Cervical Radiculopathy
What it is
Cervical radiculopathy is a pinched or irritated nerve root in the neck, which sends symptoms down the path of that nerve into the shoulder, arm, or hand. The usual causes are a herniated disc or the bone spurs and narrowing that come with age, crowding the nerve as it exits the spine.
What it feels like
The hallmark is pain, numbness, tingling, or weakness that follows one nerve into a specific part of the arm or hand — often sharper than the neck pain itself. Many people find a particular position of the head eases or worsens it, and some notice relief when they rest the hand on top of their head.
How we diagnose it
Your description of where the symptoms travel, plus a focused exam, usually points to the involved nerve. An MRI confirms the cause and the level, and occasionally a nerve test (EMG) helps. The imaging and your symptoms need to match.
How we treat it
Most cervical radiculopathy improves without surgery, often within weeks. Part of the reason is that the pain comes not only from pressure on the nerve but from inflammation around it, which settles with time and treatment. I usually want to give non-surgical care a fair trial of at least six weeks:
- Physical therapy and activity adjustments
- Anti-inflammatory or other medication for a limited time
- A steroid injection if the pain is stubborn, to calm the inflammation around the nerve
If severe arm pain persists after a fair trial, or there is meaningful weakness, surgery is reasonable — nerve pain can be genuinely debilitating. When I can, I favor a focused, motion-preserving decompression from the back (a posterior foraminotomy) that frees the nerve without fusing. In other cases the better option is to remove the disc from the front, which does involve a fusion (or sometimes a disc replacement). We choose together, and I lean toward the least destabilizing operation that solves the problem.
The science — for the curious
As with a pinched nerve in the back, the natural history here is favorable, so the main question is usually how long you are willing to wait for relief rather than whether you will improve. Surgery mostly speeds relief of arm pain. I weigh fusing carefully because a fused level shifts load onto its neighbors over time — so when a motion-preserving decompression or a disc replacement will do the job, I prefer it. Progressive weakness or cord warning signs are what push toward earlier surgery.
Learn more
OrthoInfo — Cervical Spondylosis (Arthritis of the Neck): orthoinfo.aaos.org
OrthoInfo — Neck Pain: orthoinfo.aaos.org
This handout is general education about a common condition and does not replace the personalized advice we discuss in clinic. If anything here does not match what we talked about, what we talked about wins — please ask me.