Pinched Nerve in Neck (Cervical Radiculopathy): Treatment, Symptoms and Causes

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Key Takeaways

Cervical radiculopathy (CR) occurs when a nerve located along the cervical spine in your neck becomes impinged, causing muscle weakness, numbness, and other complications on one side of your body.
CR generally occurs due to slow, natural degeneration or a herniated disc caused by age or injury.
CR generally disappears between 8 and 12 weeks, but non-surgical treatment can help improve outcomes and strengthen the neck.
In more severe cases, surgery is needed to remove a degenerated intervertebral disc and replace it with a bone graft or artificial disc.

What is Cervical Radiculopathy?

Typically referred to as a pinched nerve in the neck, cervical radiculopathy (or CR) happens when a nerve in the neck (cervical spine) is inflamed or compressed. As a result, you may also feel pain radiating into your shoulder or arm, along with muscle weakness and numbness.

The nerves that run through your cervical spine are necessary to transmit messages between the brain and your muscles. Nerve roots branch out of your spinal cord through openings along the sides of your spinal vertebrae; these openings are called foramen. Where the nerves are inflamed or damaged, this can influence the type of pain you will experience.

Cervical Radiculopathy Symptoms

These nerves primarily connect to your arms, shoulders, chest, and upper back, so when a nerve is pinched, you may experience pain along the neck that radiates towards the area served by the damaged nerve. It also typically affects only one side of your body, so you may only feel pain in one arm and no pain in the other.

This “neuropathic pain” can feel like a sharp stinging or burning sensation and can manifest when making any neck movements. You may also experience:

It has been noted that some people who have worn out discs and pinched nerves do not exhibit any symptoms, though these are rare instances. Others have also shared that placing their hands on top of their head can briefly relieve the pressure on the affected nerve.

Specific Signs and Symptoms of Cervical Radiculopathy

C5 radiculopathy: Pain radiates from the neck into the shoulder and down your arm towards the thumb.
C6 radiculopathy: Pain radiates through the arm towards your index finger, accompanied by weakness in your upper arm (the biceps) or wrist.
C7 radiculopathy: Pain radiates down your arm and into the middle finger, with weakness in the back of the upper arm (the triceps).
C8 radiculopathy: Pain radiates down your arm and towards the little finger, accompanied by reduced hand grip strength.

What Causes Cervical Radiculopathy?

Between the vertebrae, you will find flexible intervertebral discs that act as shock absorbers for the spine. Think of these discs as being similar to the meniscus cushion tissue found in your knee. Within each disc is a gel-like substance called the nucleus pulposus that helps cushion your spinal column.

Most cases of CR involve damage to these discs, whether due to degeneration or accidental injuries.

Cervical Radiculopathy and Degenerative Conditions

Over time, these discs will slowly lose height and swell while drying up as they lose their water content. Over time, the discs become stiffer, and the space between discs reduces, causing the vertebrae to move closer to each other.

When this happens, the body creates bone spurs around the discs to help strengthen them. However, the growth of these bone spurs can narrow the foramen and press on the nerve root, thus causing CR. This degeneration occurs in anyone and is usually called arthritis or spondylosis.

Cervical Radiculopathy and Herniated Discs

Intervertebral discs may also experience gradual wear and tear due to injury or ageing. A herniated disc occurs when the gel-like nucleus pulposus pushes through the outer layer, and the leaking material pinches nearby nerves.

A herniated disc can occur due to any of the following:

What Happens If Cervical Radiculopathy is Left Untreated?

Symptoms of CR can come and go at infrequent intervals, while others report gradual or sudden instances of pain and discomfort, especially with particular head or neck movements and positions. Regardless, most cases of CR will gradually subside over time – faster if supported with non-surgical methods. As long as you do not put undue stress on your neck, you should see gradual improvements in your condition.

However, even with treatment, there is a rare chance of CR exhibiting worsening symptoms. If treatment is still unable to address this persistent issue, it could likely lead to permanent nerve damage or weakened functions; paralysis is also another risk factor of concern. It may be necessary to pursue surgical treatment instead to prevent this worst-case scenario from happening.

