A pinched nerve in the neck, medically known as cervical radiculopathy, occurs when a nerve root in the cervical spine becomes irritated or compressed. This can cause symptoms that begin in the neck and travel into the shoulder, arm, hand, or fingers.
Common symptoms include pain, tingling, numbness, and muscle weakness. Symptoms vary depending on which nerve root is affected, and some people may also have changes in reflexes.
Treatment depends on the symptoms, their severity, and the underlying cause. Many cases are initially managed without surgery, although medical assessment is important when symptoms are severe, getting worse, or accompanied by signs that may suggest spinal cord compression or another serious condition.
Main symptoms
The most common symptoms of a pinched nerve in the neck include:
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Neck pain
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Pain that travels from the neck into the shoulder or arm
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Pain that may extend into the hand or fingers
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Tingling in the arm, hand, or fingers
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Numbness or reduced sensation
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Muscle weakness in the arm or hand
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Changes in reflexes
Cervical radiculopathy is different from neck pain alone because it usually involves symptoms that extend along the affected nerve into the shoulder, arm, hand, or fingers. The exact location and type of symptoms can vary depending on the nerve root involved.
Common causes
The two main causes of a pinched nerve in the neck are age-related changes in the cervical spine and a herniated disc.
Age-related wear in the cervical spine can gradually reduce the space available around a nerve root. This narrowing can irritate or compress the nerve and cause cervical radiculopathy. These changes become more common as the structures of the spine change over time.
A herniated cervical disc can also put pressure on or irritate a nearby nerve root. Disc problems may sometimes be related to injury, although symptoms can also develop without a major traumatic event.
Inflammation around a nerve root can contribute to symptoms in addition to direct mechanical pressure.
Confirming a diagnosis
Diagnosis of cervical radiculopathy begins with the person's symptoms and a physical and neurological examination. The doctor may assess muscle strength, sensation, reflexes, and movements that reproduce or relieve symptoms.
Physical examination techniques such as the Spurling test, upper-limb neurodynamic tests, and shoulder-abduction relief test may provide additional information. However, evidence for the accuracy of individual physical tests is limited, so no single test should be used by itself to confirm cervical radiculopathy.
Imaging is selected according to the symptoms, warning signs, and whether the results are likely to affect treatment. MRI without contrast may be appropriate for new or worsening cervical radiculopathy, while contrast may have specific uses when conditions such as infection or cancer are suspected. Imaging results must be considered together with symptoms and the physical examination because abnormalities on scans can also occur in people without symptoms.
Treatment options
Treatment for a pinched nerve in the neck depends on its cause, severity, duration, and whether neurological problems are progressing. They may include:
1. Staying active and conservative care
People with cervical radiculopathy may be advised to remain active as tolerated rather than unnecessarily limiting all movement. Education about the expected course of symptoms and warning signs is also an important part of conservative management.
Treatment should be individualized because no single nonsurgical approach has been shown to be necessary or effective for everyone. Progress and neurological symptoms may need to be reassessed during treatment.
2. Physical therapy and exercise
Physical therapy may include supervised exercises designed to improve movement, strength, and function. Exercise-based rehabilitation can be adjusted to symptoms and physical limitations.
Some guidelines also consider other physical therapy techniques, but the quality of evidence supporting individual treatments varies. Rehabilitation is therefore generally selected according to clinical assessment rather than following the same routine for every case.
3. Manual therapy and traction
Manual therapy has been associated with short-term improvements in symptoms in some studies. However, current evidence does not clearly identify which manual therapy techniques are most effective.
Traction is another approach that may be considered in some treatment programs, but evidence does not support presenting it as an effective treatment for everyone with cervical radiculopathy. These treatments should be selected based on individual assessment.
4. Medications
Pain-relieving medications may be considered as part of conservative treatment when appropriate. The choice of medication depends on individual symptoms and medical assessment.
Systemic corticosteroids, including oral steroids, have also been studied for cervical radicular pain. Evidence supporting their use remains very limited, so they should not be described as a standard or proven treatment for all cases.
5. Surgery
Surgery may be considered when nonsurgical management is not sufficient or when neurological problems require surgical assessment. The specific procedure depends on the structures causing nerve compression and other clinical findings.
Evidence comparing different surgical approaches for cervical degenerative disease has not consistently shown that one technique provides better results for every patient. Surgical decisions therefore depend on the individual condition and specialist assessment.
When to seek urgent medical care
Prompt medical assessment is important when symptoms suggest that the problem may involve more than an isolated nerve root or when another serious condition is possible.
Warning signs include:
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Increasing or progressive muscle weakness
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Trouble walking
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New balance problems
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Loss of coordination in the hands
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New bowel or bladder changes
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Fever or signs that could suggest an infection
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Symptoms in someone with a history of cancer
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Symptoms following serious trauma
Problems with walking, balance, hand coordination, or progressive neurological changes may indicate compression of the spinal cord rather than cervical radiculopathy alone and require appropriate medical assessment.