C5
Less common
Where it is felt
Shoulder and the outer part of the upper arm, sometimes around the shoulder blade.
What can weaken
Lifting the arm out to the side. The shoulder muscle and rotators.
Cervical radiculopathy: neck and arm pain from a pinched nerve
When a nerve root in your neck is compressed or inflamed, the pain, pins and needles or weakness is often felt down the arm rather than only in the neck. It is common, it can be miserable, and in most people it settles without an operation. This page explains what is happening, which nerve does what, and when it is worth getting seen.
What you need to know in 30 seconds
Radiculopathy means a nerve root is irritated or compressed. The symptoms travel down the arm because that is where the nerve goes.
The C7 nerve is affected most often, then C6. Which fingers tingle and which movements weaken point to the level involved.
Most cases improve without surgery. More than eight in ten settle within about eight to twelve weeks.
Surgery is considered mainly for weakness that is getting worse, or pain that will not settle despite proper treatment.
Progressive weakness, or clumsy hands and unsteadiness in both hands, needs a prompter opinion. The reasons are below.
An MRI shows the anatomy. Whether that anatomy explains your symptoms is the part that takes a specialist assessment.
C7, then C6
The two nerve levels most often involved. C7 alone accounts for more than half of cases.
8 in 10+
Improve without surgery, most within about eight to twelve weeks of it starting.
Down the arm
The hallmark is pain or tingling that follows the nerve into the arm or hand, not just neck pain.
Surgery is rare
Reserved mainly for worsening weakness or pain that does not settle with time and treatment.
WHAT IT IS
A nerve pinched where it leaves the spine
Between each pair of neck vertebrae, a nerve root exits through a small bony opening and travels out to the shoulder, arm and hand. Radiculopathy is what happens when something narrows that space and presses on the root.
1
Vertebra, one of the seven bones of the neck
2
Healthy disc, the cushion between two vertebrae
3
Herniated disc, bulging backward out of place
4
Nerve root exiting freely at a healthy level
5
Pinched nerve root, pressed by the bulging disc
01
The problem is pressure, not the neck itself
The root is the electrical cable for one strip of the arm. Press on it and the arm, not just the neck, is where you feel it: pain, burning, pins and needles, or a specific muscle going weak. This is why arm symptoms can dominate while the neck feels almost normal.
02
Usually a disc or a bony spur
In younger people it is most often a disc herniation pressing on the root. With age it is more often a bony spur from wear and tear narrowing the exit. Both produce the same picture of a compressed nerve.
03
Radiculopathy is not myelopathy
This page is about a single nerve root. When the pressure is on the spinal cord itself, that is cervical myelopathy, a different and more urgent problem. The two can occur together, which is one reason a proper assessment matters.
WHAT IT FEELS LIKE
The level involved decides where you feel it
Each nerve root serves a predictable strip of the arm and hand, so the pattern of your symptoms is a strong clue to which level is affected. This is a guide, not a diagnosis: overlap is common, and only an examination confirms it.
C6
Common
Where it is felt
Down the outer forearm into the thumb and index finger.
What can weaken
Bending the elbow and cocking the wrist back. Biceps and wrist extensors.
C7
Most common
Where it is felt
Back of the arm and forearm into the middle finger.
What can weaken
Straightening the elbow and the fingers. The triceps.
C8
Less common
Where it is felt
Inner forearm into the ring and little fingers.
What can weaken
Grip and the fine movements of the hand. The small muscles of the hand.
Symptoms often include a deep ache in the shoulder blade, pain that eases when you rest your hand on top of your head, and difficulty finding a comfortable sleeping position. Many people notice the tingling more at night. None of that is dangerous in itself, though it can be exhausting.
WHEN TO ACT SOONER
The signs that change the timeline
Ordinary nerve pain, even quite severe, can usually be given time to settle. These are the exceptions, where a prompt assessment is wiser than waiting.
1
Weakness that is getting worse
A muscle becoming visibly weaker week to week, rather than pain alone, is the main reason to bring an assessment forward.
2
Clumsy hands or unsteady walking
Dropping things, fumbling buttons, or feeling less steady on your feet suggests the cord may be involved, not just a single root.
3
Symptoms in both arms or the legs
A single pinched root affects one arm. Both arms, or any leg involvement, points to something that needs looking at sooner.
4
Pain that is relentless despite treatment
Severe pain not easing at all after several weeks of proper non-surgical treatment is worth a specialist opinion.
Seek urgent care
Sudden or rapidly worsening weakness, new unsteadiness or clumsiness in both hands, or any change in bladder or bowel control can signal pressure on the spinal cord rather than a single nerve. Do not wait: call 000 or go to your nearest emergency department. GPs with an urgent concern can phone the rooms directly on (07) 3870 3708.
WHAT CAUSES IT
Four ways a root gets compressed
They often overlap, and more than one can be present at the same level. What they share is the end result: less room for the nerve where it exits.
01
Disc herniation
Part of a disc bulges out of place and presses on the root. The most common cause in younger and middle-aged people, often after an ordinary movement rather than an injury.
02
Bony spurs
With age, the body lays down extra bone around worn joints. These spurs, part of cervical spondylosis, can narrow the nerve's exit over time.
03
A narrowed exit
The small canal the nerve passes through can tighten from a mix of disc bulging, spurs and thickened ligament. This foraminal narrowing is a common finding on scans.
04
Disc wear
As discs lose height with age, the exits shrink and the joints take more load. This gradual change explains why radiculopathy becomes more common through middle age.
