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Health condition · Clinically reviewed

Brachialgia, radicular arm pain from the neck, and how it is treated.

Most cervical nerve root pain settles with time, physiotherapy and the right medication. A small number need injections or surgery, and knowing which is which is the whole game.

Jump to treatment
A radiographer guides a patient onto the bed of an advanced 3 Tesla MRI scanner in a London imaging suite

Why trust this guide

  • 01

    Clinically reviewed

    Written by our editorial team and reviewed by a UK spinal specialist before publication.

  • 02

    Sourced from guidance

    Checked against NICE CG112, British Association of Spine Surgeons and peer-reviewed sources you can see at the end.

  • 03

    Current for 2026

    Reflects modern UK practice including motion-preserving cervical disc replacement and image-guided epidural injections.

Key facts

Brachialgia at a glance.

The essentials in plain English: what cervical radicular arm pain is, why it happens, and the ladder of treatment used in the UK.

  • What it is

    Radicular arm pain from irritation or compression of a cervical nerve root, usually C5 to C8, radiating from the neck down the arm.

  • Most common cause

    Cervical disc prolapse in the 30 to 50 age group; cervical spondylosis with foraminal stenosis in older adults.

  • Typical pattern

    Dermatomal pain, tingling, numbness or weakness in a specific nerve distribution, often worse with neck movement.

  • Gold-standard test

    MRI of the cervical spine to see the nerve root, disc, osteophyte, cord and any tumour or infection.

  • First-line treatment

    Analgesia, neuropathic agents, physiotherapy and time; around 85% improve within 6 to 12 weeks without surgery.

  • When surgery helps

    Progressive neurology, myelopathy or refractory pain with concordant imaging, considered together with a spinal surgeon.

Why this guide matters

A stepped plan, not a rush to surgery.

Brachialgia is common, treatable and, in the majority of people, self-limiting. Three ideas shape everything else on this page.

  • Time and rehabilitation come first

    Around 85% of people with cervical radiculopathy improve within 6 to 12 weeks with medication, physiotherapy and sensible activity.

  • Red flags change the pathway

    Myelopathic features, rapidly progressive weakness, infection, tumour or major trauma need urgent MRI and a specialist opinion, not more physiotherapy.

  • Surgery is for the right patient

    When concordant imaging, persistent pain or progressive neurology align, ACDF or cervical disc replacement can give dramatic and durable relief.

How the diagnosis is made

From first arm pain to a clear plan.

The steps a UK GP, spinal physiotherapist or neurosurgeon will normally follow, in order, so you know what to expect and why.

  1. 01

    Assessing

    History and red flag screen

    Onset, pattern of pain, neurological symptoms and screening for infection, cancer, trauma and myelopathic features.

  2. 02

    Assessing

    Full upper-limb neuro examination

    Dermatomes, myotomes, reflexes, Spurling test, Hoffman and Babinski signs, gait and tandem walking to separate LMN from UMN patterns.

  3. 03

    Assessing

    Bloods where indicated

    FBC and inflammatory markers if infection, inflammatory arthritis or malignancy is a concern.

  4. 04

    Confirming

    MRI cervical spine

    The gold-standard investigation; shows the nerve root, disc, osteophyte, foraminal stenosis, cord signal, tumour and infection.

  5. 05

    Confirming

    X-ray and CT where useful

    Flexion and extension views for instability; CT for bony detail, preoperative planning or when MRI is not tolerated.

  6. 06

    Confirming

    Nerve conduction and EMG

    Selective use to separate a nerve root problem from brachial plexus injury or a peripheral entrapment such as carpal or cubital tunnel.

  7. 07

    Escalating

    Urgent pathway when red flags

    Suspected myelopathy, cauda-type deficit, infection, tumour or major trauma triggers urgent admission, imaging and neurosurgery review.

Typical timeline: a first visit to a settled plan in days for red flags, weeks for the rest.

Symptoms

What brachialgia actually feels like.

The classic mix of neck pain, dermatomal arm pain and neurological signs, plus the features that mean it is time to escalate.

