Nerve pain
Cervical Radiculopathy (Pinched Nerve in the Neck)
A pinched nerve in the neck causes arm pain, tingling or weakness; most improve in weeks. Nerve map, injection safety, and when surgery is needed. Houston.
Cervical radiculopathy is pain, tingling, numbness or weakness that travels from the neck down the arm because a nerve root is being compressed or inflamed where it leaves the spine, usually by a herniated disc in younger adults or a bone spur in older ones. It follows a predictable map: which fingers tingle tells the physician which nerve is involved. Most people improve substantially within 6–12 weeks without surgery. Gulf Coast Pain & Spine confirms the level with an exam and MRI, treats persistent arm pain with cervical epidural steroid injections performed under strict safety protocols, and refers for surgery when weakness or unrelenting pain calls for it, at its Houston and Webster offices and, from November 2026, in Pearland.
Key facts
| What it is | Compression or inflammation of one of the eight cervical nerve roots. C7 (at the C6–7 disc) is the most common, followed by C6 (at C5–6); together they account for about 70% of cases. |
|---|---|
| Most common causes | Foraminal narrowing from bone spurs and disc degeneration (about 70–75%, mostly over age 50) and disc herniation (about 20–25%, mostly ages 30–50). |
| Typical course | Favorable. In long-term studies, about 75–90% of people improve substantially with nonsurgical care, most within 6–12 weeks, though numbness can linger for months. |
| See a specialist when | Arm pain has lasted more than 4–6 weeks, there is any weakness or worsening numbness, or pain is not controlled with medication and activity changes. |
| Treatments we offer | Medication review, coordinated therapy, cervical interlaminar epidural steroid injection, selective nerve root block for diagnosis, and referral for surgical opinion when criteria are met. |
When to get emergency care
Seek emergency care or call 911 if you have arm symptoms with any of these:
- Clumsy hands on both sides, trouble with buttons or handwriting, dropping objects, or a change in walking or balance. These are signs of spinal cord compression (myelopathy), not a simple pinched nerve, and need urgent evaluation.
- Arm or hand weakness that is getting worse over hours to days, or weakness in a leg.
- New trouble controlling your bladder or bowel.
- Symptoms that began after a fall, car accident, or diving injury, until a fracture or instability is ruled out.
- Arm pain with chest pressure, shortness of breath, sweating or nausea, particularly on the left side. Rule out a heart cause first.
- Fever with severe neck pain, or a history of cancer with new neck and arm pain.
Mild, stable weakness in one muscle group (for example slightly weaker triceps) is common with radiculopathy and is followed rather than operated on. Weakness that is progressing or involves the hand's fine control is different.
What a pinched nerve in the neck is
Eight pairs of nerve roots leave the cervical spine through small openings (foramina) between the vertebrae. Each root carries sensation from a strip of skin and power to a set of muscles in the shoulder, arm and hand. When a root is squeezed or irritated at its exit, it produces symptoms along its entire territory even though the problem is in the neck. That is radiculopathy, and it is why a nerve pinched at C6 makes the thumb tingle.
The compression comes from two sources. In people under 50 it is usually a herniated disc: the disc's soft center pushes out sideways into the foramen. In people over 50 it is usually bone: the joints at the front (uncovertebral) and back (facet) of the vertebra develop spurs as the disc flattens, and the spur narrows the foramen. The second type tends to come on more gradually and to recur.
Inflammation matters as much as pressure: disc material sets off a chemical reaction around the nerve, and an inflamed nerve hurts at a pressure a healthy one would tolerate. That is why steroid injections work; they reduce inflammation, not the size of the herniation.
Symptoms and the nerve map
The classic picture is neck pain that is overshadowed by arm pain: sharp, burning or electric pain running from the neck across the shoulder and down the arm, with tingling or numbness in specific fingers and sometimes weakness in specific movements. Turning or tilting the head toward the painful side, looking up, and coughing make it worse. Many people find relief by resting the hand on top of the head, which takes tension off the root.
Each root has a signature:
- C5 (C4–5 disc): pain in the shoulder and outer upper arm; numbness over the deltoid; weakness lifting the arm out to the side and bending the elbow.
- C6 (C5–6 disc): pain down the outer arm to the thumb and index finger; numbness in the thumb; weakness in the biceps and in bending the wrist back; reduced biceps reflex.
- C7 (C6–7 disc): pain down the back of the arm to the middle finger; numbness in the middle finger; weakness straightening the elbow (triceps) and bending the wrist; reduced triceps reflex. The most common level.
- C8 (C7–T1 disc): pain along the inner forearm to the ring and small fingers; numbness in those fingers; weak grip and finger flexion.
