It often starts as a stiff neck. Then the pain starts travelling: across the shoulder blade, down the arm, sometimes all the way into the fingers. There might be pins and needles, numbness, or a hand that doesn't feel quite as strong as it used to.
This is often described as a "pinched nerve". The medical term is radiculopathy, and while it can be very painful and worrying, the good news is that most people recover well.
In this article we'll cover what cervical radiculopathy is, what the research says about recovery and treatment, and the other places along a nerve's path where irritation can cause similar symptoms.
What is radiculopathy?
Your spinal cord sends nerves out between each pair of vertebrae. Each of these nerve roots travels to a specific area of your body, carrying messages for sensation and muscle control.
Radiculopathy happens when one of these nerve roots becomes irritated or compressed. Because the nerve supplies an area away from the spine, symptoms are often felt along that nerve's path rather than just where the problem is.
In the neck, this is called cervical radiculopathy. It typically causes:
Neck pain, often with pain around or under the shoulder blade
Pain travelling down one arm, sometimes sharp, burning or electric
Pins and needles or numbness in part of the arm or hand
Weakness in certain muscles, such as grip or lifting the arm
Symptoms that change with neck position, such as looking up or turning your head
What causes it?
It's often assumed that a "slipped disc" is the cause, but that's only part of the picture.
A large population-based study from Rochester, Minnesota, followed 561 people with cervical radiculopathy. A confirmed disc protrusion was the cause in about 22% of cases, while around 68% were related to spondylosis, age-related changes such as bony spurs and narrowing of the spaces where nerves exit the spine, with or without a disc component.
The same study found that only about 15% of people could link the start of their symptoms to physical exertion or an injury. For most, it came on without an obvious trigger. The condition was most common between 50 and 54 years of age, and the C7 and C6 nerve roots were most often involved.
The good news: most people get better
Cervical radiculopathy can be very painful, especially in the first few weeks. But the long-term outlook is generally favourable.
In the Rochester study, 90% of people were symptom-free or only mildly affected at follow-up, which averaged almost five years. About a quarter did go on to have surgery, and around a third had a recurrence at some point, which is worth knowing so a flare-up doesn't come as a shock.
Surgery or conservative care?
A Swedish randomised trial published in 1997 compared surgery, individualised physiotherapy and a cervical collar in 81 people who had cervical radicular pain for at least three months, with nerve root compression confirmed on imaging.
Shortly after treatment, the surgery group had less pain, and both the surgery and physiotherapy groups had better function than the collar group. But at the 12-month follow-up, there were no significant differences in pain, function or mood between the three groups. The researchers concluded that the three approaches appeared equally effective in the long term, with surgery giving faster early relief.
This mirrors what we see with lumbar disc problems: surgery can give quicker relief for some people, while conservative care often catches up over time.
What does the research say about conservative care?
Conservative care for cervical radiculopathy typically includes education, exercise, manual therapy such as mobilisation and manipulation, nerve mobility exercises and sometimes traction.
The honest answer is that the research is still developing. A 2023 systematic review in the Clinical Journal of Pain looked at 59 trials and found the overall quality of evidence was low, making firm conclusions difficult. It found very-low certainty evidence supporting short-term benefits from approaches including cervical manipulation, and inconclusive evidence when comparing conservative care with surgery.
Other reviews have found that manual therapy combined with exercise tends to produce better outcomes than either approach on its own.
Putting it together, the most sensible approach is a tailored, multimodal plan: education and reassurance, carefully selected hands-on care, and a progressive exercise program, with regular monitoring to catch anyone who needs a medical or surgical opinion.
Nerve pain from other places
Not all nerve pain in the arm or leg comes from the spine. A nerve can become irritated anywhere along its path, and some of these conditions can look very similar to radiculopathy.
In the neck and upper body
Carpal tunnel syndrome: the median nerve is compressed at the wrist, often causing pins and needles in the thumb, index and middle fingers, especially at night
Cubital tunnel syndrome: the ulnar nerve is irritated at the elbow, often causing tingling in the ring and little fingers
Thoracic outlet syndrome: nerves or blood vessels are compressed between the collarbone, first rib and neck muscles, causing arm pain, heaviness or tingling, often worse with arms overhead
In the lower back and leg
Lumbar radiculopathy (sciatica): compression of a nerve root in the lower back, often from a disc herniation or narrowing of the space where the nerve exits
Lumbar spinal stenosis: narrowing of the spinal canal, often causing leg pain, heaviness or tingling when walking or standing that eases with sitting or bending forward
Deep gluteal syndrome (including piriformis syndrome): irritation of the sciatic nerve in the buttock region, which can mimic sciatica
Meralgia paraesthetica: compression of a sensory nerve near the hip, causing burning or numbness on the outer thigh
Sometimes a nerve can be irritated in more than one place at once, which can make symptoms more complex. A careful assessment helps work out where the problem is coming from, and that guides the right treatment.
When to seek urgent care
Most nerve-related pain can be safely managed in the community. However, some symptoms need prompt or urgent medical attention.
Go to the emergency department straight away if you have:
New difficulty with walking or balance, or a feeling of unsteadiness in your legs
Clumsiness in both hands, such as difficulty with buttons, writing or handling small objects
Pins and needles or numbness in both arms or both legs
New bladder or bowel problems
Numbness in the groin or around the back passage
Severe neck pain after a significant fall or accident
Some of these can be signs of compression of the spinal cord itself, called myelopathy, or of cauda equina syndrome in the lower back. Both need urgent assessment.
Get a prompt medical review if you have:
Muscle weakness that is getting worse
Severe pain that isn't settling despite appropriate care
Symptoms along with fever, unexplained weight loss or a history of cancer
What good care looks like
At Epoch Health, care for nerve-related neck, arm, back and leg pain usually includes:
A thorough assessment, including a neurological examination of strength, reflexes and sensation, so changes can be tracked over time
Working out where the nerve is being irritated, whether in the spine or further along its path
Clear explanation of what's going on and what to expect
Hands-on care where appropriate, such as mobilisation, soft tissue work, manipulation if suitable, and nerve mobility techniques
A progressive exercise program to rebuild strength, mobility and confidence
Practical advice on sleep positions, work setup and activity modification
Coordination with your GP, including referral for imaging, nerve studies or a specialist opinion when needed
How our team can help
Our chiropractors work together to help you understand what's causing your symptoms and build a plan to get you back to normal life.
If your symptoms suggest you need a medical or surgical opinion, we'll tell you clearly and work with your GP to arrange it promptly.
Book an appointment at our Dundas Valley or Telopea clinic: epochhealth.net.au/bookings
This article is general information only and isn't a substitute for personalised health advice. If you have any of the emergency symptoms listed above, go to your nearest emergency department immediately.
References
Radhakrishnan K, et al. Epidemiology of cervical radiculopathy: a population-based study from Rochester, Minnesota, 1976 through 1990. Brain. 1994;117(2):325–335.
Persson LC, Carlsson CA, Carlsson JY. Long-lasting cervical radicular pain managed with surgery, physiotherapy, or a cervical collar: a prospective, randomized study. Spine. 1997;22(7):751–758.
Plener J, et al. Conservative management of cervical radiculopathy: a systematic review. Clinical Journal of Pain. 2023;39(3):138–146.
Kuligowski T, Skrzek A, Cieślik B. Manual therapy in cervical and lumbar radiculopathy: a systematic review of the literature. International Journal of Environmental Research and Public Health. 2021;18(11):6176.