Cervical Radiculopathy

Also known as: Cervical nerve root compression, Cervical nerve root impingement, Cervical radiculitis, Pinched nerve in the neck, Neck nerve compression, Cervical root syndrome

Last updated: December 18, 2024

Cervical radiculopathy is a syndrome in which a nerve root in the neck becomes irritated or compressed, disrupting sensory and motor signaling. It often causes neck pain that can radiate into the shoulder, arm, or hand, sometimes with sharp, burning, or electric arm pain in a dermatomal pattern, plus numbness or tingling. Symptoms often improve over weeks to months with conservative management.

Key Facts

•Cervical radiculopathy describe a clinical syndrome in which one or more cervical spinal nerve roots become irritated or compressed, producing pain and neurologic symptoms along a dermatomal or myotomal pattern into the shoulder, arm, or hand
•Neck pain that radiate into the shoulder and arm and fluctuate with activity or posture
•Diagnosed through history, physical exam, and imaging
•First-line treatment includes exercise, weight management, and activity modification

What It Is

Cervical radiculopathy may describe a clinical syndrome in which one or more cervical spinal nerve roots can become irritated or compressed, often producing pain and neurologic symptoms along a dermatomal or myotomal pattern into the shoulder, arm, or hand. The underlying pathophysiology can involve mechanical compression, inflammatory mediators from degenerative discs, or a combination of both, which may disrupt sensory and motor signaling. Symptoms can vary by the affected level (commonly C5–C8) and may include sensory changes, weakness, and altered reflexes. The condition can occur acutely (for example, after disc herniation) or more gradually (for example, with cervical spondylosis and foraminal narrowing).

Affected Anatomy

This condition affects several structures in and around the joint:

•Cervical spinal nerve roots (commonly C5, C6, C7, C8)
•Intervertebral discs of the cervical spine (annulus fibrosus and nucleus pulposus)
•Intervertebral foramina (neural foramina) where nerve roots exit
•Facet (zygapophyseal) joints and associated osteophytes that can narrow foraminal space
•Uncovertebral joints (joints of Luschka) that can contribute to foraminal stenosis
•Posterior longitudinal ligament and adjacent epidural space where inflammation can occur
•Dorsal root ganglion (sensory ganglion) which can be a pain generator
•Cervical spinal cord and central canal (relevant when stenosis coexists with radicular symptoms)

Common Symptoms

Symptoms can vary in intensity and may change over time. Common experiences include:

•Neck pain that may radiate into the shoulder and arm and can fluctuate with activity or posture
•Arm pain that may follow a dermatomal distribution (for example, lateral forearm and thumb with C6 involvement) and can be sharp, burning, or electric in quality
•Numbness or tingling (paresthesia) in the arm or hand that may correspond to the affected nerve root level
•Muscle weakness in a myotomal pattern (for example, wrist extension or triceps weakness) that can affect grip or lifting
•Reduced or asymmetric deep tendon reflexes (for example, biceps, brachioradialis, or triceps reflex changes) that can correlate with root level
•Symptoms that may worsen with neck extension, rotation, or certain positions and can improve with unloading postures in some cases
•Scapular or periscapular pain that can accompany radicular symptoms and may be mistaken for shoulder pathology
•Sensory hypersensitivity or pain with light touch in the affected distribution, which can reflect nerve irritation

Causes and Risk Factors

Multiple factors can contribute to the development of this condition:

Causes

•Cervical disc herniation that can compress or chemically irritate a nerve root, often producing more acute symptom onset
•Cervical spondylosis (degenerative changes) with osteophyte formation that can narrow the neural foramen and irritate the exiting nerve root
•Foraminal stenosis from combined degenerative disc height loss, facet arthropathy, and uncovertebral joint hypertrophy that can reduce space for the nerve root
•Trauma or repetitive mechanical stress that can contribute to disc injury, inflammation, or accelerated degenerative change
•Less common space-occupying lesions (for example, tumors or cysts) that can compress nerve roots and mimic degenerative radiculopathy
•Inflammatory or infectious processes affecting spinal structures that can produce radicular-type pain, typically with additional systemic or red-flag features

Risk Factors

•Increasing age, which can be associated with higher prevalence of cervical spondylosis and foraminal narrowing
•Occupational or recreational activities involving repetitive neck motion, overhead work, or heavy lifting that can increase mechanical load on the cervical spine
•Prior neck injury or whiplash-type mechanisms that can contribute to disc or joint changes
•Smoking, which can be associated with disc degeneration and impaired disc nutrition
•Poor ergonomic exposures (for example, prolonged forward head posture) that can increase cervical loading over time
•Genetic predisposition to degenerative spine disease, which can influence disc and joint degeneration patterns
•Coexisting cervical degenerative conditions (for example, facet arthropathy) that can contribute to foraminal stenosis
•High body mass index, which can be associated with increased mechanical stress and degenerative changes in some populations

How It's Diagnosed

Diagnosis typically involves a combination of clinical assessment and imaging studies:

