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Neck pain with arm symptoms (cervical radiculopathy)

Before anything else — 5 symptoms that need urgent care
  • •Hand clumsiness or difficulty with buttons
  • •Gait imbalance
  • •Loss of dexterity
  • •Bilateral arm symptoms
  • •Lhermitte sign (electric sensation down spine with neck flexion)
Full red-flag guide

Likely conditions

Common causes based on epidemiology alone — a physical exam and sometimes imaging are needed to identify which one applies to you.

Cervical radiculopathy

Annual incidence ~85 per 100,000

Condition detail

Cervical disc herniation

Common cause in adults under 55

Condition detail

Cervical spondylotic myelopathy

Increases with age

Condition detail

Who to see first

Physical Medicine & Rehabilitation (PM&R)

Physicians who specialize in non-surgical treatment of musculoskeletal and nerve-related conditions. Often called "physiatrists."

When to see them: First stop for most persistent back or neck pain without red flags. Non-surgical. Often faster to book than a spine surgeon.

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Treatment sequence

Published guidelines (NASS, AAOS, ACP, NICE) recommend a conservative-first sequence unless red flags are present. Each step below lists the evidence strength and the primary source.

  1. 1
    Week 1–2Moderate evidence

    Activity modification + NSAIDs

    Relative rest, avoiding aggravating positions. Short course of oral corticosteroids may be considered for acute radicular flare.

  2. 2
    Week 2–6Moderate evidence

    Physical therapy

    Cervical PT with traction, manual therapy, and nerve mobilization. Many radicular episodes resolve within 6 weeks without intervention.

  3. 3
    Week 6–12Limited evidence

    Cervical epidural steroid injection

    Transforaminal cervical injections carry a higher complication profile than lumbar injections. Use by experienced interventionalists. Interlaminar is generally preferred.

  4. 4
    Week 8–12+Moderate evidence

    Surgical consultation

    Anterior cervical discectomy and fusion (ACDF) or cervical disc replacement for persistent radiculopathy. Multiple RCTs show equivalent-to-superior outcomes compared with continued conservative care for appropriately selected patients.

    Source

Common causes

  • •Cervical disc herniation compressing a nerve root
  • •Cervical foraminal stenosis (spondylotic)
  • •Cervical spondylotic myelopathy (spinal cord compression)

Your next steps

  • 1Screen yourself for red flags. If any apply, go to an emergency department before continuing with this Guide.
  • 2Start the first stage of the treatment ladder. Most new pain episodes improve significantly in the first 2–6 weeks with self-care and PT.
  • 3If symptoms persist, book with the specialist above. Bring: when it started, what makes it better or worse, medications tried, any imaging you have, and the questions from our surgery decision framework.
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