HOW IT IS DIAGNOSED
Matching the scan to the symptoms
The examination usually locates the level before any scan does. Imaging then confirms it, and rules out anything that needs different treatment.
01
History and examination
Where the pain travels, which fingers tingle, and which movements are weak usually point to the level. Reflexes and specific strength tests confirm the pattern.
02
MRI
The best test for showing discs, nerves and how much room the root has. It is the scan most decisions are based on, and it involves no radiation.
03
Nerve studies, sometimes
When the picture is unclear, or to tell a pinched neck nerve from a problem further down the arm such as carpal tunnel, nerve conduction studies can help.
A scan on its own rarely settles it. Bulging discs and worn joints show up on the scans of plenty of people with no symptoms at all, so the finding that matters is the one that matches your examination. Reading the two together is the point of the consultation.
WILL IT GET BETTER?
For most people, yes, and without surgery
This is the most important thing to know, and the part that is easy to miss when the pain is at its worst. The natural course of cervical radiculopathy is genuinely reassuring.
8 in 10+
More than eight in ten people with acute cervical radiculopathy improve without any surgery, most within about eight to twelve weeks. Even where a disc fragment is pressing on the nerve, the body often reabsorbs part of it over months. The job of early treatment is to keep you comfortable and moving while that happens, not to rush toward an operation.
TREATMENT
A ladder, climbed only as far as you need
Almost everyone starts at the bottom, and most get better there. Each rung is tried before the next is considered.
FIRST
Time and staying active
Most nerve pain settles over weeks. Gentle activity, and avoiding the positions that flare it, beats resting the arm completely.
ALONGSIDE
Physiotherapy and medication
Targeted physiotherapy, anti-inflammatory or nerve-specific pain medication, and good sleep positioning carry most people through.
SOMETIMES
A targeted injection
A carefully placed nerve-root injection can calm a stubborn, well-localised nerve, and buy time for it to recover on its own.
ONLY IF NEEDED
Surgery to free the nerve
Considered for weakness that is worsening, or pain that will not settle. The aim is simply to take the pressure off the root.
If surgery is the right step, the usual options are
ACDF
The disc is removed from the front and the level is fused. A long-established, reliable operation for taking pressure off the nerve.
About ACDF ›Disc replacement
The disc is removed and replaced with a mobile artificial one, preserving motion at that level. Suitable for selected patients.
About disc replacement ›Foraminotomy
The nerve's exit is opened from behind to release the root, without fusing the level. An option in the right anatomy.
About foraminotomy ›Which operation suits you depends on the cause, the level, and your own anatomy, and it is a decision made together. Still weighing it up? Do I need neck surgery? and non-surgical treatment go into more detail.
More than eight in ten people improve without an operation
Most people with a pinched nerve in the neck get better without an operation. The point of being assessed early is to establish which nerve is involved, and to identify the small number of cases where waiting is not the right plan.
COMMON QUESTIONS
The things people ask most
How long does cervical radiculopathy take to settle?
Most cases ease over about eight to twelve weeks, and more than eight in ten improve without surgery. Some resolve faster, a minority take longer. Worsening weakness rather than slow improvement is the sign to be reassessed.
Is a pinched nerve in the neck serious?
Usually not. It is painful but rarely dangerous, and it typically settles on its own. The exceptions are weakness that is getting worse, or signs the spinal cord is involved, such as clumsy hands and unsteadiness, which need a prompter look.
Should I rest or keep moving?
Keep gently moving. Complete rest tends to stiffen the neck and does not speed recovery. Staying active within comfort, and avoiding the positions that flare the arm, is the better approach for most people.
Will I need surgery?
Probably not. Surgery is considered mainly for weakness that is worsening, or pain that will not settle despite proper non-surgical treatment. Most people never reach that point. Do I need neck surgery? covers how the decision is made.
What is the difference between radiculopathy and a herniated disc?
A herniated disc is one cause; radiculopathy is the result when any cause presses on a nerve root. You can have a herniated disc with no symptoms, and radiculopathy from a bony spur rather than a disc.
Can it come back?
It can, at the same or a different level, particularly where there is underlying wear. Good posture, staying active and managing load help, but nothing guarantees it will never recur. A fresh episode is assessed on its own terms.
RELATED CONDITIONS
Closely connected to this one
Cervical disc herniation
When part of a disc bulges out of place and presses on a nerve or the cord. Often the thing behind the pinched nerve.
Read about disc herniation ›Cervical myelopathy
Pressure on the spinal cord itself rather than a single root. Clumsy hands and unsteadiness are the signs worth acting on early.
Read about myelopathy ›Cervical spondylosis
Age-related change in the discs and joints of the neck, and a frequent source of the bony narrowing that traps a nerve.
Read about spondylosis ›About this information
This page is general information about the cervical spine. It is not a substitute for an individual assessment and it cannot tell you what is happening in your own neck. Where figures are given, they come from the published research listed below and describe groups of people rather than individuals. Please discuss your own circumstances with your GP or a specialist. More about Dr Tollesson.
References
Cervical Radiculopathy, StatPearls, National Library of Medicine, for the level frequency and the natural history of acute cervical radiculopathy.
Cervical Radiculopathy, American Academy of Physical Medicine and Rehabilitation, for the nerve-root symptom patterns by level.
If neck and arm pain is disrupting your sleep, your work or your grip, let us take a proper look.
You will find out which nerve is involved, whether it needs treating now, and what the realistic options are. A referral from your GP or another specialist is needed for a Medicare rebate.