Cervical radiculopathy: symptoms, causes, treatment and recovery

CKS describes cervical radiculopathy as pain and weakness and/or numbness in one or both of the upper limbs, corresponding to the area supplied by the affected cervical nerve root. It often occurs alongside neck pain, and pain can also be experienced in the shoulders, upper back and chest. The NHS says to see a GP if neck pain comes with other symptoms such as pins and needles or a cold arm, as this could be something more serious.

Which fingers or parts of the arm are affected helps a clinician work out which nerve root is involved. Other conditions, such as nerve compression at the wrist, can produce arm symptoms too, so assessment is important.

The cervical spine is the neck section of the spine, and nerves branch off it to supply the shoulders, arms and hands. CKS explains that radiculopathy is a state in which conduction is limited or blocked along a spinal nerve or its roots. It is usually due to compression or injury to a nerve root.

People often call it a trapped or pinched nerve in the neck. The NHS lists a pinched nerve as one of the most common causes of neck pain, alongside the neck becoming locked in an awkward position while sleeping, bad posture and injury such as whiplash.

For people with neck pain for less than 4 to 6 weeks and no objective neurological signs, CKS says management should include reassurance, information and advice, oral painkillers, consideration of nerve pain medicines such as amitriptyline, duloxetine, pregabalin or gabapentin, and consideration of physiotherapy referral.

For general neck pain the NHS suggests paracetamol or ibuprofen (or ibuprofen gel), a low firm pillow, heat or cold packs and neck flexibility exercises. It says not to wear a neck collar, as it is better to keep your neck moving unless a doctor tells you not to, and not to do anything dangerous because you cannot move your neck, such as driving or cycling. In many areas you can get help such as physiotherapy from NHS community MSK services without a GP referral.

If cervical radiculopathy has been present for 4 to 6 weeks or more, or there are objective neurological signs, CKS says the person should be referred for magnetic resonance imaging (MRI) and for invasive procedures to be considered. These may include interlaminar cervical epidural injections, transforaminal injections or spinal surgery. The NHS says that surgery for cervical spondylosis is only considered if a nerve is being pinched by a slipped disc or bone (cervical radiculopathy) or there is a problem with the spinal cord (cervical myelopathy).

CKS states that most people with cervical radiculopathy will improve regardless of the treatment, and that around 88% of people improve within four weeks with non-operative management. Some people have persistent or recurring symptoms and need more input, which is why the guidance sets a time point of 4 to 6 weeks for imaging and specialist options.

The NHS says most neck pain only lasts a few weeks, and that treatment for cervical spondylosis usually takes a few weeks to work, although pain and stiffness can come back.

CKS says radicular pain is usually caused by compression of the nerve root due to cervical disc herniation or degenerative spondylotic changes, though symptoms can occur without evident compression, for example from inflammation of the nerve. The most common causes are degenerative changes, including disc herniation and spondylosis.

The NHS describes cervical spondylosis as wear and tear of the bones and discs in the neck that many people over 40 get as part of getting older. You may also be more likely to get it if you have had a neck injury or have a family history.

CKS says assessment should exclude red flag features that suggest serious spinal pathology, ask about the symptoms, and examine for signs of radiculopathy. A combination of tests is used, including the Spurling test, arm squeeze test and axial traction, which together increase the likelihood of cervical radiculopathy, and a combination of upper limb neurodynamic tests with the arm squeeze test can rule it out.

Imaging is not routine. CKS says cervical X-rays and other imaging studies are not normally required to diagnose or manage cervical radiculopathy. The NHS says that for cervical spondylosis a health professional will examine your neck and shoulders and may test your reflexes and watch you walk, and depending on symptoms you may be sent for X-rays or scans.

The NHS neck pain and cervical spondylosis pages say the following need urgent attention. These can be signs of a medical emergency.

• Call 999 for new problems walking, loss of bladder or bowel control, or sudden lack of co-ordination, for example with tasks like buttoning a shirt.

• Call 999 if somebody's face droops on 1 side, they cannot lift both arms and keep them there, or they have difficulty speaking.

• Ask for an urgent GP appointment or get help from NHS 111 for severe neck pain that starts suddenly or is getting worse quickly, heaviness or weakness in your arms or legs, or pins and needles in an arm as well as pain in your neck.

• See a GP if neck pain does not go away after a few weeks, painkillers have not worked, or you are worried about the pain.

On the NHS, cervical radiculopathy is usually managed by a GP or community MSK physiotherapy service, with MRI and specialist referral if symptoms persist beyond 4 to 6 weeks or neurological signs are present. Physiotherapy on the NHS can have long waits, and you can also see a physiotherapist privately. Private spinal consultations and MRI can shorten waits, but the same indications for imaging and procedures apply.