What Is Radiculopathy (Pinched Nerve)? Symptoms, Types, and Treatment

Two of the most common complaints in primary care are neck and back pain. In fact, up to 20% of adults have either neck or back pain at any given time. Sometimes these symptoms are due to radiculopathy. Radiculopathy is more common in the back, but it can also occur in the neck — both of which can affect your daily life. 

Many people can’t enjoy their usual activities due to the pain and weakness radiculopathy can cause. Fortunately, for most people, the pain and discomfort are temporary. If you have radiculopathy, understanding the symptoms, causes, and treatments can help you know what to expect. 

What is radiculopathy?

Radiculopathy is an irritation or compression of a nerve root in the spine. People often call it a “pinched nerve.” But inflammation can cause irritation to the nerve, even if the nerve isn’t pinched or compressed. 

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Types of radiculopathy

There are different types of radiculopathy based on location of the affected nerve root. Nerve roots exit the spinal cord and run near the discs of the spine down to the rest of your body. The nerves then reach the limbs and send signals for movement and sensation to your arms and legs. The type of radiculopathy you have will depend on where the affected nerve is along the spine. 

Types of radiculopathy include:

• Cervical radiculopathy: Nerve roots in the neck or cervical spine 

• Thoracic radiculopathy: Nerve roots in the middle of the back or thoracic spine

• Lumbar radiculopathy: Nerve roots in the low back or lumbar spine

• Lumbosacral radiculopathy: Nerve roots in the lowest part of the spine

What causes radiculopathy?

The causes of radiculopathy can vary based on age and the area of the spine affected. But, in general, the most common causes of radiculopathy are a herniated disc and degenerative disc disease — or changes due to wear and tear. A herniated disc is when the cushion between the bones of your spine slips out of place and pushes on the nerve, which causes pain. 

The most common cause of cervical radiculopathy in younger adults is disc herniation. Certain activities can increase your risk for cervical radiculopathy, including:

• Heavy lifting 

• Handling vibrating equipment

• Smoking

• Having neck trauma

In older adults, radiculopathy is more often due to degenerative changes of the spine. Degenerative changes happen when the cushion of the disc has age-related thinning and damage. With age, arthritis can narrow the canal where the nerve root runs and compress it.

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The most common causes of thoracic radiculopathy are disc disease and nerve damage due to diabetes. In rare cases, it may also be due to thoracic surgery.

Degenerative changes and disc injuries are common causes for lumbar radiculopathy. But other causes may include fractures, tumors, or infections.

Symptoms of radiculopathy

The symptoms of radiculopathy will also vary depending on the nerve root it affects. It typically involves pain, numbness, or weakness. 

Symptoms of cervical radiculopathy include:

• Neck pain that goes down the arm, upper back, or shoulder 

• Numbness and tingling, or an electrical sensation down the arm

• Muscle weakness of the arm or hand

Symptoms of lumbar radiculopathy typically involve sciatica. Sciatica refers to pain that starts at the buttock and shoots down the leg. Sciatica pain can happen with radiculopathy or other irritation of the nerve root. It may also come from irritation of the sciatic nerve itself. 

Common sciatica symptoms include:

• Low-back pain that goes down the leg and foot 

• Numbness and tingling, or a shooting pain down the leg

• Leg or foot weakness (It may cause trouble walking or falls, in severe cases.)

Thoracic radiculopathies aren’t as common. Symptoms include a burning or shooting pain in these areas:

• Upper to middle back

• Torso

• Chest wall

• Abdomen 

• Inner arm 

Radiculopathy diagnosis

A healthcare professional may have different ways to check your radiculopathy symptoms. These can include: 

• Physical exam: This exam will check your muscle strength, reflexes, and sensation.

• Imaging studies: This could include X-rays of the spine or a CT scan. For chronic pain, MRI is the preferred imaging to check for herniated discs and nerve compression. You may also have an MRI before certain treatments, like injection or surgery. 

• Electromyography and nerve conduction studies: These check the function of the nerves and can help find the irritated nerve.

Treatments for radiculopathy

Treatment is conservative for most radiculopathy cases. Most of the time cervical radiculopathy responds well. Similarly, most cases of low back pain with radiculopathy improve spontaneously (on their own).

