Understanding Cervical Radiculopathy by Megan Schneider Senior APA Physiotherapist
Have you ever experienced neck pain that travels down your arm, accompanied by tingling, numbness, or weakness? You might be dealing with cervical radiculopathy. Cervical radiculopathy is a condition caused by compression or irritation of one or more nerve roots in the cervical spine (neck), leading to pain, weakness, or sensory changes in the neck, shoulder, arm, or hand.
This condition can affect your ability to work, sleep, and enjoy daily activities. But the good news? Physiotherapy can help you recover and regain control.
Cervical radiculopathy occurs when a nerve root in the cervical spine (neck) becomes compressed or inflamed. Common causes include:
· Degenerative disc disease
· Cervical spondylosis
· Trauma
· Tumors
· Infections
Typical symptoms include:
· Neck pain that may radiate to the shoulder, arm, or hand.
· Sensory changes such as numbness or tingling in a dermatomal pattern.
· Motor weakness in muscles innervated by the affected nerve root.
· Diminished reflexes, especially the triceps reflex (C7 root).
· Positive Spurling test: pain radiates down the arm when the neck is extended and rotated toward the symptomatic side
It is important to understand that cervical radiculopathy is not always the diagnosis when experiencing some of the above symptoms. You may instead be experiencing radicular pain. The distinction between cervical radiculopathy and radicular pain is subtle but clinically important. Here's a breakdown:
Cervical Radiculopathy
· Definition: A clinical syndrome involving both radicular pain and objective neurological deficits due to compression or damage to a cervical nerve root.
· Cause: Often from degenerative changes, disc herniation, or foraminal narrowing in the cervical spine.
· Symptoms:
o Radiating pain (same as radicular pain).
o Plus: Weakness, numbness, or diminished reflexes in the affected limb.
o May include muscle atrophy or coordination issues in severe cases.
· Key Point: It includes both pain and neurological impairment.
Radicular Pain
· Definition: Pain that radiates from the spine along the path of a spinal nerve root.
· Cause: Typically due to irritation or inflammation of a nerve root, often from a herniated disc or spinal stenosis.
· Symptoms:
o Sharp, shooting, electric-like pain.
o Follows a dermatomal pattern (specific area of skin supplied by a spinal nerve).
o No objective neurological deficits (i.e., no weakness, numbness, or reflex changes).
· Key Point: It is pain only, without measurable loss of nerve function.
To gain an accurate diagnosis of cervical radiculopathy a combination of tests and examination may be utilised. Your physiotherapist should perform a history taking and physical exam which includes testing your reflexes, muscle strength, and sensory function. They may also request imaging such as an MRI (gold standard), to confirm their diagnosis and determine the cause of the irritation/compression to help guide ongoing treatment options.
Treatment should commence with conservative care as first-line management, unless red flags are present. Conservative treatment includes interventions such as:
· Physical therapy: exercise therapy improves pain and function. Targeted strengthening and mobility exercises are key.
· Medications: NSAIDs, muscle relaxants, and sometimes corticosteroids.
· Activity modification and ergonomic adjustments.
· Manual therapy: can reduce symptoms, especially when combined with exercise
A 2023 systematic review in Musculoskeletal Science and Practice found that multimodal physiotherapy (exercise + manual therapy + education) was more effective than passive treatments alone.
If conservative treatment is not effective and symptoms persist beyond 12 weeks, or you are experiencing significant motor weakness or myelopathy, surgical treatment may be considered. Common procedures include anterior cervical discectomy and fusion (ACDF) or posterior foraminotomy.
Next Steps
If you’re experiencing symptoms of cervical radiculopathy, book an assessment with your physiotherapist. Early intervention leads to better outcomes, and we’re here to help you move better, feel better, and live better.
References
Kothari, M. J., & Chuang, K. (2025). Treatment and prognosis of cervical radiculopathy. UpToDate. Retrieved October 2, 2025, from https://www.uptodate.com/contents/treatment-and-prognosis-of-cervical-radiculopathy
BMJ Best Practice. (2025). Degenerative cervical spine disease. BMJ Publishing Group. Retrieved October 2, 2025, from https://bestpractice.bmj.com/topics/en-gb/577
Callaghan, B. C., Rae-Grant, A., & van Zuuren, E. J. (2025). Cervical radicular pain and radiculopathy. DynaMed. Retrieved October 2, 2025, from https://www.dynamed.com/condition/cervical-radicular-pain-and-radiculopathy
North American Spine Society. (2010). Diagnosis and treatment of cervical radiculopathy from degenerative disorders: Evidence-based clinical guidelines. Burr Ridge, IL: North American Spine Society. Retrieved from https://www.urmc.rochester.edu/MediaLibraries/URMCMedia/SOAR/documents/NASS_Cervical_Radiculopathy_Guidelines.pdf
Thoomes, E., Thoomes-de Graaf, M., Cleland, J., Gallina, A., & Falla, D. (2021). Timing of evidence-based non-surgical interventions as part of multimodal treatment guidelines for the management of cervical radiculopathy: A Delphi study protocol. BMJ Open, 11(3), e043021. https://doi.org/10.1136/bmjopen-2020-043021
Yousif, M. S., Occhipinti, G., Bianchini, F., Feller, D., Schmid, A. B., & Mourad, F. (2025). Neurological examination for cervical radiculopathy: A scoping review. BMC Musculoskeletal Disorders, 26, Article 334. https://doi.org/10.1186/s12891-025-08560-9