•Clinical history and symptom mapping, which can include characterization of radiating pain, sensory changes, weakness patterns, and symptom triggers consistent with dermatomal or myotomal involvement
•Physical examination that can include cervical range-of-motion assessment, focused neurologic examination (strength, sensation, reflexes), and evaluation for shoulder or peripheral nerve mimics
•Provocative maneuvers such as Spurling-type testing and symptom-relief maneuvers (for example, shoulder abduction relief sign), which can support a radicular pattern when interpreted in clinical context
•Magnetic resonance imaging (MRI) of the cervical spine, which can identify disc herniation, foraminal stenosis, nerve root impingement, and coexisting central canal stenosis
•Computed tomography (CT) and CT myelography, which can be used when MRI is limited or when bony foraminal narrowing requires detailed assessment
•Electrodiagnostic testing (EMG and nerve conduction studies), which can help differentiate cervical radiculopathy from peripheral neuropathy or plexopathy and can characterize chronicity
•Plain radiographs (X-rays) including possible flexion-extension views, which can show alignment, degenerative changes, and potential instability in selected contexts

Treatment Options

Treatment approaches range from conservative measures to surgical interventions, often starting with the least invasive options:

Self-Care and Activity Modification

•Activity modification and relative rest, which can reduce symptom provocation while maintaining general mobility as tolerated
•Neuropathic pain-modulating medications (for example, gabapentinoids or certain antidepressants), which can be considered for radiating nerve pain in appropriate clinical contexts
•Cervical traction (supervised or home-based in selected cases), which can reduce foraminal loading and may improve symptoms for some individuals
•Management of contributing factors such as ergonomics and comorbid musculoskeletal conditions (for example, shoulder pathology), which can influence symptom persistence and functional limitation

Physical Therapy and Exercise

•Physical therapy approaches that can include cervical stabilization, postural training, range-of-motion work, and nerve mobilization techniques in selected cases

Medications

•Non-opioid pain-relieving medications such as NSAIDs or acetaminophen, which can be used for symptom control depending on individual risk factors and clinician guidance

Injections and Office-Based Procedures

•Short-term use of oral corticosteroids in selected cases, which can reduce inflammation and may provide temporary symptom improvement in some patients
•Epidural steroid injections or selective nerve root blocks, which can provide anti-inflammatory effect and may be used for diagnostic clarification and short- to intermediate-term symptom relief

Surgery

•Surgical decompression for persistent or progressive neurologic deficits or refractory pain, which can include anterior cervical discectomy and fusion (ACDF), cervical disc arthroplasty in selected patients, or posterior cervical foraminotomy depending on anatomy and pathology

Prognosis and Recovery

The course of this condition varies between individuals:

•Symptoms often can improve over weeks to months with conservative management, particularly when the primary driver is acute disc-related irritation rather than fixed bony stenosis.
•Prognosis can vary by cause, duration of symptoms, and presence of objective neurologic deficits, with progressive weakness generally indicating a more complex course.
•Degenerative foraminal stenosis can be associated with recurrent or fluctuating symptoms, and symptom patterns may evolve with activity and posture over time.
•Interventional procedures may provide temporary or partial relief for some individuals, and response can depend on accurate targeting and the underlying pain generator.
•Surgical outcomes often can include meaningful pain reduction and functional improvement in appropriately selected patients, although residual numbness or weakness can persist depending on nerve injury duration and severity.

Anterior Cervical Discectomy and Fusion (ACDF)(Procedure)
Cervical Spinal Fusion(Procedure)
Cervical Disc Herniation(Condition)

Frequently Asked Questions

Common symptoms include: Neck pain that may radiate into the shoulder and arm and can fluctuate with activity or posture; Arm pain that may follow a dermatomal distribution (for example, lateral forearm and thumb with C6 involvement) and can be sharp, burning, or electric in quality; Numbness or tingling (paresthesia) in the arm or hand that may correspond to the affected nerve root level; Muscle weakness in a myotomal pattern (for example, wrist extension or triceps weakness) that can affect grip or lifting; Reduced or asymmetric deep tendon reflexes (for example, biceps, brachioradialis, or triceps reflex changes) that can correlate with root level.

Diagnosis typically involves: Clinical history and symptom mapping, which can include characterization of radiating pain, sensory changes, weakness patterns, and symptom triggers consistent with dermatomal or myotomal involvement; Physical examination that can include cervical range-of-motion assessment, focused neurologic examination (strength, sensation, reflexes), and evaluation for shoulder or peripheral nerve mimics; Provocative maneuvers such as Spurling-type testing and symptom-relief maneuvers (for example, shoulder abduction relief sign), which can support a radicular pattern when interpreted in clinical context; Magnetic resonance imaging (MRI) of the cervical spine, which can identify disc herniation, foraminal stenosis, nerve root impingement, and coexisting central canal stenosis.

Treatment options range from conservative measures to surgical interventions, including: Activity modification and relative rest, which can reduce symptom provocation while maintaining general mobility as tolerated; Physical therapy approaches that can include cervical stabilization, postural training, range-of-motion work, and nerve mobilization techniques in selected cases; Non-opioid pain-relieving medications such as NSAIDs or acetaminophen, which can be used for symptom control depending on individual risk factors and clinician guidance; Short-term use of oral corticosteroids in selected cases, which can reduce inflammation and may provide temporary symptom improvement in some patients; Neuropathic pain-modulating medications (for example, gabapentinoids or certain antidepressants), which can be considered for radiating nerve pain in appropriate clinical contexts.