  • Dermatomal arm pain

    Sharp, burning or aching pain radiating from the neck down the arm in a nerve-root distribution, often into the hand.

  • Paraesthesia and numbness

    Pins and needles, tingling or reduced sensation in a specific dermatome, most often C6, C7 or C8.

  • Weakness and reflex change

    Loss of power in the corresponding myotome, with reduced or absent biceps, brachioradialis or triceps reflex.

  • Neck pain and stiffness

    Localised cervical pain and reduced range of movement, often worse with extension or rotation to the affected side.

  • Positive Spurling test

    Extension, rotation and axial loading of the neck to the affected side reproduces the arm pain, pointing to a root cause.

  • Shoulder abduction relief

    Resting the hand on top of the head often eases arm pain by reducing tension on the nerve root.

  • Root-specific patterns

    C5 deltoid and lateral arm; C6 biceps, brachioradialis and thumb; C7 triceps and middle finger; C8 finger flexors and medial hand.

  • Red flag: myelopathic features

    Bilateral symptoms, unsteady gait, clumsy hands, Lhermitte, Hoffman or Babinski signs, or bladder or bowel change need urgent MRI.

Treatment

How brachialgia is treated in the UK.

Analgesia, neuropathic agents and physiotherapy first; image-guided injections next; ACDF or cervical disc replacement for the right patient.

  • Analgesia and neuropathic agents

    NSAIDs and paracetamol for nociceptive pain, with gabapentin, pregabalin, amitriptyline or duloxetine for the burning, radicular component.

  • Physiotherapy

    Postural work, gentle traction, mobilisation, isometric strengthening and graded exposure, guided by a spinal physiotherapist.

  • Short oral steroid course

    Selective use of a short tapering course of oral steroid can settle a severe acute flare while other treatments take effect.

  • Cervical epidural injection

    Image-guided transforaminal or interlaminar epidural steroid injection by a specialist pain team can calm root inflammation and buy time for healing.

  • Selective nerve root block

    A targeted block confirms the pain generator and can give useful medium-term relief in the right patient.

  • Facet radiofrequency

    Radiofrequency neurotomy of the medial branches for facet-mediated neck and referred arm pain, after a diagnostic block.

  • ACDF or disc replacement

    Anterior cervical discectomy and fusion (ACDF) is the gold-standard operation; cervical disc replacement is a motion-preserving alternative in selected patients.

  • Posterior decompression

    Posterior foraminotomy for a lateral disc, or laminectomy, fusion or laminoplasty for multilevel myelopathy in a specialist spinal centre.

Complex or multilevel disease is best managed in a specialist spinal centre such as RNOH Stanmore, Nuffield, Manchester, Leeds, Sheffield, Cambridge, Cardiff, Edinburgh or Bristol, with multidisciplinary input from pain management, psychology, rehabilitation and occupational therapy.

What this guide is based on

The sources behind every claim on this page.

UK national guidance and specialist society standards, current at the time of last review.

Key references

Guidelines and standards we relied on.

A quiet reminder

This guide is for information, not medical advice.

Your GP, spinal physiotherapist or surgeon knows your history and imaging and can tell you which parts apply to you. If in doubt, get seen.

  • NICE. Neuropathic pain in adults: pharmacological management (CG173) and low back pain and sciatica in over 16s (CG112, principles applied to radicular pain).

  • British Association of Spine Surgeons (BASS). Guidance on cervical radiculopathy and myelopathy.

  • North American Spine Society (NASS). Evidence-based guidelines for cervical radiculopathy from degenerative disorders.

  • MHRA and NICE. Guidance on pregabalin, gabapentin and opioid prescribing for chronic pain.

Red flags

When brachialgia needs urgent attention.

Most cervical radicular pain is manageable in primary care with physiotherapy support. These are the situations that are not, and where a specialist opinion is needed.

  • Cervical myelopathy

    Bilateral symptoms, clumsy hands, unsteady gait, Lhermitte, Hoffman or Babinski signs, or bladder or bowel change need urgent MRI and spinal surgery review.

