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Cervical radiculopathy, often referred to as a “pinched nerve” in the neck, occurs when a nerve in the cervical spine becomes compressed or irritated as it exits the spinal cord. These nerves exit the spinal cord through the intervertebral space, which is the space between adjacent vertebrae (the bones in our neck), and our discs, which act as cushions between our vertebrae. Compromise of the nerve can lead to pain, weakness, numbness, or tingling that radiates from the neck down into the shoulder, arm, and hand. Understanding cervical radiculopathy is essential for managing symptoms effectively and preventing further complications.

Causes

There are many causes of cervical radiculopathy, and each will put pressure on or irritate a spinal nerve root.

(Magnus et al., 2024) found the most common causes per age group:

  • > 50 years: disc hernation (protrusion) or trauma. This causes impingement on the nerve that exits the compromised intervertebral space
  • 50+ years: disc degeneration, also known as Cervical Spondylosis. As we get older, our discs will dry out and shrink, this is normal ‘wear and tear’ of ageing. As the discs lose height, the body may form additional bone, known as bone spurs, to provide extra support. However, these bone spurs can cause joint-space narrowing — potentially compressing the nerve root.

Symptoms

When talking about the symptoms of cervical radiculopathy, you may come across the terms dermatomes and myotomes.

A dermatome refers to a specific area of skin that receives sensory input from a single spinal nerve, while a myotome is a group of muscles controlled by a single spinal nerve. For example, the 5th cervical nerve (C5) supplies sensation to the outside of the shoulder and upper arm and plays a role in bending the elbow. The connection between dermatomes and myotomes explains why certain areas of the neck/shoulder/arm/hand are affected in cervical radiculopathy, depending on which nerve is involved.

Depending on which nerve is involved, signs & symptoms in the neck/upper back/shoulder/arm/hand include:

  • Pain
  • Pins & needles
  • Numbness
  • Muscle weakness
  • Weakened deep tendon reflexes

Diagnosis

Diagnosing cervical radiculopathy involves looking at your history, physical exam and specific diagnostic tests conducted by your Physiotherapist. You may also be referred for the following:

  • Magnetic resonance imaging (MRI): This is the primary imaging technique used, offering detailed views of disc herniations and nerve compressions. However, it should be noted that while disc herniations and intervertebral space narrowing are closely associated with these symptoms, they may not always be the cause. MRI studies carry the risk of false positives. (Juijper et al., 2011) examined 78 patients with recent-onset cervical radiculopathy. The results indicated that while 73% of affected nerves showed compression on MRI, 45% revealed nerve compression without corresponding clinical symptoms. This study emphasises that MRI alone (without associated symptoms) may not always reflect the cause of pain.
  • Electromyography (EMG): This measures the electrical activity in muscles. This can help confirm whether nerves are being affected by radiculopathy, by identifying signs of nerve damage or muscle denervation (the nerve being unable to send signals to muscles)
  • Nerve root blocks: can be valuable for confirming dysfunction in the affected nerve. Selective nerve root blocks can offer temporary pain relief while also helping to identify the nerve root responsible for symptoms.

Management

While this diagnosis may sound daunting, a study by (Magnus et al., 2024) found that over 85% of acute cervical radiculopathy cases resolves without any specific treatments within 8 – 12 weeks.

Physiotherapy management

Physiotherapy for cervical radiculopathy aims to reduce pain, restore function, and prevent recurrence through a combination of manual therapy, exercises, and patient education. A tailored approach based on individual assessment ensures optimal recovery. This includes but is not limited to:

  • Rest & Activity Modification: Avoid activities that exacerbate symptoms.
  • Manual Therapy: to reduce nerve compression, reduce muscle tension and reduce stiffness in associated areas
  • Ergonomic Modifications & Postural Correction: This will be implemented into work, daily activities and sleep to reduce neural tension and improve symptoms
  • Exercise Therapy: For range of motion, strengthening and reducing neural tension & irritation

The general consensus in the literature, including (Boyles et al., 2011), demonstrate that combining manual therapy techniques with therapeutic exercise is effective for improving function and range of motion, while also reducing pain.

Corticosteroid injections

  • These are commonly used as an adjunct to treatment in more debilitating cases. These injections allow for local delivery of a high dose of corticosteroids that are believed to reduce inflammation and reduce pain inputs from nerves. The goal of these injections is usually to offer sufficient short-term pain relief, allowing you to start or continue physical therapy, or to help prevent the need for more invasive pain management procedures
  • A study conducted by (Hashemi et al., 2019) found that of the total 37 cases, injections provided substantial pain relief and functional improvement over a two-year follow-up period, along with above-average patient satisfaction in the majority of patients.

Surgery

This is generally indicated for patients who:

  • Do not respond to at least six weeks of conservative treatments
  • Experience significant pain that impairs daily activities
  • Have progressive neurological deficits, such as muscle weakness or loss of sensation
  • Present with structural issues, like herniated discs or bone spurs, compressing nerve roots

Common surgical procedures include:

  • Anterior Cervical Discectomy and Fusion: Involves removing the problematic disc and fusing the adjacent vertebrae to stabilise the spine.
  • Posterior Cervical Foraminotomy: Relieves nerve root compression by removing bone or tissue from the back of the spine.
  • Cervical Disc Arthroplasty (Artificial Disc Replacement): Replaces the damaged disc with an artificial one to preserve motion

Information is provided for education purposes only. Always consult your physiotherapist or other health professional.