Cervical Radiculopathy (Pinched Nerve in the Neck)
Cervical radiculopathy is a nerve root in the neck being compressed or inflamed, usually by a herniated disc or a bone spur. The pain is felt in the shoulder blade, arm, or hand, sometimes with numbness or weakness. Like its cousin in the low back, it usually improves without surgery.
How a pinched nerve in the neck feels
Each nerve root in the neck supplies a predictable strip of skin and set of muscles in the arm. That is why the pattern of symptoms, pain between the shoulder blades and down the outside of the arm into the thumb, for example, tells the surgeon which level is involved before an MRI is ordered. Turning the head toward the painful side or looking up often makes it worse; resting the hand on top of the head often makes it better.
Diagnosis
The examination tests strength, sensation, and reflexes in the arm. An MRI of the cervical spine is the standard imaging test when symptoms persist or when weakness is present. Occasionally a nerve conduction study is used to distinguish a neck problem from carpal tunnel syndrome or a shoulder problem, which can mimic it.
Treatment
Most cervical radiculopathy improves over weeks to a few months. Early care includes avoiding aggravating positions, a short course of anti-inflammatory medication, and physical therapy for posture, mobility, and nerve gliding. A soft collar for brief periods can be comfortable but should not be used long term. When pain is severe, a cervical epidural steroid injection can reduce nerve inflammation and shorten the course.
Surgery is discussed when arm pain persists after a fair trial of nonsurgical care, or when weakness is significant. The two most common operations are cervical disc replacement, which removes the disc and bone spur and preserves motion with an artificial disc, and anterior cervical discectomy and fusion (ACDF). A posterior cervical foraminotomy, which enlarges the nerve opening from the back of the neck without fusion, is an option for certain herniations. Dr. Michael discusses the trade-offs of each in the context of your anatomy and goals.
Common questions
Is a pinched nerve in the neck serious?
It is painful but rarely dangerous, and most cases improve. Weakness that is significant or getting worse, or symptoms of spinal cord involvement such as hand clumsiness and imbalance, should be evaluated promptly.
Can I avoid surgery?
Most patients do. Surgery is reserved for persistent disabling pain after a proper trial of nonsurgical care, or for meaningful weakness.
Disc replacement or fusion, which is better?
For appropriately selected patients, cervical disc replacement preserves motion and long-term studies show outcomes at least comparable to fusion with fewer additional operations at neighboring levels. ACDF remains the right choice when there is instability, significant arthritis of the facet joints, poor bone quality, or several levels involved.