  • Rapidly progressive weakness

    Fast-worsening weakness in the arm or hand is an urgent surgical problem, not a wait-and-see one.

  • Severe unremitting night pain

    Pain that wakes the patient from sleep every night, especially with weight loss, warrants urgent imaging to exclude tumour or infection.

  • Fever and spinal pain

    Fever, systemic upset and spinal tenderness raise the question of discitis or epidural abscess and need same-day assessment.

  • Known or suspected cancer

    A history of malignancy with new neck or arm pain and neurology should be investigated urgently for metastatic disease.

  • Significant trauma

    High-energy injury or a fall on an osteoporotic or ankylosed spine needs imaging before manipulation or physiotherapy.

  • Pancoast or apical lung symptoms

    Shoulder or medial arm pain with Horner syndrome, weight loss or a smoking history needs a chest and thoracic outlet review.

  • Post-surgical deterioration

    New or worsening neurology after previous cervical spine surgery deserves prompt review by the operating team.

  • Inflammatory features

    Morning stiffness, alternating buttock pain or peripheral joint synovitis suggests an inflammatory cause needing rheumatology input.

Living with it

A treatable condition, with a clear ladder.

Four things that make the biggest difference day to day: patience, gentle movement, sensible ergonomics, and knowing when to escalate.

A quiet reminder

Consistency beats intensity, every time.

Small, steady habits over weeks do more than a heroic few days that leave you flared and disheartened.

  1. 01 Time

    Most root pain settles

    Around 85% of people with a compressive cervical radiculopathy improve within 6 to 12 weeks without surgery.

  2. 02 Movement

    Stay as active as you can

    Gentle movement, walking and guided physiotherapy beat prolonged bed rest and stiff collars for most people.

  3. 03 Ergonomics

    Fix the desk and the phone

    Screen at eye level, arms supported, and phone off the shoulder. Small daily changes reduce recurrent flares.

  4. 04 Escalate

    Know when to push for review

    Progressive weakness, myelopathic features or pain that is not improving after 6 to 12 weeks deserves a spinal opinion.

Frequently asked

Everything we get asked about brachialgia.

Quick answers on causes, MRI, physiotherapy, injections and cervical spine surgery.

  • What is brachialgia?

    Brachialgia is arm pain caused by irritation or compression of a cervical nerve root, typically C5 to C8. The pain radiates from the neck into the shoulder, arm and hand in a specific dermatomal pattern, often with tingling, numbness or weakness.

  • What causes it most often?

    A cervical disc prolapse in younger adults and cervical spondylosis with osteophyte formation and foraminal stenosis in older adults. Less common causes include facet arthropathy, tumour, infection, syringomyelia, trauma, brachial neuritis and referred pain from peripheral entrapments or the rotator cuff.

  • Do I need an MRI?

    MRI of the cervical spine is the gold-standard investigation and is arranged urgently when there are red flag features such as myelopathy, severe or progressive weakness, suspected infection, tumour, trauma or a history of cancer. In milder cases MRI is often reserved for people not improving after 6 to 12 weeks of conservative care.

  • Will I need surgery?

    Most people do not. Around 85% improve within 6 to 12 weeks with analgesia, neuropathic agents, physiotherapy and time. Surgery is considered for severe or progressive neurological deficit, myelopathy, or persistent concordant pain that has not responded to conservative and interventional care.

  • What are the surgical options?

    Anterior cervical discectomy and fusion (ACDF) is the traditional gold-standard operation. Cervical disc replacement using devices such as Mobi-C, Prestige, ProDisc-C or M6-C is a motion-preserving alternative in selected single or two-level cases. Posterior foraminotomy, laminectomy, laminoplasty or fusion are used for specific patterns of disease.

  • What do cervical epidural injections do?

    An image-guided cervical epidural steroid injection, delivered transforaminally or interlaminarly by a specialist pain team, reduces inflammation around the affected nerve root. It can settle a severe flare and support rehabilitation, and is often used when medication and physiotherapy alone are not enough.

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