Cervical Radiculopathy: Pain Down the Arm From a Pinched Neck Nerve
Quick answer: Cervical radiculopathy is irritation or compression of a nerve root as it exits the cervical spine. Symptoms radiate into a specific part of the arm or hand depending on which level is affected. About 80% of cases resolve with physiotherapy in 6 to 12 weeks - surgery is reserved for the minority with progressive weakness or unrelenting pain despite good conservative care.
What it feels like
- Pain, tingling, or numbness in a specific arm distribution - not all over
- Often worse with neck extension or rotation to the affected side (the Spurling's position)
- Sometimes worse at night
- May be associated with neck pain - not always
- Arm weakness - grip, biceps, or triceps, depending on the level
Which level is affected
A physiotherapist maps symptoms to the likely level:
- C5 (shoulder, lateral upper arm, weakness in shoulder abduction)
- C6 (thumb and index finger, biceps weakness, diminished biceps reflex) - most common
- C7 (middle finger, triceps weakness, diminished triceps reflex)
- C8 (little finger and ring finger, grip weakness)
What causes it
- Disc herniation - common in ages 30-50
- Foraminal stenosis - bony narrowing from age-related changes, common 50+
- Less commonly - tumour, infection, trauma (these need medical workup)
MRI confirms the anatomy, but imaging correlates poorly with symptoms in the general population - many people have "bulges" on MRI without symptoms. Imaging is driven by clinical picture, not curiosity, and usually requested if symptoms don't improve after 4-6 weeks of physiotherapy or if red flags appear.
Red flags
- Progressive weakness - not just fatigue, actual strength loss
- Bilateral arm symptoms or leg involvement (suggests myelopathy - cord compression)
- Bladder/bowel changes or gait disturbance
- Severe trauma history
- Fever, unexplained weight loss, cancer history
Any of these and we refer you for medical/surgical workup first.
Physiotherapy management
The evidence supports a combined approach:
Centralisation exercises - certain positions (usually retraction + extension, or contralateral side-glide) reduce arm pain and move it back toward the neck. Centralisation predicts good outcome.
Cervical traction - manual or mechanical intermittent traction, especially for foraminal compression. Short-term symptom relief, often substantial.
Nerve glides - median or ulnar nerve mobilisations, gradual introduction once acute pain has settled. Wrong dosing worsens irritable nerves - so this is a clinician-guided progression.
Postural and motor control - deep neck flexor activation, scapular stability, thoracic mobility. Weak deep flexors + a tight upper trapezius is a classic driver.
Manual therapy - cervical mobilisation and soft-tissue release, typically combined with the above rather than alone.
Progressive loading - once pain is manageable, gradual return to overhead activity, loaded carries, and pressing/pulling movements.
What not to do
- Heat or ice alone - may feel nice, doesn't change the trajectory
- Aggressive stretching into the painful range - often aggravates an irritable nerve
- Long-term collar - weakens the neck and delays recovery
- Repeated steroid injections - sometimes useful as a bridge, not a long-term answer
Surgical considerations
Discectomy or anterior cervical discectomy and fusion (ACDF) is considered if:
- Progressive neurological deficit
- Pain intolerable despite 6-12 weeks of good conservative care
- Myelopathy (cord compression) features
Outcomes after surgery are generally good for arm pain; less reliable for neck pain itself.
In Ipoh
Expect RM80-150 per session, typically 6-10 sessions over 6-10 weeks. We liaise with orthopaedic and neurosurgery colleagues when imaging or a surgical opinion is needed. WhatsApp us for an assessment.