For several weeks, Kirti had tried to carry on despite a nagging ache in her shoulder and upper arm.
But the sensation she described as an electric ‘zing’ was becoming impossible to dismiss. It travelled down her arm and, at times, reached her little finger. Concerned by what was happening, she arranged an appointment.
After hearing her symptoms, I explained that I wanted to begin the examination by looking at her neck. She seemed puzzled. The pain was in her shoulder and arm, she reminded me — not her neck.
I understood her point. Patients often ask why doctors examine an area that does not hurt. The answer is that nerves follow connected pathways, meaning pain can be felt far from the place where the problem actually starts.
In Kirti’s case, the source was her neck. Age-related changes in the joints and discs of her spine had irritated a nerve root, causing cervical radiculopathy — commonly known as a trapped or pinched nerve in the neck.
Many people are familiar with sciatica, in which an irritated nerve in the lower back — often because of a disc problem — causes pain down the leg. Cervical radiculopathy is a similar condition, but it affects the upper part of the spine.
Nerve branches leave the spinal cord through narrow openings between the neck bones. When one of these nerve roots becomes compressed, inflamed or irritated, symptoms can appear anywhere along the route it follows.
The result may be neck pain extending into the shoulder, arm or hand. In some cases, however, the discomfort is felt only in the shoulder or arm, with no obvious neck pain at all.
Sciatica is widely recognised as nerve irritation in the lower back that can send pain down the leg, explains Dr Philippa Kaye
Other warning signs include pins and needles in the arm, hand or fingers, areas of reduced sensation and, occasionally, weakness.
Cervical radiculopathy becomes more frequent in middle age, and I regularly see it in women in this age group. Gradual wear in the neck’s discs and joints can reduce the space available for passing nerves.
Modern habits can add to the strain. Spending hours bent over a computer, looking down at a smartphone or holding a phone between the ear and shoulder all place extra pressure on the neck. Stress can contribute, too.
When people feel tense, they often raise their shoulders and draw their head forward in a protective ‘turtle’ posture. Combined with ageing joints, this repeated tension can leave the nerves increasingly irritated.
The condition is frequently missed because it is natural to assume that pain begins where it is felt. Like Kirti, many people conclude they have a shoulder injury and tolerate the symptoms for weeks or even months.
If the assessment focuses solely on the shoulder, the neck-related cause may go undetected. Standard painkillers may also provide little relief when the discomfort is coming from a nerve, leaving patients convinced that nothing will help.
Fortunately, most people improve with time. One of the most important parts of recovery is continuing to move.
Neck pain often makes the surrounding muscles tighten as they try to protect the area, much as you might keep an injured wrist still without thinking. Unfortunately, that muscle spasm can become painful in its own right.
As the muscles remain contracted, they can restrict blood flow through their small internal vessels. They may also tug on nearby joints and nerves, adding to the irritation.
Pain then encourages even less movement. The shoulders become stiff, head-turning is avoided and the body remains guarded. Although this can feel sensible, it creates a cycle in which muscles and joints lose strength and flexibility, recovery slows and further spasms become more likely.
Gentle movement performed regularly can help interrupt that cycle by reducing stiffness, encouraging circulation and loosening tense muscles. Prolonged bed rest, once commonly advised, is more likely to prolong the problem than solve it.
That doesn’t mean pushing through severe pain – just carrying on with normal life and doing simple exercises. Mild discomfort doesn’t mean you’re causing damage.
There are even a specific set of exercises that cervical radiculopathy patients are recommended.
Do them several times a day, ideally after a warm shower when the muscles are looser. Slowly tilt your ear towards your shoulder, hold for a few seconds, then repeat on the other side. Lower your chin to your chest, then slowly look up.
Turn your head to look over one shoulder, then the other. Pull your chin back into a double chin and hold. Add shoulder shrugs and rolls. Move slowly, and stop if anything sharply worsens your symptoms.
GP, author and broadcaster Dr Philippa Kaye
Another important step is to take regular breaks from sitting, and raise your computer screen to eye level to avoid hunching the shoulders.
Heat relaxes tight muscles and cold eases pain – so a heat patch or ice pack, each for about 15 minutes, can help ease some of the uncomfortable symptoms.
Research suggests that managing stress matters to avoid the strain it puts on the joints. This is, of course, often easier said than done.
But relaxation, mindfulness, exercise and good sleep all ease the tension that makes us hunch and clench.
What I’d absolutely avoid is a neck brace or collar. They weaken muscles and prolong stiffness.
If symptoms haven’t improved after a few weeks, or you have weakness, see your GP, who may refer you to a physiotherapist.
In particularly severe cases, patients might be offered injections of local anaesthetic, often with steroid, into tight, tender knots in the muscle can help you get moving again, or steroid injections around the nerve root to reduce inflammation, which can make rehab easier.
Most neck pain is painful but not serious. But see a doctor if you have increasing weakness in your arm or hand, spreading numbness, pain that keeps worsening, or pain after an injury. In rare cases, this can be something serious like cancer.
Thankfully, for Kirti, the problem was indeed cervical radiculopathy and, with the right exercises sustained over several weeks, eventually solved.
But it worries me that so many patients are dealing with this exact injury without doing anything about it. So, if you have shoulder or arm pain, it’s always worth seeing your GP. Suffering like this is needless.