Cervical Radiculopathy
Also known as: cervical radiculopathy, cervical nerve-root compression, pinched nerve in the neck, cervicobrachial pain, cervical spondylotic radiculopathy, cervical disc radiculopathy
Cervical radiculopathy describes pain and/or neurological impairment caused by irritation or compression of a cervical nerve root. Symptoms may include neck, scapular, shoulder or arm pain, paraesthesia, numbness, altered reflexes and myotomal weakness. [S1][S2] Common causes include cervical disc herniation, degenerative foraminal narrowing, osteophytes and cervical spondylosis. Less common causes include trauma, infection, inflammatory disease and tumour. [S2][S3] Diagnosis is primarily clinical and includes neurological examination of strength, sensation and reflexes, assessment for cervical myelopathy, shoulder pathology, peripheral nerve entrapment and other mimics. Imaging is not routinely required in an uncomplicated early presentation but may be indicated for trauma, red flags, progressive neurological deficit, diagnostic uncertainty or persistent disabling symptoms. [S1][S4] In the absence of urgent neurological or systemic features, initial management is generally conservative and may include education, maintenance of tolerable activity, exercise-based rehabilitation, physiotherapy and appropriate medicines. Specialist review may be required for progressive weakness, myelopathy or persistent disabling pain. [S1][S4][S5] Acupuncture may be considered as an adjunct for short-term pain and function in selected medically stable patients. Recent reviews report potential benefit, but the overall evidence is limited by low certainty, heterogeneous studies and incomplete safety assessment. It must not replace neurological examination, rehabilitation or indicated surgical assessment. [S6][S7]
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Lifestyle & Diet
- •Activity: Remain active within tolerable limits and avoid prolonged immobilisation unless specifically advised.
- •Activity: Use graded exercise and physiotherapy to restore cervical and scapular control, strength and confidence.
- •Activity: Temporarily modify activities that repeatedly provoke severe arm pain or neurological symptoms.
- •Activity: Return to work progressively with task and workstation adjustments where required.
- •Ergonomics: Change position regularly rather than attempting one rigid perfect posture.
- •Ergonomics: Position screens to reduce sustained neck flexion or rotation.
- •Ergonomics: Support the forearms and avoid prolonged phone cradling.
- •Ergonomics: Use a pillow height that maintains a comfortable neutral neck position.
- •Self-monitoring: Track arm pain, numbness, grip, dexterity and functional ability.
- •Self-monitoring: Seek prompt review for worsening weakness, gait change, bilateral symptoms or bladder or bowel disturbance.
- •Self-monitoring: Avoid forceful self-manipulation of the neck.
Cautions & Contraindications
- •Absolute: No acupuncture or manual treatment that delays emergency referral for myelopathy, fracture, infection, malignancy or progressive neurological deficit.[]
- •Absolute: No forceful cervical manipulation where instability, vascular pathology or serious neurological disease is suspected.[]
- •Absolute: Do not needle directly into the spinal canal or towards the lung apex or major cervical neurovascular structures.
- •Relative: Use additional caution with anticoagulants, bleeding disorders, osteoporosis, previous cervical surgery and severe sensory loss.
- •Relative: Avoid electroacupuncture across the anterior neck or in patients with relevant implanted electronic devices.
- •Relative: Avoid strong stimulation of LI4 Hégǔ and SP6 Sānyīnjiāo during pregnancy unless specifically indicated and within scope.
- •Herbal: Review pregnancy, breastfeeding, surgery, anticoagulants, antihypertensives, sedatives and hepatic or renal disease.
- •Herbal: Exclude banned, restricted, endangered, toxic or undeclared ingredients.
When to reassess or seek care again
- •Reassess neurological findings and function at every visit. A short adjunctive trial may be reviewed after two to four weeks, with earlier referral if symptoms worsen.
- •Weakness progresses
- •Myelopathic signs appear
- •Symptoms become bilateral or involve the legs
- •Severe pain persists despite appropriate conservative care
- •Red flags or diagnostic uncertainty emerge
- •Meaningful functional improvement is absent after an appropriate conservative period
Pain distribution and severity; Dermatomal sensation; Myotomal strength; Reflexes; Grip and hand dexterity; Gait and balance; Sleep and daily function; Response to exercise and medication
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Sources & Further Reading
Clinical guidance, red flags and safety notes on this page draw on the following current sources alongside the classical references above.
Educational reference for licensed practitioners. Not a substitute for individual clinical assessment. Refer to conventional care for any red-flag or undiagnosed presentation.