Pinched Nerve in Neck

A pinched nerve in the neck, known medically as cervical radiculopathy, happens when a nerve root leaving the spine in your neck becomes irritated or compressed. The result is pain that spreads into the shoulder, arm or hand, often with pins and needles, numbness or weakness, and sometimes less neck pain than you’d expect. It’s one of the more distressing neck problems, but the outlook is usually good.

Understanding cervical radiculopathy

The nerves that supply your arms and hands exit the spine through small openings between the neck bones. These can narrow when a disc bulges or when the joints and discs of the neck change with age, and the nerve can also become inflamed by chemical irritation from a damaged disc. Which part of your hand or arm is affected tells us which nerve root is involved.

It’s more common in adults over about 40, but can occur at any age, for example after a lifting strain or a neck injury. Because changes on neck scans are extremely common in people without symptoms, diagnosis depends on whether your symptoms, examination and any imaging all point to the same nerve.

Symptoms we commonly see

• Pain spreading from the neck or shoulder blade into the arm, sometimes as far as the hand
• Pins and needles, numbness or burning in particular fingers or areas of the arm
• Weakness, such as difficulty gripping or lifting the arm
• Pain that’s worse with certain neck positions, looking up or turning toward the sore side
• Relief when resting your hand on top of your head
• Neck stiffness and aching between the shoulder blades

Our evidence-based approach

Guidelines emphasise a careful examination, information about the outlook and warning signs, and staying active, with supervised exercise and manual therapy as the core of non-surgical care. Physical tests help, but no single test is perfect: Spurling’s test, for example, is highly specific but not always sensitive, so we combine several findings. Our approach includes:

1. Assessment of your neck, shoulder, arm and nerves, including strength, reflexes and sensation, to identify the nerve root involved and screen for warning signs
2. Education and reassurance, so you understand what’s happening and what to expect
3. Positions and activity advice that settle arm symptoms in the early stage, such as comfortable sleeping and working positions
4. Hands-on treatment or dry needling to ease pain and muscle tension around the neck and shoulder
5. Gentle movement and nerve-friendly exercises to restore comfortable motion
6. Progressive strengthening of the neck, shoulder blade and arm muscles as symptoms settle
7. Referral for imaging or specialist review when your symptoms, signs or progress call for it

See our neck pain page for other causes of neck pain and arm symptoms.

What to expect: recovery timeline

• First few weeks: arm pain often starts easing as the nerve root settles
• Six to twelve weeks: many people see a good improvement in pain, with strength and sensation continuing to return
• Persistent symptoms: may need medical review, imaging or a specialist opinion, particularly if weakness is present

When to seek help urgently

Seek urgent medical attention if you notice clumsiness or weakness in both hands, difficulty walking or balance problems, changes in bladder or bowel control, or rapidly worsening weakness in an arm. Also seek help promptly for severe neck pain after an injury, neck pain with fever or feeling unwell, or chest pain and shortness of breath with arm pain.

References

• Woods BI, Hilibrand AS. Cervical radiculopathy: epidemiology, etiology, diagnosis, and treatment. J Spinal Disord Tech. 2015;28(5):E251-E259.
• Kjaer P, et al. National clinical guidelines for non-surgical treatment of patients with recent onset neck pain or cervical radiculopathy. Eur Spine J. 2017;26(9):2242-2257.
• Thoomes EJ, et al. Value of physical tests in diagnosing cervical radiculopathy: a systematic review. Spine J. 2018;18(1):179-189.