Cervical radiculopathy: when neck pain reaches the arm

What is cervical radiculopathy?

In the neck, nerve roots leave the spine through small openings between the vertebrae and travel to the shoulder, arm and hand. When one of these roots is compressed or irritated where it exits, the pain follows the path of the nerve: this is cervical radiculopathy, meaning a problem with a nerve root in the neck. In everyday language, people often speak of a "pinched nerve in the neck".

It is not the same as a stiff neck or neck pain that stays in the neck: here, the arm is often what hurts most.

Cervical radiculopathy: what are the symptoms?

According to the American Academy of Orthopaedic Surgeons (AAOS), the pain usually starts in the neck and travels down the arm, in the area served by the affected nerve. It is often described as burning or sharp, typical of nerve pain. You may also notice:

• tingling or "pins and needles" in the fingers or hand;
• weakness in the muscles of the arm, shoulder or hand;
• loss of sensation or numbness.

Tingling limited to the fingers, especially at night, without neck pain, points more towards carpal tunnel syndrome, a nerve squeezed at the wrist.

Extending the neck backwards or turning the head may increase the pain. On the other hand, many people find that placing a hand on top of their head eases it for a while: this movement can reduce pressure on the nerve root.

Where does it come from?

According to the AAOS, two causes come up most often:

• age-related wear of the spine: discs lose height, bone spurs form and can narrow the opening where the nerve exits. This is known as neck osteoarthritis;
• a herniated disc, more frequent in younger people, sometimes after lifting, pulling or twisting.

Sometimes no triggering event is found. The AAOS also points out that nearly half of middle-aged and older people have worn discs without any pain: a scan showing wear does not explain everything.

The doctor examines the neck, shoulders, arms and hands, and tests strength, sensation and reflexes. An X-ray, CT scan, MRI or electromyography, a test that uses small electrodes to measure how well the nerves and muscles work, may be requested depending on the situation.

What to do day to day?

NHS inform, Scotland's health information service, and the AAOS give simple pointers:

• Move your neck for short periods every hour, and avoid staying in one position for long, at your desk or in front of a screen.
• Keep up your activities, even at a slower pace: staying active is part of recovery.
• No collar unless prescribed. If your doctor prescribes a soft collar, wear it for a short time only, so as not to weaken the neck muscles.
• Heat or ice, always with a towel between your skin and the source, leaving a few hours between applications.
• A pillow that supports your neck at night.
• Painkillers can help you move more comfortably: ask your doctor or pharmacist for advice.
• Physiotherapy offers exercises to relieve pain, strengthen the neck and regain mobility.

Warning signs: when to seek help without delay

Go to the emergency department if:

• weakness, numbness or clumsiness in your hands is getting worse, in one or both arms;
• you have had problems with balance or walking since the pain started;
• the pain follows a fall or a blow to the head or neck;
• the pain comes with a severe headache.

See your doctor if:

• you have a fever or feel generally unwell as well as having pain;
• you have a condition such as rheumatoid arthritis or cancer;
• you have blurred vision, ringing in your ears or dizziness;
• the pain has not improved after a few weeks.

These signs are rare. According to the AAOS, most people with cervical radiculopathy get better over time and with treatment that does not involve surgery (for example short rest, pain medicines, physiotherapy).

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Looking beyond the nerve

The first consultation lasts 1.5 to 2 hours (CHF 182). Bring your medical file, your test results (MRI, reports) and the list of your medications. We review your situation and build your plan together. Follow-up is then adapted to your progress. We work alongside your GP and the other professionals who follow you, including your physiotherapist or neurologist.

Which approaches can play a part at Centre Algos?

Depending on your situation, several approaches can be combined, alongside your medical follow-up:

• Naturopathy: sleep, stress, diet and daily rhythm, to work on the habits that can influence pain.
• Cupping: applied to the shoulders and upper back, it can help release muscle tension around the neck.
• Functional biology and micronutrition: an assessment to identify possible nutritional imbalances, to be discussed with your doctor.

Everyone responds differently: the aim is to help you live your days better, without promising a result.

When to seek advice