What is a pinched nerve in the neck (cervical radiculopathy)?

What it is

Cervical radiculopathy is the medical term for a pinched nerve in the neck. The cervical spine is the neck section of the backbone, made of seven bones. A nerve root is the first stretch of a nerve as it leaves the spinal cord. Cleveland Clinic explains that when a root in the neck is compressed and inflamed, the effects travel along the nerve, which is why the problem can show up in the shoulder, arm or hand rather than only in the neck.

A British Journal of General Practice review defines it as compression or irritation of the sensory or motor root of a cervical nerve, often presenting with arm pain, weakness or loss of sensation, with or without neck pain.

What it feels like

Cleveland Clinic lists pain, numbness, tingling or pins and needles, muscle weakness and weakened reflexes. It says the pain is typically described as sharp or burning, that it usually affects one side of the body, and that some neck movements, such as extending the neck, may make it worse. Some people find the pain eases when they rest a hand on top of the head.

The British Journal of General Practice review notes that the sensory symptoms most often affect the levels called C5 to C7, and that an arm ache, a headache at the back of the head or pain between the shoulder blades are other possible presentations.

Why it happens

Cleveland Clinic names two main causes. The most common is age-related wear in the neck, called cervical spondylosis, in which discs lose height and the body forms bone spurs that can narrow the small openings where nerve roots exit. The other is a herniated disc in the neck, where the soft center of a disc pushes through its outer layer and presses on a nearby nerve. Mayo Clinic notes that in the neck a herniated disc can cause pain, numbness or weakness in the neck, shoulders, arms or hands. The same disc problem in the back is described in What is a slipped disc? Other nerve-related questions are collected in Discs and nerves.

Cleveland Clinic says disc-related cases are more common in people up to 50, wear-related cases in people in their 50s and 60s, and joint narrowing from arthritis in people in their 70s or older. Neck pain has many other causes that do not involve a pinched nerve, and What causes neck pain? describes them.

Diagnosis and outlook

Diagnosis begins with a history and an examination of the neck, shoulder, arms and hands, checking strength, reflexes and sensation. Cleveland Clinic describes MRI as the imaging method of choice, with X-rays, CT and nerve tests used in some cases. The British Journal of General Practice review adds a caution: degenerative changes are common in people over 30 who have no symptoms, so scan findings must be matched to the clinical picture to avoid overdiagnosis. That idea is the subject of Are disc changes on an MRI normal?

The outlook is generally good. Cleveland Clinic states that over 85% of cases resolve without specific treatment within 8 to 12 weeks, and that about 90% of people have good to excellent outcomes with non-surgical therapy. It also says symptoms return in up to one-third of people after initial improvement. Treatments it lists include a soft collar for short periods, anti-inflammatory medicines, physical therapy and, for some, injections or surgery. It says surgery may be recommended for severe, persistent pain despite 6 to 12 weeks of non-surgical care, or for severe or worsening neurological problems. The British Journal of General Practice review notes that there is not clear evidence that surgery gives better long-term outcomes than non-surgical care, although it may help a carefully selected few. Approaches vary by country and clinician.

When to get help

Cleveland Clinic advises contacting a healthcare provider if arm or neck symptoms have not gone away after a week or more, and as soon as possible if there is muscle weakness or weakened reflexes in the arm. It advises contacting a provider or going to the nearest hospital for neck pain after an accident such as a fall.

A related but different condition, cervical myelopathy, involves pressure on the spinal cord itself. The British Journal of General Practice review lists clumsy hands, reduced manual dexterity, an unsteady walk, numbness or tingling in the hands and feet, and bladder or bowel changes as features of it, and says that symptoms on both sides, trouble walking or bladder or bowel problems should be discussed urgently with a spinal or orthopedic team. For more on warning signs, see When is neck pain serious? Practice varies by country and by clinician.