What it is not. Numbness in the thumb, index and middle fingers that wakes you at night and improves with shaking the hand is usually carpal tunnel syndrome, not C6. Ring and small finger numbness with elbow pain is often the ulnar nerve at the elbow rather than C8. Shoulder pain that worsens with reaching overhead and does not go below the elbow is usually the rotator cuff. Bilateral hand clumsiness with unsteady walking is myelopathy. Sorting these out is the main job of the first visit.
Natural history. Cervical radiculopathy usually gets better. In a long-term population study, about 90% of people were asymptomatic or only mildly bothered at final follow-up, and roughly one in three had a recurrence at some point. Pain typically improves over 6–12 weeks; numbness and weakness recover more slowly.
How we diagnose it
The exam confirms that symptoms follow a root and identifies which one. We test strength in each muscle group listed above, check the biceps, triceps and brachioradialis reflexes, map sensation finger by finger, and perform Spurling's test (extending, tilting and pressing on the head toward the painful side). A positive Spurling's test is highly specific for radiculopathy. We also check the wrist and elbow for carpal tunnel and ulnar nerve signs, the shoulder for rotator cuff signs, and the legs and gait for any evidence of myelopathy.
MRI of the cervical spine is the imaging test of choice and is ordered when arm symptoms have lasted more than 4–6 weeks, when there is weakness, when a red flag is present, or before any injection, because the injection must be planned around your specific anatomy. The MRI must match the exam: foraminal narrowing is present at multiple levels in most adults over 50, so a narrowed foramen is only meaningful at the level the symptoms point to. EMG and nerve conduction studies are ordered when the exam and MRI disagree, or to separate a C6 root from carpal tunnel, or C8 from the ulnar nerve.
When the MRI shows possible compression at two adjacent levels and the exam cannot separate them, a selective nerve root block answers the question. A small amount of anesthetic is placed at one root under X-ray guidance; if the arm pain disappears for the hours the anesthetic works, that root is the source. This is a test, not a treatment, and its main use is to direct a surgeon to the right level.
Treatment options, in order
Because most people recover on their own, the first 4–6 weeks focus on comfort and protecting the nerve. Injections are for pain that is severe or not improving on schedule. Surgery is reserved for weakness, myelopathy, or pain that has outlasted everything else.
- Weeks 1–6: activity changes and medication
Avoid the positions that provoke the arm pain (looking up, turning toward the painful side, carrying on that arm). NSAIDs for 1–2 weeks if safe; a short oral steroid taper is often used for severe early pain; gabapentin or pregabalin for burning nerve pain, though the evidence is modest. Learn more →
- Physical therapy
Nerve gliding, gentle traction, postural correction and scapular strengthening once the sharpest pain has eased, typically from week 2–3. Manual cervical traction gives short-term relief for some people. Learn more →
- Cervical epidural steroid injection
For arm pain that is severe or persists beyond 4–6 weeks with a matching MRI. Steroid placed in the epidural space to reduce inflammation around the root. Relief typically begins within 2–7 days; about half to two-thirds of people get meaningful relief lasting weeks to months. Limited to 3–4 per year, repeated only if the first helped. Learn more →
- Selective nerve root block
A diagnostic test to confirm the symptomatic level when imaging is ambiguous, usually before a surgical decision. Learn more →
- Surgical referral
Anterior cervical discectomy and fusion or artificial disc replacement, or posterior foraminotomy for a single-level soft herniation. Relieves arm pain in about 80–90% of patients who meet the criteria below. Learn more →
- Neuromodulation
Spinal cord or dorsal root ganglion stimulation for arm nerve pain that persists after surgery or when surgery is not possible. Learn more →
Cervical epidural injections: how we keep them safe
Epidural injections in the neck carry a small but real risk that lumbar injections do not: the spinal cord and the arteries feeding it sit close to the needle path. Rare cases of spinal cord injury and stroke have been reported, mostly with transforaminal injections using particulate steroids, which led the FDA in 2014 to add a warning to all injectable corticosteroids. Multisociety safety guidelines published in 2015 set out the measures that reduce this risk to a very low level, and we follow them:
- An MRI is reviewed before every cervical injection to confirm there is room for the needle at the chosen level.
- The interlaminar approach is used at C7–T1 (or C6–7 only when imaging confirms adequate space), where the epidural space is widest, rather than at the level of the herniation.
- Real-time X-ray (fluoroscopy) guidance with contrast dye to confirm the medication is going where intended before any steroid is injected.
- If a transforaminal approach is ever used in the neck, only a non-particulate steroid (dexamethasone) is injected, because particulate steroids are the ones linked to the serious events.
- Sedation is kept light so you can report any unusual sensation during the procedure.
Common side effects are the same as any epidural: a sore neck for a day or two, a temporary rise in blood sugar in diabetics, and flushing or poor sleep for a night from the steroid. Ask which approach we recommend for you.