Diagnosing Cervical Radiculopathy

Diagnosing with a Physical Examination

Your doctor will perform a physical examination to ascertain if you have CR. Apart from taking your medical history and asking if you recently had any injuries to your neck, they will also assess your neck, shoulder, arms and hands. They will look for tell-tale signs of CR, including muscle weakness, loss of sensation, or changes to your reflexes. They may compare the sensations you feel on one side of the body to the other, as CR only affects one side. They may also assess your neck and arm movements to try and recreate or relieve your symptoms.

Using Spurling’s Test

This test aims to look for symptoms by carefully compressing the cervical spine. First, you must bend your head towards the affected side of your body while your doctor gently applies pressure to the top of your head. In doing so, it causes the cervical foramen to compress and narrow, which should reproduce the effect of nerve root compression. If you feel pain during this test, then CR is highly likely.

Diagnosing with Imaging Tests

Additional tests can help to confirm the diagnosis, especially if the physical exam does not give a satisfactory result. These tests could also help differentiate your condition from other neurological conditions with similar symptoms.

X-ray scan: An X-ray can identify disc space or foramen narrowing.
Magnetic resonance imaging (MRI): This scan can reveal any damage to the soft tissues, including herniated discs. It may also point out damage to your spinal cord or the nerve roots.
Electromyography (EMG): This test measures muscle and nerve function to determine whether a nerve is healthy.

How to Treat Cervical Radiculopathy

Treating Cervical Radiculopathy Without Surgery

Treating Cervical Radiculopathy via Immobilisation

Wearing a neck brace or soft cervical collar can help mitigate the symptoms of CR by limiting neck movements and allowing your neck muscles to rest. As a result, it may also prevent frequent nerve pinching caused by frequent neck movements. While effective, it is only limited to short-term wear – not going beyond one to two weeks – to prevent permanent muscle loss.

Medications

Medications can provide much-needed relief to your CR symptoms.

Nonsteroidal anti-inflammatory drugs (NSAIDs) like aspirin can relieve pain while reducing inflammation at the affected nerve roots.
Oral corticosteroids can also help reduce pain and inflammation around the affected nerve root.

Treating Cervical Radiculopathy via Nerve Root Steroid Injection

A steroid injection directly injects an anti-inflammatory medicine into the epidural space around your neck’s spinal nerves. Like the other medications, it also relieves pain and inflammation on the affected nerves. Your doctor will walk you through the procedure and notify you of the possible side effects of its use.

Treating Cervical Radiculopathy via Physiotherapy

Physiotherapy can help you reduce pain and swelling, strengthen muscles, and slowly restore your range of motion and flexibility. Your physiotherapist will show you various exercise methods to help with this. Most activities will involve strengthening the neck and back muscles tailored to treating your symptoms. Several physiotherapy sessions can help to alleviate your symptoms and restore your neck’s mobility.

The chin tuck: This simple method requires you to sit upright in a chair and slowly draw your head backwards while straightening your upper neck. As you do this, tuck your chin slightly inwards. Keep your eyes level while your head moves straight back. Hold this position for three seconds once your neck is pulled back fully, then slowly release it. Repeat this ten times, and repeat the entire process three to four times daily.
Traction exercises: First, lay on your back on the edge of your bed, keeping your feet towards the centre. Slowly lower your head and upper torso and let your head hang down freely. Hold the position for one minute before raising your head and upper torso. You can repeat this activity six times a day.
Neck tilts: While sitting upright, slowly tilt your neck to one side and bring your ear as close as possible to your shoulder. Hold this position for three seconds before returning to the upright position. Repeat this ten times while focusing on one side or alternating with the other, if needed.

Treating Cervical Radiculopathy With Surgery

If you are still experiencing severe symptoms even with non-surgical treatment for your CR, surgery will need to be considered to prevent your condition from worsening further.

Treating Cervical Radiculopathy via Anterior Cervical Discectomy and Fusion (ACDF)

ACDF is the typical choice for CR surgical intervention and involves removing bone spurs or an entire intervertebral disc (due to significant damage) before stabilising the spine via spinal fusion. This procedure aims to restore the spine’s alignment, allow the nerve roots to pass through the spinal column, and reduce motion along the affected spinal segment.