For cases of radiculopathy that don’t improve, there are many treatments available. Treatments vary based on your symptoms and the severity. 

Treatments for radiculopathy often include:

• Medications

• Injections

• Surgery

• Spinal cord stimulation

• Physical therapy

• Medical devices, such as cervical traction devices and cervical collars

Medications 

There are several medications that can treat nerve root pain. A healthcare professional may prescribe a combination of two or more medications. 

Some medications that can treat radiculopathy are:

• Acetaminophen (Tylenol): Tylenol is commonly used because it’s safe and inexpensive. But be careful not to take more than 4 g per day.

• Nonsteroidal anti-inflammatories (NSAIDs): NSAIDs are only for short-term use, in order to avoid gastric ulcers or cardiovascular complications.

• Oral steroids: Some people improve with a tapered dose of oral steroids. Prednisone is a common one.

• Muscle relaxants: These are a popular option for pain relief, although they may make you drowsy.

• Antiepileptics: These are medications that prevent seizures. But they also help to treat nerve pain. Gabapentin and pregabalin are among the most common. 

• Antidepressants: Duloxetine (Cymbalta) can help treat nerve pain.

• Opioids: These have a potential for abuse and addiction, so they’re only for severe pain and require careful use.

Injections 

Epidural steroid injections help decrease inflammation around the nerve root. These work by injecting the medication into the fluid around the spinal cord. Your healthcare team will use X-rays to make sure you get the injection in the right location. They’ll inject a mixture of a steroid and local anesthesia to relieve pain and inflammation. 

Epidural injections are a common type of injection. You may get immediate relief from your symptoms, but it may not provide long-term relief. Some people may benefit from injections in other locations of the spine as well, like injections in the joints of the spine.

Surgery

Surgery may be an option for people whose symptoms don’t improve with less invasive treatment. Those who have severe symptoms or symptoms that started after an injury may need surgery. 

Examples of severe symptoms that may need surgery include: 

• Severe weakness 

• Loss of bowel or bladder control

• Debilitating pain 

The specific type of surgery depends on the cause of the radiculopathy and the location. Surgery for cervical radiculopathy may be done from the front or the back of the neck. Surgeons also use several techniques for lumbar radiculopathy. Over the years, less invasive procedures have become more common.

Spinal cord stimulator

A spinal cord stimulator is a device that a provider implants under the skin. It transmits electrical pulses to the spinal cord to block pain signals. It may help people who don’t improve with other measures and aren’t able to have surgery. It may even help people who continue to have pain after surgery.

Physical therapy

Physical therapy for cervical radiculopathy may include a combination of treatments, such as:

• Electrical stimulation

• Massage

• Ultrasound 

People with cervical radiculopathy may get relief with exercise. This can be in the form of a physical therapy or home exercise program. Exercise usually includes gentle range of motion exercises as well as strengthening and conditioning exercises. 

Therapies for lumbar radiculopathy may include:

• Lumbar spinal manipulation (A well-trained professional does this.)

• Spinal decompression

• Massage

• Exercise

• Heating pads

• Ice packs

• Electrical stimulation 

There are many benefits of doing exercise for lumbar radiculopathy. Stabilizing the trunk and improving posture are some of the most helpful exercises. Upper and lower extremity strengthening, as well as flexibility exercises, can also help. 

Who should I see if I’m feeling symptoms of radiculopathy?

It’s common to work with a team of healthcare professionals to help manage radiculopathy symptoms. This team may include a physiatrist and a neurologist. An interventional pain management specialist may be helpful if you need injections. If your treatment includes surgery, a spine specialist will be part of the team. A physical therapist and, in some cases, a psychotherapist, may also be helpful — especially if you have issues with chronic pain and disability.

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Written by:

Itza Rivera, MD

Dr. Rivera is a board-certified physical medicine and rehabilitation specialist. She completed her medical degree and residency training at the University of Puerto Rico School of Medicine, and her neuromuscular disorders subspecialty training at Northwestern University.

Edited by:

Karla Robinson, MD

Karla Robinson, MD, is a medical editor for GoodRx. She is a licensed, board-certified family physician with almost 20 years of experience in health through varied clinical, administrative, and educational roles.

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