic steps may include:

• Medical history and symptom review to understand neck pain, arm pain, numbness, tingling, weakness, symptom pattern, triggers, injury history, and prior treatment
• Physical examination to evaluate neck range of motion, posture, tenderness, muscle spasm, and painful movement
• Neurological examination to assess strength, sensation, reflexes, coordination, gait, balance, and hand function
• Spurling test or other nerve provocation maneuvers when clinically appropriate
• X-rays of the cervical spine to evaluate alignment, arthritis, disc space narrowing, bone spurs, fracture, or degenerative change
• Flexion-extension X-rays in selected cases to assess abnormal motion or cervical instability
• MRI of the cervical spine to evaluate nerve root compression, herniated disc, foraminal stenosis, spinal stenosis, spinal cord compression, tumor, infection, or other soft-tissue findings
• CT scan of the cervical spine when bone detail, fracture, arthritis, or surgical planning requires further evaluation
• CT myelogram in selected cases when MRI is not possible or when additional detail around the spinal cord and nerve roots is needed
• Electromyography and nerve conduction studies, also called EMG/NCS, when symptoms may overlap with carpal tunnel syndrome, ulnar neuropathy, peripheral neuropathy, or another nerve disorder
• Blood tests in selected cases when infection, inflammatory disease, or another medical condition is suspected

The goal of diagnosis is to identify the affected nerve root, determine the cause of nerve compression, and decide whether conservative care, injections, or surgical evaluation may be appropriate.

Treatment Options

Cervical radiculopathy treatment depends on the cause, severity, duration, neurological examination, imaging findings, prior treatment, activity limitations, and overall health. Many patients begin with non-surgical care when there is no progressive neurological deficit, spinal cord compression, fracture, infection, tumor, or other urgent concern.

Treatment options may include:

• Activity modification to reduce neck positions, lifting, or movements that worsen symptoms
• Physical therapy to improve posture, neck mobility, strength, flexibility, and nerve-related symptoms
• Home exercise and stretching when recommended by a clinician or therapist
• Short-term soft collar use in selected cases when medically appropriate
• Anti-inflammatory medication, acetaminophen, muscle relaxants, or nerve pain medication when medically appropriate
• Cervical traction in selected patients when recommended and supervised appropriately
• Cervical epidural steroid injection in selected cases involving nerve root inflammation or radiating arm pain
• Selective nerve root block in selected cases when diagnostic or therapeutic nerve-targeted injection is appropriate
• Treatment of contributing posture, ergonomic, or activity-related factors
• Anterior cervical discectomy and fusion, also called ACDF, in selected cases involving disc herniation, foraminal stenosis, nerve compression, spinal cord compression, or instability
• Cervical disc replacement in selected patients with appropriate anatomy and disc-related nerve compression
• Posterior cervical foraminotomy in selected cases when nerve root compression can be addressed from the back of the neck
• Cervical laminectomy or posterior cervical decompression in selected cases involving spinal stenosis or multilevel compression
• Cervical posterior fusion when stabilization is needed for instability, deformity, trauma, or selected degenerative conditions
• Rehabilitation and follow-up care to monitor strength, sensation, pain, function, and nerve recovery

Surgery is not appropriate for every patient with cervical radiculopathy. Neurosurgical treatment may be considered when symptoms are caused by structural nerve compression, progressive weakness, spinal cord compression, instability, or persistent symptoms that do not improve with appropriate non-surgical care.