The surgeon will make an incision along the neck crease and carefully remove the problematic disc and any bone spurs pinching on your nerves. Once done, they will perform spinal fusion to gradually “knit” two or more of your vertebrae into a single bone.

The surgeon places a small piece of bone graft or a spacer (a metal cage containing a bone graft) where the removed disc formerly occupied for the spinal fusion. This also ensures the disc space returns to its original height before degeneration. The surgeon will then attach a metal plate and screws to your spine to hold the bones in place and promote the fusion process.

The bone graft may be taken from your hip (an autograft) or a donor (an allograft). Sometimes, the surgeon may reuse the bone spurs they removed for the spinal fusion process.

Treating Cervical Radiculopathy via Artificial Disc Replacement (ADR)

Much like ACDF, ADR involves removing the problematic disc but replacing it with an artificial disc (hence the procedure’s name). This procedure may be more desirable if you want to retain spinal flexibility and maintain a more normal range of motion in your neck.

The artificial disc is typically made from metal or a combination of metal and plastic. Because it is a replacement, it will preserve the level of motion between the vertebrae once the damaged disc is removed while restoring the height between the vertebrae and allowing the nerve roots sufficient room to leave the spinal column.

Treating Cervical Radiculopathy via Posterior Cervical Laminoforaminotomy

This surgical procedure involves carefully incising the back of your neck. From there, the surgeon will use special tools to thin out the lamina, or the bony arch forming the backside of the spinal canal. Doing this helps the surgeon reach the affected nerve, allowing them to carefully remove any bone spurs, herniated disc, or tissue impinging on the nerve.

This procedure usually does not require spinal fusion since it does not remove the entirety of a damaged disc in many cases. Minimally invasive methods to carefully remove whatever is pinching your nerve may also be possible while improving recovery outcomes.

How to Prevent Cervical Radiculopathy

Preventing CR from affecting you can be challenging, but you can still take preventive measures to reduce your risk.

Improve your standing and sitting posture.
Try not to stay in one position for long periods.
Get regular exercise; staying fit can keep your muscles healthy and flexible.
Incorporate simple neck stretches and exercises into your routine.
Maintain a healthy weight and have a healthy diet.
Avoid overexerting your body during manual labour.
Avoid sudden, rapid twists or movements with your neck.
Apply heat pads to your neck for 5 to 10 minutes if it feels stiff or achy.
Quit smoking.

Getting Professional Medical Attention

Cervical radiculopathy can be a concerning issue, but you can rest assured that Avant Orthopaedics can help you. Contact us to book an appointment and receive personalised care, where we will diagnose your condition and recommend the best course of action.

Frequently Asked Questions

How long does cervical radiculopathy pain last?

According to some studies, 85 per cent of acute CR incidences gradually clear up after 8 to 12 weeks without any treatment interventions. The duration may vary between people, so it is best to seek medical attention promptly before symptoms worsen.

If cervical radiculopathy slowly heals on its own, do I still need treatment?

Non-surgical treatment options are still helpful in reducing nerve root inflammation and avoiding other complications from arising.

How can you tell the difference between carpal tunnel syndrome and cervical radiculopathy?

Carpel tunnel syndrome occurs when the median nerve in the wrist is compressed, which causes numbness, tingling and weakness in your hand and fingers. As both CR and carpal tunnel syndrome share this symptom, a complete differential diagnosis is needed to accurately determine what the actual condition is so that you can receive prompt and accurate treatment.

Our Orthopaedic Doctor for Pinched Nerve in Neck

Dr. Razmi

FAMS (Ortho) | M Med (Gen Surg) (SG) | FRCSEd (Gen Surg) | MBBS (SG)

Dr. Razmi, a practicing orthopaedic and spine consultant at Mount Elizabeth Novena Hospital.

Dr Razmi routinely performs discectomy (minimally invasive surgery), decompression surgery, spinal fusion, motion preservation surgery including dynamic stabilization and dynamic fusion technologies and lumbar and cervical disc replacements. He is the first surgeon in Singapore to perform stand-alone anterior approached spine fusion using the Synfix implant.

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