Neck Pain and Cervical Radiculopathy: What's Causing Your Arm Pain?

If you have pain, numbness, tingling, or weakness that travels from your neck down into your arm, shoulder, or hand — you likely have cervical radiculopathy. This is one of the most common conditions I treat, and it's one where accurate diagnosis and targeted treatment can make a dramatic difference.

What Is Cervical Radiculopathy?

"Radiculopathy" refers to symptoms caused by compression or irritation of a nerve root as it exits the cervical (neck) spine. The symptoms depend on which nerve root is affected:

• C5 nerve root: Shoulder pain, deltoid weakness, outer arm numbness
• C6 nerve root: Thumb and index finger numbness, wrist extension weakness — the most common level affected
• C7 nerve root: Middle finger numbness, triceps weakness
• C8 nerve root: Ring and little finger numbness, grip weakness

The pattern of your symptoms is a critical clue to the diagnosis — even before imaging.

Common Causes

Cervical disc herniation — the most common cause in younger patients (30s–50s). A tear in the disc's outer ring allows the inner material to press on the exiting nerve root.

Cervical foraminal stenosis — narrowing of the opening (foramen) through which the nerve exits the spine, caused by bone spurs and degenerative changes. More common in older patients.

Acute disc herniation after injury — sudden onset after trauma, often severe symptoms.

How Is It Diagnosed?

Physical examination — including specific tests for nerve root tension and motor/sensory testing — is the first step. MRI of the cervical spine is the definitive imaging study. Occasionally, a cervical nerve root block can be used diagnostically to confirm which specific level is causing symptoms.

Treatment Options

Conservative Treatment (First 4–6 Weeks)

For most patients, a short course of conservative management is appropriate:

• Activity modification and positioning education
• Short course of oral corticosteroids or NSAIDs for acute herniations
• Cervical collar (limited use — prevents excessive movement initially)
• Physical therapy once acute pain is controlled

Cervical Epidural Steroid Injection (CESI)

For patients who don't improve with conservative management, or who have significant radicular arm pain, cervical ESI delivers anti-inflammatory steroid directly to the affected nerve root. Many patients experience substantial arm pain relief within 1–2 weeks.

I perform all cervical epidurals under fluoroscopic guidance with contrast confirmation — the standard of care for this procedure.

Cervical Nerve Root Block

For single-level pathology where the symptomatic level needs confirmation or targeted treatment, a cervical transforaminal nerve root block may be preferred.

Surgery

Cervical discectomy and fusion (ACDF) or disc arthroplasty is appropriate for:

• Progressive neurological deficits
• Spinal cord compression (myelopathy)
• Failure of 3–6 months of comprehensive non-surgical treatment

For most patients with cervical radiculopathy from disc herniation, surgery is not the first or necessary step. Natural disc resorption can occur with appropriate management.

When to Seek Urgent Care

Seek immediate medical attention if you develop:

• Difficulty walking or loss of balance (suggests spinal cord compression)
• Bowel or bladder changes
• Rapidly progressive weakness in the hand or arm

Otherwise, call 516-492-3100 to schedule an evaluation for neck and arm pain.