Cervical radiculopathy: symptoms and relief

Living with cervical radiculopathy

Cervical radiculopathy often starts as neck pain that then shoots into one arm. You might feel burning, stabbing, or electric pain running past the elbow, or tingling and numbness in your hand. Turning your head, looking up, driving, or sitting at a computer can quickly flare your symptoms. Sleep can be hard, and simple things like lifting a kettle, drying your hair, or carrying a bag may feel painful or unsafe.

Most cases are caused by age related changes or a disc bulge that narrows the tunnel where the nerve exits the spine. The encouraging news is most people improve with time, education, and guided rehabilitation, without any need for injections or surgery. Long term population studies suggest that around 9/10 people are symptom free or only mildly symptomatic at follow-up.¹ ⁴ ⁷

What are the symptoms of cervical radiculopathy?

People with cervical radiculopathy commonly notice:

• Neck pain that may be mild or moderate compared with the arm symptoms
• Sharp, burning, or aching pain that travels from the neck into the shoulder, arm, and hand, usually on one side
• Pain that goes below the elbow in a clear strip of skin
• Tingling, pins and needles, or numbness in part of the arm or hand
• Weakness when lifting the arm, bending or straightening the elbow, extending the wrist, or gripping objects
• Decreased or uneven reflexes at the elbow or wrist when tested
• Pain made worse by turning or tilting the head toward the painful side, or by looking up
• Pain that sometimes eases when you rest your hand on top of your head ¹ ⁴ ⁷

Symptoms from cervical radiculopathy are different from mechanical neck pain alone, which does not cause a dermatomal arm pattern.

What causes cervical radiculopathy?

Cervical radiculopathy happens when a nerve root in your neck is compressed or irritated where it leaves the spinal canal. Two main processes are usually involved:

1. Disc herniation

• The soft centre of a disc pushes out through a small tear in the outer ring and presses on or inflames the nerve root.
• More common in middle aged adults and often causes more sudden, intense symptoms.

2. Degenerative changes and foraminal stenosis

• Over time, discs can lose height and small bone spurs can form around the joints and uncovertebral areas.
• These changes can narrow the opening (foramen) and pinch the nerve, especially with certain neck positions. ¹ ² ³

Risk factors for a pinched nerve

Factors that make cervical radiculopathy more likely include:

• Age (most cases occur in people in their 40s, 50s, and 60s)
• Smoking
• Vibration or heavy manual work
• Prior neck injury
• Possibly obesity and low physical activity, which may contribute to degeneration, though evidence is indirect ¹ ² ⁴

It is important to distinguish cervical radiculopathy from:

• Cervical myelopathy which is a compression of the spinal cord, with gait and hand changes, which needs a faster pathway.
• Shoulder, elbow, or peripheral nerve problems: such as rotator cuff tears, carpal tunnel syndrome, or ulnar neuropathy, which can mimic arm symptoms but need different care ¹ ³

How is cervical radiculopathy diagnosed?

Diagnosis is based on your story, examination, and sometimes imaging or nerve tests.Your clinician will typically: ¹ ² ³ ⁵ ⁶ ¹⁶

• Ask about how and when symptoms started, what makes them worse or better, and any previous neck or arm problems
• Map pain and numbness into nerve patterns (C5–T1 dermatomes)
• Test strength in key muscles (myotomes), such as shoulder abduction, elbow flexion/extension, wrist extension, and finger movements
• Check reflexes at the biceps, triceps, and brachioradialis muscles

Imaging and nerve tests

MRI is the preferred test when red flags or suspected myelopathy are present, symptoms are severe or progressive, and they persist despite good conservative care. ² ³

• Plain X-rays can show alignment and degenerative change but are less useful for confirming a pinched nerve. ²
• Electrodiagnostic tests (EMG/NCS) may be used when the diagnosis is uncertain or when differentiating from peripheral nerve entrapments such as carpal tunnel syndrome. ¹⁶

Routine early MRI is not recommended for straightforward cases that are improving with conservative care. ¹ ² ⁷ ¹⁵

[Diagnosis & Treatment →]

Clinical insight

For many years, people with neck and arm pain were often sent for early imaging and sometimes surgery based mainly on scan findings. Modern guidelines have shifted this approach. They emphasise that cervical radiculopathy often improves with time, education, and active care. Patients do not usually need immediate MRI or surgery in uncomplicated cases¹ ² ⁷ ¹⁵. In most situations, the first line is to explain the condition and likely course, encourage staying active within limits, optimise ergonomics (body posture and and sleep positions, then start a structured physical therapy program, with medicines used thoughtfully for symptom relief.

