Cervical radiculopathy, commonly known as a pinched nerve in the neck, occurs when a nerve root near the spinal cord is compressed or irritated. This compression often causes neurological dysfunction, resulting in symptoms that radiate down the arm, such as sharp pain, tingling, numbness, or muscle weakness. While many cases resolve with conservative care, seeking professional guidance is necessary for proper diagnosis and treatment.
The First Step: Primary Care and Initial Diagnosis
The initial point of contact for a suspected pinched nerve is usually a Primary Care Physician (PCP) or General Practitioner. Your PCP’s role is to conduct a thorough physical examination, review your symptoms, and rule out other potential causes of arm and neck pain. They will specifically check your neck’s range of motion, assess your reflexes, and look for any signs of muscle weakness or loss of sensation in your arms and hands.
This initial assessment often includes ordering diagnostic imaging to help confirm the diagnosis and identify the cause of compression. Standard X-rays are typically used first to visualize the bones and look for degenerative changes, such as bone spurs or narrowing of the disc space. If symptoms are persistent, severe, or if the PCP suspects a soft tissue issue, they may refer you for a Magnetic Resonance Imaging (MRI) scan. An MRI provides detailed images of soft tissues, making it the preferred method for evaluating herniated discs or other abnormalities compressing the nerve root.
The PCP will also initiate the first line of conservative treatment, which commonly includes prescribing rest, nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen, or a short course of oral corticosteroids to reduce inflammation around the nerve. If the symptoms do not improve after a few weeks of this initial management, or if the diagnosis remains uncertain, the PCP will then refer you to a specialist for more targeted care.
Specialists Focused on Non-Surgical Treatment
If the initial conservative measures fail to provide relief, the next step involves consulting specialists focused on non-surgical interventions. The majority of pinched nerves respond well to these treatments, which aim to manage pain and restore function without resorting to an operation.
One such specialist is a Physical Medicine and Rehabilitation (PM&R) physician, also called a physiatrist. Physiatrists specialize in nerve, muscle, and bone disorders and focus on restoring function through comprehensive, non-surgical treatment plans. They are experts in diagnosing the precise location of nerve irritation and often utilize specialized diagnostic tools like electromyography (EMG) and nerve conduction studies to evaluate nerve function.
A Physical Therapist (PT) is often one of the first non-surgical professionals you will see following a diagnosis. The PT’s role is to develop a customized exercise program aimed at strengthening the muscles supporting the neck and improving posture. They employ techniques such as manual therapy, stretching, and neck traction to gently decompress the nerve root and increase the mobility of the cervical spine.
Pain Management Specialists, who are often anesthesiologists or physiatrists with subspecialty training, focus on targeted pain relief procedures. Their specific intervention for a pinched nerve is the epidural steroid injection (ESI). This procedure delivers a powerful anti-inflammatory medication, such as a corticosteroid, directly into the epidural space near the irritated nerve root. Although ESIs do not permanently remove the source of compression, they can significantly reduce the inflammation and pain, providing a window for physical therapy to be more effective.
When to Consult a Spine Surgeon
The decision to consult a spine surgeon is typically reserved for cases where conservative treatments have failed to resolve symptoms over a substantial period, generally between six to twelve weeks. Surgery may also be considered earlier if the patient experiences pain that is intolerable and significantly reduces their quality of life. The goal of a surgical consultation is to evaluate whether a procedure to decompress the nerve root is necessary.
The most pressing reason to consult a surgeon immediately involves the presence of progressive neurological deficits. These “red flag” symptoms include rapidly worsening muscle weakness, loss of coordination, or, rarely, a loss of bowel or bladder control. These signs can indicate severe or worsening nerve compression that may require urgent intervention to prevent permanent nerve damage.
Two types of surgical specialists commonly handle cervical spine issues: Neurosurgeons and Orthopedic Spine Surgeons. Neurosurgeons specialize in the entire nervous system, including the brain, spinal cord, and nerve roots. Orthopedic Spine Surgeons are orthopedic doctors who have completed specialized fellowship training focused exclusively on the spine, treating conditions related to the bones, joints, and soft tissues. For routine cervical radiculopathy requiring decompression, both types of surgeons are considered equally qualified.