A pinched nerve in the neck, medically known as cervical radiculopathy, occurs when a nerve root near the spine becomes compressed or irritated. This typically results in pain that radiates from the neck into the shoulder, arm, or hand, often accompanied by numbness, tingling, or muscle weakness. Finding the appropriate medical professional depends heavily on the severity and duration of the symptoms.
The Initial Consultation
The first point of contact for new or worsening neck pain symptoms is usually a Primary Care Provider (PCP) or a physician at an Urgent Care clinic. These providers specialize in assessment, which involves taking a detailed history and performing a physical examination to evaluate strength and reflexes. Their main goal is to screen for signs of more serious conditions, such as spinal cord compression, and to begin conservative treatment.
Management often includes prescribing a short course of non-steroidal anti-inflammatory drugs (NSAIDs) or muscle relaxers to address pain and inflammation. If symptoms persist or suggest nerve involvement, the PCP will initiate the referral process to a specialist for a more focused diagnosis and advanced care.
Non-Surgical Medical Specialists
Once screening is complete, patients are typically referred to medical doctors specializing in musculoskeletal and nervous system disorders for definitive diagnosis and advanced non-surgical treatment. These specialists manage the majority of cervical radiculopathy cases, as most patients improve without the need for surgery.
Physical Medicine and Rehabilitation (PM&R) Physicians
PM&R physicians, also known as physiatrists, are experts in diagnosing and treating nerve and muscle problems. They coordinate comprehensive non-surgical care plans, which frequently include prescribing physical therapy, medication, and functional modifications. A key part of their role is the use of electrodiagnostic studies, such as Nerve Conduction Studies (NCS) and electromyography (EMG), which measure nerve and muscle function. These tests help confirm the specific nerve root affected and differentiate radiculopathy from other conditions.
Neurologists
Neurologists are medical doctors who specialize in the nervous system, including the brain, spinal cord, and peripheral nerves. While they often collaborate with physiatrists, their role is primarily focused on confirming the diagnosis and assessing the severity of nerve damage. They frequently perform and interpret EMG and NCS testing, which provides objective evidence of chronic nerve root compression or irritation. This diagnostic clarity helps determine the most effective long-term treatment strategy.
Pain Management Specialists
For patients whose pain does not respond adequately to conservative measures, a pain management specialist may be consulted. These physicians are trained in interventional procedures aimed at reducing inflammation directly at the source of the irritation. The most common procedure for cervical radiculopathy is an epidural steroid injection (ESI). This delivers an anti-inflammatory corticosteroid into the epidural space surrounding the inflamed nerve root. This targeted injection can provide temporary pain relief, lasting from a few weeks to several months, allowing the patient to participate more fully in rehabilitation. The procedure is performed using fluoroscopy (real-time X-ray guidance) to ensure precise placement of the medication.
Rehabilitation and Manual Therapies
Non-physician professionals play a role in the recovery process, focusing on hands-on techniques and movement to restore function and alleviate nerve pressure. These conservative treatments are often prescribed by medical specialists to address the mechanical factors contributing to nerve irritation.
Physical Therapists (PTs)
Physical therapists are central to conservative management, designing individualized programs aimed at decreasing pain, improving posture, and increasing range of motion. A common technique utilized is cervical traction, which involves gently pulling the head away from the neck to create space in the spinal joints and reduce pressure on the nerve root. PTs also teach specific exercises, such as chin tucks and nerve gliding, to strengthen deep neck muscles and improve the mobility of the irritated nerve. They also provide education on proper body mechanics and ergonomics to prevent symptom recurrence.
Chiropractors
Chiropractors manage musculoskeletal pain through manual adjustments and spinal manipulation. For cervical radiculopathy, this may involve gentle manipulation techniques intended to improve joint mobility in the neck and upper back. Patients seeking chiropractic care should ensure the practitioner is experienced with cervical issues and uses gentle, controlled techniques. Chiropractic treatment is typically integrated into a broader conservative care approach.
Massage Therapists
Massage therapists provide ancillary support by focusing on the soft tissues surrounding the neck and shoulders. A pinched nerve often causes secondary muscle spasms and tension as the body attempts to guard the neck. Therapeutic massage helps to relax these tight muscles, reduce localized pain, and improve blood circulation, which aids in the overall healing process.
Surgical Experts
Surgery is reserved for a small percentage of patients, typically those whose symptoms persist despite 6 to 12 weeks of structured conservative treatment, or those who experience progressive muscle weakness. When surgery becomes necessary, the patient is referred to a spine surgeon.
Neurosurgeons and Orthopedic Spine Surgeons
Both neurosurgeons and orthopedic spine surgeons are qualified to perform the decompression and stabilization procedures used to treat cervical radiculopathy. Neurosurgeons specialize in the entire nervous system, with extensive training in delicate nerve decompression techniques. Orthopedic surgeons specialize in the musculoskeletal system; those who focus on the spine complete fellowship training to become experts in spinal biomechanics and reconstruction. For cervical radiculopathy, both types of fellowship-trained specialists are considered equally qualified to perform the necessary procedures. The choice often depends more on the surgeon’s specific sub-specialty and experience with the patient’s condition.