How is cervical radiculopathy treated?

Most people start with nonoperative care. Treatment aims to calm irritation around the nerve, protect the spinal cord, and restore strength and confidence. Surgery and injections are reserved for specific situations.

Education and activity changes

• Stay as active as you can within your limits, using a pain monitoring approach rather than strict rest.
• Avoid long periods of fixed postures such as looking down at a phone, driving without breaks, or sitting with your head poked forward.
• Set up your workstation so the screen is at eye level and your shoulder blades can rest comfortably.
• Use pillows or towel rolls to support a neutral neck position in sitting and sleeping.
• A soft collar may be used for a few days in severe acute pain to help with rest and sleep, but long term immobilisation is avoided to prevent deconditioning. ¹ ³ ⁷

Exercise based rehabilitation

Supervised, impairment based rehabilitation is a core part of care and typically includes: ⁷ ⁸ ⁹

• Gentle neck and upper back (cervico-thoracic) mobility work
• Deep neck flexor endurance training and postural retraining
• Scapular and upper quarter strengthening 
• Nerve gliding (neurodynamic) exercises for the arm and neck, within tolerable ranges
• Graded aerobic activity such as walking or cycling

Evidence highlights that adding mechanical traction to exercise improved pain and disability compared with exercise alone at 6 to 12 weeks in selected patients, with benefits that could last up to 6 months. ⁷ ⁸

A randomized trial found that neural mobilization plus conventional therapy improved short term pain and range of motion compared with conventional therapy alone. ⁹

Overall, guidelines support a multimodal approach. This means combining exercise, manual therapy, traction where appropriate, and education—rather than relying on a single technique. ⁷

Medications

Medicines can help manage symptoms while you recover:

• Short courses of non steroidal anti inflammatory drugs and simple pain relief can help, if they are safe for you.
• In selected people, a short course of neuropathic pain medicine may be considered.
• Long term opioid use is discouraged because benefits are limited and risks are significant.
• Evidence for oral steroids is limited and practices vary; some clinicians may use a brief taper in specific circumstances.

Any medicine plan should be individualised and reviewed regularly. ³ ¹⁰

Injections

Fluoroscopy (image guided) cervical epidural steroid injections can provide short term pain relief in people with persistent radicular pain that has not responded enough to conservative care.

• Benefits are mainly short term; medium term results are mixed and there is no clear disease modifying effect.
• Serious neurologic complications (nerve-related conditions) are rare but real, including spinal cord or brain injury.
• Safety measures include using real time imaging guidance, test doses with contrast, and preferential use of non particulate steroids for transforaminal injections

The US Food and Drug Administration has issued a specific safety warning about epidural corticosteroid injections, so risks and benefits should be carefully discussed as part of shared decision making. ¹⁰ ¹¹

Surgery

Surgery is not needed for most people, but it can help when: ¹ ³ ⁷ ¹² ¹³ ¹⁴

• Arm pain is severe and ongoing despite an adequate trial (often 6–12 weeks) of high quality nonoperative care
• There is progressive or severe movement deficit that affects function
• Signs of cervical myelopathy are present (this follows a separate, more urgent pathway)

Common procedures include:

Anterior cervical discectomy and fusion (ACDF)

• The most established operation: the surgeon removes the removes the damaged disc and fuses the vertebrae, stabilizing the spine
• Provides reliable decompression but reduces motion at that level.

Cervical disc arthroplasty (CDA)

• A motion preserving disc replacement at that creates space between the vertebrae and decompresses nerves
• Several randomized trials show:
• Similar or better patient reported outcomes compared with ACDF
• Less radiographic degeneration at nearby levels at 5 to 10 years with some devices ¹³ ¹⁴

Posterior cervical foraminotomy (PCF)

• A motion preserving decompression from the back of the neck that opens the foramen to relieve nerve root. It can be done using small skin holes and a camera (endoscopy)
• A recent randomized trial (FACET) found PCF non inferior to ACDF at 1 year for single level foraminal radiculopathy, with similar patient reported outcomes at 1 to 2 years but different profiles for risks and recovery. ¹²

Choice of surgery depends on factors such as

• Which level and side are involved
• Your spinal alignment and overall neck health
• Whether motion preservation is a priority
• Your work, sport, and lifestyle goals
• Surgeon expertise and device availability

Sword's approach

Sword Health helps people manage pain and movement issues with expert-guided AI care you can use from home. Our model combines clinical support with modern technology, designed to work around your life.