Neck Disc Problems and Arm Pain: Understanding Cervical Radiculopathy
Quick summary
- Cervical radiculopathy means a nerve root in the neck is irritated, often by a disc or by age-related narrowing, causing pain, tingling, numbness or weakness down the arm.
- The outlook is generally favourable. A systematic review of conservative treatments found people tended to improve over time whichever treatment they received (Thoomes et al., 2013).
- A review of cervical disc herniation with radiculopathy found substantial improvement in pain and function was common within the first 4 to 6 months (Wong et al., 2014).
- Clumsy hands, trouble walking or balance changes point to the spinal cord rather than a single nerve and need prompt medical review.
Neck pain on its own is common. Neck pain that runs down into the shoulder blade, arm or hand, sometimes with pins and needles or a weak grip, is a different picture. When a nerve root in the neck is irritated it is called cervical radiculopathy. People often call it a "pinched nerve". It tends to appear in mid-life, and it can be frightening because the arm symptoms feel so far from the source.
What's Actually Happening
Nerve roots leave the spinal canal through small openings between the vertebrae. Two things commonly narrow that space or irritate the nerve: a disc herniation, which is more common in younger and middle-aged adults, and age-related thickening of the joints and disc margins, which is more common later in life. The irritated nerve can produce:
- pain that travels from the neck or shoulder blade into the arm, often along a fairly consistent path
- pins and needles or numbness in part of the hand or fingers
- weakness in particular movements, such as gripping or lifting the arm
- symptoms that change with neck position, often worse when looking up or turning towards the painful side
Hand symptoms can also come from the wrist (carpal tunnel syndrome) or from nerves further along the arm. Telling these apart is a key part of an assessment. We've written more about that in Carpal Tunnel vs. Cervical Radiculopathy.
How It Usually Recovers
The encouraging news is that most people get better. A systematic review of conservative treatments, including physiotherapy, collars and traction, found that no single treatment was clearly superior. Patients tended to improve over time regardless of which they received, which the authors took as a sign of a favourable natural course (Thoomes et al., 2013).
A separate review focused on cervical disc herniation with radiculopathy. It found that people commonly improved substantially in pain and activity within the first 4 to 6 months, and many returned to normal activities over the following couple of years (Wong et al., 2014). An older natural history study, summarised in a 2014 review, reported improvement in most patients within the first month (Alentado et al., 2014). The timeline varies, but steady improvement is the usual pattern.
What Helps While It Settles
- Find positions that ease the arm. Some people get relief by resting the hand on top of their head or keeping the neck in a slightly forward position. Use whatever settles symptoms.
- Keep moving within comfort. Gentle neck and shoulder movement and general activity such as walking help more than holding still for days.
- Adjust your workstation. Bring screens to eye level so you aren't tipping your head back to look at them. Avoid long stretches cradling a phone or looking down at a laptop.
- Build strength gradually as pain allows, especially through the shoulder blade and deep neck muscles.
At Spirit Chiropractic in Kogarah, an assessment includes a neurological examination of strength, sensation and reflexes in the arms, plus tests that gently load the nerve. Management usually combines education, movement and exercise, and manual therapy chosen to suit your presentation. With radiculopathy that usually means gentle mobilisation and soft-tissue work rather than forceful techniques. If your examination suggests you need imaging, a nerve study or a specialist opinion, we'll liaise with your GP.
See a doctor promptly if you notice:
- clumsiness in both hands, such as trouble with buttons or handwriting, or dropping things
- unsteady walking, or changes in balance
- symptoms in both arms, or in the legs as well
- rapidly worsening weakness
- neck pain with fever, unexplained weight loss, or after significant trauma
These can indicate pressure on the spinal cord itself (cervical myelopathy) or another serious cause.
Arm pain or pins and needles that seems to start in your neck?
A careful assessment can work out whether the neck is the source, check your nerve function, and set a plan you can follow at work and at home.
Spirit Chiropractic is at Shop 23/6 Belgrave Street, Kogarah. If your GP has put you on a chronic condition management plan, here's how Medicare works for chiropractic.
Request an appointment Call 0410 420 856Frequently Asked Questions
Can a pinched nerve in the neck heal on its own?
Often, yes. Research on cervical radiculopathy shows a generally favourable natural course, with many people improving substantially over weeks to months. Progressive weakness or signs of spinal cord involvement need medical review.
How do I know if my arm pain is coming from my neck?
Clues include pain that starts in the neck or shoulder blade, symptoms that change with neck movement, and a pattern of numbness or weakness matching a particular nerve root. Carpal tunnel syndrome and shoulder problems can feel similar, so an examination is needed to tell them apart.
Should I get an MRI for cervical radiculopathy?
Imaging is usually reserved for people with significant or progressive neurological signs, symptoms that aren't improving as expected, suspected serious causes, or when surgery or injections are being considered.
What sleeping position is best for a pinched nerve in the neck?
There is no single best position. Many people find a pillow that keeps the neck level with the body, and avoiding sleeping with the painful arm overhead, more comfortable. Use whatever position settles your arm symptoms.
Is cervical radiculopathy the same as cervical myelopathy?
No. Radiculopathy affects a single nerve root and usually causes symptoms in one arm. Myelopathy means the spinal cord itself is compressed, and can cause clumsy hands, balance problems or symptoms in both arms or legs. It needs prompt medical assessment.
References
- Thoomes, E.J., Scholten-Peeters, W., Koes, B., Falla, D., & Verhagen, A.P. (2013). The effectiveness of conservative treatment for patients with cervical radiculopathy: a systematic review. The Clinical Journal of Pain, 29(12), 1073–1086. https://doi.org/10.1097/AJP.0b013e31828441fb
- Wong, J.J., Côté, P., Quesnele, J.J., et al. (2014). The course and prognostic factors of symptomatic cervical disc herniation with radiculopathy: a systematic review of the literature. The Spine Journal, 14(8), 1781–1789. https://doi.org/10.1016/j.spinee.2014.02.032
- Alentado, V.J., Lubelski, D., Steinmetz, M.P., Benzel, E.C., & Mroz, T.E. (2014). Optimal duration of conservative management prior to surgery for cervical and lumbar radiculopathy: a literature review. Global Spine Journal, 4(4), 279–286. https://doi.org/10.1055/s-0034-1387807
This article is general information, not a diagnosis or a substitute for an individual assessment. If you have new or worsening symptoms, see a registered health practitioner.
