Cervical Radiculopathy: Pinched Nerves in the Neck Explained

What Is Cervical Radiculopathy?

Cervical radiculopathy is a clinical syndrome produced by compression or chemical irritation of a cervical nerve root, resulting in a combination of neck and arm pain, altered sensation, and potentially weakness in the distribution of the affected nerve root. The cervical spine has eight nerve roots (C1–C8), each exiting through the intervertebral foramen formed between adjacent cervical vertebrae. The most commonly affected levels are C6 (at C5–C6) and C7 (at C6–C7), which together account for approximately 70% of all cervical radiculopathy presentations. It is distinct from cervical myelopathy — compression of the spinal cord itself — which produces bilateral symptoms, gait disturbance, and requires urgent management.

Causes of Nerve Root Compression

In younger patients (under 45), the most common cause is acute or subacute cervical disc herniation — protrusion of nuclear material into the lateral recess or foramen, directly compressing or chemically irritating the nerve root. In older patients, cervical spondylosis — degenerative change producing osteophyte formation, uncinate process hypertrophy, ligamentum flavum thickening, and foraminal narrowing — is the predominant cause. Both mechanisms can coexist. Rarely, tumour, infection, or fracture accounts for radiculopathy. The natural history of cervical radiculopathy from disc herniation is generally favourable — the majority of patients improve within six to twelve weeks with conservative management, as disc material resorbs and the inflammatory response resolves.

Dermatomal Patterns

Identifying the affected nerve root guides assessment, treatment, and investigation. C5 radiculopathy produces pain and altered sensation in the lateral shoulder and upper arm, with potential deltoid and biceps weakness and a reduced biceps reflex. C6 radiculopathy — the most common — produces lateral forearm, thumb, and index finger symptoms, with potential wrist extensor and biceps weakness and a reduced brachioradialis reflex. C7 radiculopathy produces posterior forearm, middle finger, and sometimes index and ring finger symptoms, with potential triceps and wrist flexor weakness and a reduced triceps reflex. C8 radiculopathy produces medial forearm and ring and little finger symptoms, with intrinsic hand muscle weakness.

Evidence-Based Management

The majority of cervical radiculopathy responds to conservative management. Manual therapy — cervical traction, joint mobilisation, and neural mobilisation — reduces foraminal compression and neural irritation. Evidence supports manual cervical traction (sustained or intermittent) as one of the most effective interventions for reducing radicular arm pain. Neural mobilisation exercises (cervical lateral glide with arm movement) improve neural excursion and reduce mechanosensitivity. Progressive therapeutic exercise targets deep cervical flexor function, scapular stability, and cervical proprioception — the neuromuscular deficits that commonly accompany radiculopathy and contribute to recurrence if left unaddressed. Corticosteroid injections (epidural or foraminal) can provide short-term relief when conservative measures are insufficient. Surgical discectomy or foraminotomy is indicated for progressive neurological deficit, myelopathy, or failed conservative management over three to six months.