What causes cervical radiculopathy?

The root leaves the neck through a bony window a few millimeters across. Two things shrink it. A disc can push into it from the front. More often, bone does. The small uncovertebral joints at the edge of the disc, and the facet behind it, thicken with age and grow spurs into the opening. Radhakrishnan and colleagues traced every case in Rochester, Minnesota from 1976 to 1990, 561 patients in all. They found a confirmed disc protrusion in only 21.9%. Spondylosis (bone spurs and thickening), disc or both accounted for 68.4%. Only 14.8% could point to a strain or injury that started it. The peak was the early fifties. This is a wear problem far more often than an accident problem, whatever the timing suggests.

Why does a pinched nerve in the neck hurt some people more than others?

A root is living tissue with its own blood supply. How much squeeze it can take depends on its state before the spur arrived. That is the second biological driver, and it is metabolic. High glucose thickens the walls of the tiny vessels that feed the nerve. It stiffens the nerve’s outer sheath with glycation (sugar binding to protein). It floods the nerve with waste from the polyol pathway. So the same millimeter of narrowing makes more swelling, more ischemia (loss of blood flow) and more pain. The clearest evidence comes from a nearby trapped nerve. Pourmemari and Shiri pooled 25 studies covering 92,564 people. They found diabetes nearly doubled the odds of carpal tunnel syndrome. The association held across more than 37 million people once other factors were controlled. A nerve that handles a wrist tunnel poorly handles a neck opening poorly, for the same reason.

Upton and McComas gave the third piece its name in 1973: the double crush. A nerve squeezed at the neck is more easily hurt by a second squeeze farther down, at the elbow or the wrist. That is because axonal transport, the nerve’s inner delivery system, is already impaired. So take the patient who had a carpal tunnel release and whose arm still hurts. That patient so often has a root problem nobody ever examined. And then there is the driver in no textbook. The welder at the Granite City steel works spends a shift looking up under a beam with a helmet on his head. The driver checks mirrors a thousand times between the Collinsville yards and the airport. The second-shift nurse sleeps in daylight. Tipping the head back and turning it close the opening. Sleep loss turns up the volume on whatever the root is sending.

Is the arm pain coming from my neck, my shoulder or my wrist?

The exam sorts it, and the exam comes before any scan is believed. Turning the neck and tipping it back can bring on the arm pain. Resting the hand on top of the head can ease it. When those happen, they point to the root. Wainner and colleagues showed that a small cluster of such findings carries most of the diagnostic weight. Pain with lifting the arm and no numbness points to the shoulder itself. Numbness in the thumb and first two fingers that wakes you at night points to the wrist. Two of these can exist together. Treat the wrong one, and a patient spends a year with the right diagnosis still unexamined.

What helps cervical radiculopathy besides an injection?

The opening widens when you bend the head forward. It narrows when you tip it back or turn it toward the painful side. So the movement plan is specific: chin tucked, head over the shoulders, and overhead tasks rearranged so the neck does not spend a shift tipped back. Glucose and insulin are treated as nerve treatment. That is because a root heals through the same small vessels that glycation had been stiffening. Sleep is treated because the nerve repairs itself at night, and because a short night lowers the threshold on every signal it sends. The fear of moving the neck is treated too. A licensed, pain-trained behavioral clinician in this building uses Acceptance and Commitment Therapy, because a neck held rigid to protect a root sits in the tipped, guarded posture that closes the opening hardest. Follow-up for the Illinois patient happens by telehealth where that is clinically right; strength testing does not.

Frequently asked questions

Do I need a referral for a pinched nerve in the neck?

No. You can schedule a cervical radiculopathy visit yourself. Some plans, mostly HMOs, want a referral on file before they pay, so check your card. If a neck epidural is planned, driving home after a spine injection covers the trip back to Illinois.

Will a pinched nerve in my neck heal on its own?

Most do, over weeks to a few months. The Rochester population data put 90% symptom-free or only mildly limited at follow-up. The job is to make the wait livable. It is also to measure strength, so the minority who are losing function are caught early, as what to expect describes.

How do I know if my arm pain is from my neck or my shoulder?

When turning the neck and tipping it back brings on the arm pain, that points to the root. Pain that comes with raising the arm and has no numbness points to the shoulder. When the exam cannot separate them, an anesthetic image-guided shoulder injection is the test.

Does diabetes make a pinched nerve in the neck worse?

A nerve fed by glycated vessels handles a squeeze poorly and heals slowly. That is the same reason diabetes nearly doubles the odds of carpal tunnel syndrome. And it is why the first visit draws blood, as the page on why a pain clinic checks your blood sugar explains.

Is a cervical epidural steroid injection safe?

It is done under fluoroscopy (live X-ray), with contrast confirming the spread. The interlaminar route is preferred in the neck, and blood sugar is accounted for. Done that way, it is a routine procedure with a stated job and a stated endpoint. The epidural steroid injection page covers routes and limits.

When does cervical radiculopathy need surgery?

When weakness is getting worse. When signs of spinal cord involvement appear. Or when pain has outlasted a well-placed injection and a corrected terrain. Surgery gets to recovery faster, and the two-year outcomes end up close. Cord signs are listed on when it is an emergency.

What are the common symptoms of cervical radiculopathy?

Pain that starts in the neck and runs down one arm along the same path each time. Tingling in a matching patch of skin. Some people also notice a weaker grip or a weak shoulder. Turning the head or tipping it back often brings the arm pain on. Clumsy hands, trouble with buttons, unsteady walking or a change in bladder control point to the spinal cord instead. That needs care right away.

What makes a pinched nerve in the neck flare up?

Tipping the head back and turning it toward the painful side both narrow the opening the nerve passes through. Long shifts looking up at overhead work, or checking mirrors all day, keep that opening narrow. A short night of sleep makes the nerve more sensitive. High blood sugar leaves it less able to handle the squeeze. Holding the neck stiff out of fear keeps it in the posture that pinches hardest.

What should I not do with a pinched nerve in my neck?

Do not spend hours with your neck tipped back or twisted. Do not hold it rigid to protect it either; a guarded neck sits in the position that closes the nerve’s opening hardest. Keep the chin tucked and the head over the shoulders. Rearrange overhead tasks so your neck is not tipped back all shift. Do not wait out clumsy hands, unsteady walking or bladder changes: read when it is an emergency.

Related reading

• Epidural steroid injection
• Peripheral neuropathy
• Occipital neuralgia
• Injured at work
• Metabolic health and pain
• First visit from Illinois
• Trigger point injections
• Rotator cuff tendinitis
• Tennis elbow