Cervical Radiculopathy (Pinched Nerve in the Neck)

**Cervical radiculopathy** occurs when a nerve root in the neck (C1-C8) becomes compressed or irritated, typically by a herniated disc or bone spur (osteophyte). The compressed nerve sends pain, tingling, numbness, and sometimes weakness down the arm following a specific pattern (dermatome) depending on which nerve root is affected. **Common nerve root patterns:** - **C5 radiculopathy**: Shoulder pain, deltoid weakness, numbness over the lateral shoulder - **C6 radiculopathy**: Pain down the arm to the thumb, biceps weakness, reduced brachioradialis reflex - **C7 radiculopathy**: Pain down to the middle finger, triceps weakness, reduced triceps reflex — **the most common** - **C8 radiculopathy**: Pain into the ring and little fingers, grip weakness, intrinsic hand muscle weakness **Primary causes:** - **Disc herniation** (most common in adults <50) — soft disc material protrudes and compresses the nerve root - **Cervical spondylosis** (most common in adults >50) — bone spurs and degenerative narrowing of the nerve exit foramen - **Combination**: Disc degeneration + osteophyte formation progressively narrows the foramen The condition differs from [cervical myelopathy](/condition/cervical-spondylosis) (spinal cord compression), which affects the central cord rather than individual nerve roots and causes bilateral symptoms and gait disturbance.

## Root Causes **In younger adults (<50 years):** - **Cervical disc herniation** — the soft inner disc (nucleus pulposus) herniates through the outer annulus and compresses the exiting nerve root - Often precipitated by neck trauma, heavy lifting, or sustained poor posture - Acute onset with a specific inciting event common **In older adults (>50 years):** - **Cervical spondylosis** with foraminal stenosis — degenerative bone spurs (osteophytes) and disc space narrowing progressively compress the nerve root - Gradual onset without a specific triggering event - Often bilateral foraminal narrowing on imaging but unilateral symptoms **Risk Factors:** - Sedentary work with poor neck posture (computer/desk workers) - Repetitive neck movements or vibration exposure - Previous cervical spine injury - Smoking — accelerates disc degeneration by 50-70% - Heavy physical labor with overhead work - Genetic predisposition to disc degeneration

## Conservative Treatment (First-Line — 80-90% Success) **1. Physical Therapy (Most Important):** - Cervical traction — mechanical or manual — reduces foraminal compression; 75-85% symptom improvement - Cervical isometric strengthening — deep neck flexor activation, scapular stabilization - Neural mobilization — median, ulnar, and radial nerve gliding exercises - Postural correction — chin tucks, thoracic extension, ergonomic workstation setup - McKenzie method — repeated retraction movements for disc-related radiculopathy **2. Medications:** - NSAIDs (ibuprofen, naproxen) — first-line for pain and inflammation - Short course oral corticosteroids (methylprednisolone taper) — significant relief in acute cases - Gabapentin or pregabalin — for persistent nerve pain (neuropathic component) - Muscle relaxants — for associated cervical muscle spasm **3. Cervical Epidural Steroid Injection:** - Fluoroscopy-guided transforaminal or interlaminar injection - Provides 60-75% pain relief; can be repeated 2-3 times per year - Particularly effective for acute disc herniations **4. Activity Modification:** - Cervical collar for short-term use only (1-2 weeks) during acute phase - Ergonomic workstation — monitor at eye level, regular breaks - Avoid prolonged neck extension (looking up) and heavy overhead lifting - Sleep with a cervical contour pillow to maintain neutral spine alignment ## Surgical Treatment (10-20% of Cases) **Anterior cervical discectomy and fusion (ACDF):** - The gold standard surgery for cervical radiculopathy - Removes the herniated disc/osteophyte compressing the nerve - Success rate: 85-95% for arm pain relief - Recovery: 4-6 weeks for desk work, 3-6 months for full activity - Indicated for: progressive neurological deficit, intractable pain after 6-12 weeks of conservative care, or myelopathy