What does a pinched nerve in the neck feel like, and how is it treated?

What causes a pinched nerve in the neck?

Nerve roots leave the spinal cord through small openings between the vertebrae in the neck. A herniated disc or bony changes from wear and tear, such as bone spurs, can narrow these openings and press on a nerve root, causing irritation and inflammation.

In younger people, a disc herniation is a more common cause, while in older people age-related narrowing of the openings is more frequent. Symptoms can start suddenly or develop gradually.

What are the symptoms?

Typical symptoms are sharp, burning or aching pain from the neck into the shoulder blade, arm or hand, following the path of the affected nerve. Tingling or numbness in specific fingers, weakness of certain arm or hand muscles and reduced reflexes may occur.

Pain often worsens with certain neck movements, such as looking up or turning towards the painful side, and some people find relief by placing the hand on top of the head. Arm pain is frequently worse than the neck pain.

How is it diagnosed?

Diagnosis is based on symptoms and examination of strength, sensation and reflexes, and tests that reproduce arm symptoms. Imaging such as MRI is used when symptoms are severe, persistent, include significant weakness, or when injections or surgery are being considered.

An evidence-based guideline on cervical radiculopathy from degenerative disorders summarises diagnostic tests and treatments and emphasises matching imaging findings to clinical symptoms 1.

Does it get better without surgery?

Many people improve with time. In a trial of 205 people with recent onset cervical radiculopathy, arm pain in the group who waited and saw decreased by 19 mm on a 100 mm pain scale over six weeks 2. People who wore a semi-hard collar or had physiotherapy achieved about 12 mm more pain reduction over the same period 2.

A systematic review found low-level evidence that a collar is no more effective than physiotherapy in the short term, and that traction is no more effective than placebo traction 3. Collars are therefore not routinely used for long periods.

What does physiotherapy involve?

Neck pain guidelines recommend exercise and manual therapy approaches. For radicular symptoms, treatment may include neck and upper back mobility exercises, nerve gliding techniques, strengthening of the neck and shoulder muscles, advice on positions that ease symptoms and gradual return to activity 4.

Staying active within tolerable limits is encouraged. Short-term modification of activities that provoke severe arm pain, such as prolonged looking up, can help while symptoms settle.

When are injections or surgery considered?

If arm pain remains severe despite several weeks of non-surgical treatment, image-guided steroid injections near the nerve root may be considered to reduce inflammation. Surgery, such as removing the disc or bone pressing on the nerve, may be considered for persistent disabling pain, progressive weakness or when there is evidence of spinal cord compression 1.

The decision depends on the balance of symptoms, examination findings, imaging and personal preferences, discussed with a spinal specialist.

What are the warning signs of spinal cord compression?

Symptoms such as clumsiness of both hands, difficulty with fine tasks like buttoning, unsteady walking, electric shock sensations down the back when bending the neck, or problems with bladder or bowel control may indicate compression of the spinal cord, called myelopathy.

These symptoms need urgent assessment, as they are different from a single pinched nerve and may require earlier surgery.

Frequently asked questions