PONOS · Specialist assessment
Cervical
radiculopathy
When neck pain extends into the arm and hand.
What is cervical radiculopathy?
Cervical radiculopathy involves a nerve root in the neck. It may cause pain radiating into the arm, tingling, reduced sensation or weakness. Common causes include a herniated disc and narrowing of the opening through which the root exits, often associated with degenerative changes.[1]
In the PONOS pathway, the priority is to establish which structure is responsible for the symptoms and how they affect movement, rest and daily life. This guides the choice between conservative treatment, targeted injections and neuromodulation procedures.
Recognising the symptoms
Pain and sensory changes
Pain may extend from the neck into the shoulder, arm or hand. Burning, electric shock sensations, numbness and tingling may accompany it. Certain neck movements may make it worse.
Strength and function
Lifting the arm, extending the wrist or using the hand may become difficult. Examination distinguishes actual weakness from movement limited by pain and assesses sensation and reflexes.[1]
C5, C6, C7 and C8: an approximate map
| Nerve root | Typical sensory area |
|---|---|
| C5 | Outer shoulder and upper arm |
| C6 | Thumb side of the hand, sometimes extending into the forearm |
| C7 | Middle finger region |
| C8 | Little finger side and ulnar border of the hand |
These territories overlap and vary. The finger that tingles does not, on its own, identify the nerve root. The pattern must be considered alongside strength, reflexes, investigations and possible peripheral nerve conditions.[2]
Diagnosis: examination, investigations and clinical correlation
An MRI finding does not automatically explain the pain. Assessment considers how symptoms began, their distribution, previous treatments and any history of surgery.
- Neurological examination: focused assessment of strength, sensation and reflexes.
- MRI and other investigations: interpreted in context. Electromyography may help when findings are uncertain or a peripheral neuropathy needs to be distinguished.
- A selective diagnostic injection: when indicated, symptom changes after local anaesthetic provide additional information. This is not an infallible test and does not replace clinical assessment.
When not to wait
New or worsening weakness, walking difficulties, increasingly clumsy hands or new bladder or bowel problems require prompt assessment. These may indicate a problem beyond an isolated nerve root, including spinal cord involvement.[3]
Care matched to the symptoms
How is cervical radiculopathy treated?
1. Conservative care
Many episodes, particularly recent ones, improve over time. Individually selected medication, adapted activity and targeted rehabilitation may be the first step. Progress is reviewed, particularly when neurological deficits are present.[4]
2. Targeted injections
If pain remains limiting, a selective injection may be considered. In the PONOS pathway, ultrasound allows real-time observation of tissues, blood vessels and the spread of medication without using X-rays for guidance.[5]
Local anaesthetic may contribute to diagnostic assessment; a corticosteroid, when used, targets the inflammatory component. Ultrasound does not remove every risk or automatically replace fluoroscopy for all procedures.
3. Dorsal root ganglion PRF
In selected cases of persistent radicular pain, pulsed radiofrequency may be considered for neuromodulation of the dorsal root ganglion. It does not aim to create a thermal nerve root lesion or remove mechanical compression. Available evidence and expectations need individual discussion.[6]
4. Surgical assessment
When neurological deficits, compression or persistent symptoms warrant it, the pathway includes surgical assessment. Injections and PRF must not delay indicated surgery and are not equivalent alternatives to decompression.
A PONOS clinical case
C6 radiculopathy after fusion: 12-month follow-up
In the documented case, symptoms persisting for six years after surgery were treated with ganglion PRF and a corticosteroid. Improvement was gradual. At twelve months, the benefit was maintained, with only rare, mild tingling.
This is one patient’s outcome, not a guarantee of benefit or an estimate of the likelihood of success.
Frequently asked questions
Are radiculopathy and ordinary neck pain the same?
No. Neck pain describes pain in the cervical region; radiculopathy involves a nerve root. They can coexist, and examination helps distinguish the components.
Does hand tingling always come from the neck?
No. A compressed peripheral nerve can also cause tingling. Symptom location, neurological examination and any necessary investigations help distinguish the causes.
Does a cervical disc herniation always require surgery?
No. The decision depends on the clinical picture, neurological function and progression. Increasing weakness requires prompt reassessment.
Is PRF the first treatment?
No. It is considered for selected patients after an accurate diagnosis and assessment of alternatives, when pain remains troublesome.
What should I bring to the consultation?
Bring available scans and reports, records of previous surgery, a medication list and a brief account of symptoms and treatments tried. Do not stop medication yourself.
Key references
- American Academy of Orthopaedic Surgeons. Cervical radiculopathy (pinched nerve).
- Hong CG, Nam WD. Dermatomes and myotomes in surgically verified cervical radiculopathy. Neurospine, 2022. Original study.
- NICE NG127. Suspected neurological conditions: recognition and referral.
- Kuijper B et al. Cervical collar or physiotherapy versus wait and see policy for recent onset cervical radiculopathy: randomised trial. BMJ, 2009;339:b3883. Original study.
- Cui X et al. Ultrasound-guided selective cervical nerve root block versus fluoroscopy-guided cervical transforaminal epidural block: randomised trial. Ann Med, 2022;54:2681–2691. PubMed.
- Van Zundert J et al. Pulsed radiofrequency adjacent to the cervical dorsal root ganglion: randomised trial. Pain, 2007;127:173–182. PubMed.