When surgery is the right answer
Most cervical radiculopathy does not need surgery, and for pain alone, waiting is reasonable because the natural history is good. We refer for a surgical opinion when any of the following is present:
- Progressive weakness in the arm or hand, or significant weakness at presentation (for example, unable to hold the arm up against gravity).
- Any sign of myelopathy: hand clumsiness, gait change, brisk reflexes, or cord signal change on MRI. This is urgent.
- Severe, disabling arm pain that has not responded after 6–12 weeks of medication, therapy and at least one well-placed epidural injection, with an MRI that shows compression at the level the symptoms indicate.
- Recurrent radiculopathy at the same level when the cycle is affecting work or function.
Surgery is not indicated for numbness alone, for neck pain without arm symptoms, or for imaging findings that do not match the exam. When we refer, we send the exam findings, the MRI, and the results of any diagnostic block so the surgeon starts with a clear target.
What you can do now
- Rest the hand on your head when the arm pain flares; if it helps, that is both relief and a clue.
- Avoid looking up and turning toward the painful side for the first few weeks. Move the whole body instead of the neck to check blind spots when driving.
- Sleep on your back or the unaffected side with one supportive pillow; a pillow under the painful arm reduces pull on the root.
- Take NSAIDs on a schedule for 1–2 weeks if your doctor has said they are safe.
- Test your strength each week: push against a wall (triceps), lift a full cup (biceps), squeeze a hand (grip). Report any loss.
Frequently asked questions
How long does a pinched nerve in the neck take to heal?
Pain usually improves over 6–12 weeks, sometimes faster with an epidural injection. Numbness and weakness recover more slowly, over months, and a small patch of numbness sometimes remains. About 75–90% of people recover without surgery.
Which fingers are affected by which nerve?
C6 goes to the thumb and index finger, C7 to the middle finger, and C8 to the ring and small fingers. C5 does not reach the hand; it affects the outer shoulder. If your pattern does not fit a single root, the problem may be carpal tunnel, the ulnar nerve at the elbow, or more than one level.
Is a cervical epidural injection dangerous?
Serious complications are rare and are almost entirely linked to transforaminal injections with particulate steroids, which we avoid. With an MRI reviewed beforehand, an interlaminar approach at C7–T1, live X-ray with contrast, and light sedation, the risk is very low. The common side effects are a sore neck for a day or two and a temporary rise in blood sugar.
Will an MRI show a pinched nerve?
MRI shows the disc herniation or bone spur that is narrowing the nerve's exit. It cannot show whether the nerve is irritated, and most adults over 50 have narrowing at several levels without symptoms. The MRI is only meaningful when it matches the exam. When it does not, a selective nerve root block or EMG settles it.
Can a pinched nerve in the neck cause chest pain?
C6 and C7 radiculopathy occasionally refers pain to the chest wall or shoulder blade, but arm and chest pain together should be evaluated for a heart cause first, especially with pressure, sweating or shortness of breath. Once the heart is cleared, a nerve root source is straightforward to confirm.
What is the difference between radiculopathy and myelopathy?
Radiculopathy is a single nerve root pinched as it exits the spine; it affects one arm in a specific pattern and usually gets better. Myelopathy is compression of the spinal cord itself; it causes clumsy hands on both sides, unsteady walking and brisk reflexes, often with little pain, and it tends to worsen. Myelopathy is treated surgically and the earlier the better.
Should I see a pain specialist or a surgeon for a pinched nerve?
For arm pain without progressive weakness or myelopathy, a pain specialist is the right first stop: most cases resolve with medication, therapy and, when needed, an epidural injection. We refer to a surgeon promptly when weakness is progressing, when myelopathy is present, or when pain has outlasted 6–12 weeks of complete nonsurgical care.
Sources
- Cervical Radiculopathy (Pinched Nerve) (opens in new tab) — American Academy of Orthopaedic Surgeons, OrthoInfo
- Diagnosis and Treatment of Cervical Radiculopathy from Degenerative Disorders: Evidence-Based Clinical Guidelines (opens in new tab) — North American Spine Society
- FDA Drug Safety Communication: Rare but serious neurologic problems after epidural corticosteroid injections for pain (2014) (opens in new tab) — U.S. Food and Drug Administration
- Safeguards to Prevent Neurologic Complications after Epidural Steroid Injections: Consensus Opinions from a Multidisciplinary Working Group and National Organizations (opens in new tab) — Anesthesiology, 2015
- Epidemiology of cervical radiculopathy: a population-based study from Rochester, Minnesota, 1976 through 1990 (opens in new tab) — Brain, 1994
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Call (832) 916-2075 or request an appointment online. New patients are welcome; the team confirms insurance and referral requirements before scheduling.