{"id":27933,"date":"2026-05-14T12:49:47","date_gmt":"2026-05-14T11:49:47","guid":{"rendered":"https:\/\/apps.nhslothian.scot\/refhelp\/?page_id=27933"},"modified":"2026-09-23T10:30:19","modified_gmt":"2026-09-23T09:30:19","slug":"cervical-spine-related-arm-symptoms","status":"publish","type":"page","link":"https:\/\/apps.nhslothian.scot\/refhelp\/cervical-spine-related-arm-symptoms\/","title":{"rendered":"Cervical spine related arm symptoms"},"content":{"rendered":"\n<p class=\"wp-block-paragraph\">Clinical subcatergories within this category include:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Cervical radiculopathy<\/li>\n\n\n\n<li>Radicular arm pain<\/li>\n\n\n\n<li>Non-specific radiating arm pain<\/li>\n<\/ul>\n\n\n\n<h2 class=\"wp-block-heading\">Cervical radiculopathy<\/h2>\n\n\n\n<h4 class=\"wp-block-heading\">Patient resources<\/h4>\n\n\n\n<ul class=\"wp-block-list\">\n<li><a href=\"https:\/\/www.nhsinform.scot\/illnesses-and-conditions\/muscle-bone-and-joints\/neck-and-back-problems-and-conditions\/neck-problems\" target=\"_blank\" rel=\"noreferrer noopener\">NHS Inform &#8211; Neck problems self-management-advice<\/a><\/li>\n\n\n\n<li><a href=\"https:\/\/www.nhsinform.scot\/illnesses-and-conditions\/muscle-bone-and-joints\/neck-and-back-problems-and-conditions\/exercises-for-neck-problems\" target=\"_blank\" rel=\"noreferrer noopener\">NHS Inform &#8211; Exercises for neck problems<\/a><\/li>\n<\/ul>\n\n\n\n<h4 class=\"wp-block-heading\">Definitions<\/h4>\n\n\n\n<p class=\"wp-block-paragraph\">Cervical Radiculopathy is where there is a neurological deficit within the upper limb, often occurring with radicular pain, in keeping with a single nerve root level.<\/p>\n\n\n\n<h4 class=\"wp-block-heading\">Typical Signs &amp; Symptoms<\/h4>\n\n\n\n<p class=\"wp-block-paragraph\">Cervical radiculopathy can present clinically as pain, sensory loss, motor weakness and reflex deficit in the distribution of the affected nerve root.<\/p>\n\n\n\n<h4 class=\"wp-block-heading\">Prevalence<\/h4>\n\n\n\n<p class=\"wp-block-paragraph\">The annual incidence of cervical radiculopathy in men is 107 in 100,000 and in women is 64 in 100,000.&nbsp; The most commonly affected nerve roots are C7 (50 &#8211; 70%), C6 (&gt;20%), C8 (10%), and C5 (2 &#8211; 10%).<\/p>\n\n\n\n<h4 class=\"wp-block-heading\">Risk Factors<\/h4>\n\n\n\n<ul class=\"wp-block-list\">\n<li>White race<\/li>\n\n\n\n<li>Cigarette smoking<\/li>\n\n\n\n<li>Prior lumbar radiculopathy<\/li>\n\n\n\n<li>Other risk factors that have been proposed include lifting heaving objects, frequent diving from a board and driving equipment that vibrates.<\/li>\n<\/ul>\n\n\n\n<h4 class=\"wp-block-heading\">Prognosis<\/h4>\n\n\n\n<p class=\"wp-block-paragraph\">Most people with cervical radiculopathy will improve regardless of the treatment, with over 85% of acute cervical radiculopathy&nbsp;resolving&nbsp;without any specific&nbsp;treatments, within 8 to 12 weeks.<\/p>\n\n\n\n<h4 class=\"wp-block-heading\">Differential diagnosis<\/h4>\n\n\n\n<p class=\"wp-block-paragraph\">The differential diagnosis is broad but includes trauma and non-musculoskeletal disease processes that can be classified as neoplastic, inflammatory, infectious, vascular, endocrinological or neurological.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">Radicular arm pain<\/h2>\n\n\n\n<h4 class=\"wp-block-heading\">Patient resources<\/h4>\n\n\n\n<ul class=\"wp-block-list\">\n<li><a href=\"https:\/\/www.nhsinform.scot\/illnesses-and-conditions\/muscle-bone-and-joints\/neck-and-back-problems-and-conditions\/neck-problems\" target=\"_blank\" rel=\"noreferrer noopener\">NHS Inform &#8211; Neck problems self-management-advice<\/a><\/li>\n\n\n\n<li><a href=\"https:\/\/www.nhsinform.scot\/illnesses-and-conditions\/muscle-bone-and-joints\/neck-and-back-problems-and-conditions\/exercises-for-neck-problems\" target=\"_blank\" rel=\"noreferrer noopener\">NHS Inform &#8211; Exercises for neck problems<\/a><\/li>\n<\/ul>\n\n\n\n<h4 class=\"wp-block-heading\">Definitions<\/h4>\n\n\n\n<p class=\"wp-block-paragraph\">Radicular arm pain describes pain in one or both arms, often on the background of neck pain. The pain typically corresponds to a specific dermatomal pattern, without any clinical signs of reduced nerve function.<\/p>\n\n\n\n<h4 class=\"wp-block-heading\">Typical signs &amp; symptoms<\/h4>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Unilateral or bilateral arm pain in a dermatomal pattern<\/li>\n\n\n\n<li>Neck pain \u2013 if present, which is less severe than any arm pain<\/li>\n\n\n\n<li>Neurological examination of the arms is expected to be normal. If there are signs of loss of nerve function in keeping with the corresponding nerve root level to the pain distribution, consider cervical radiculopathy as the clinical diagnosis.<\/li>\n<\/ul>\n\n\n\n<h4 class=\"wp-block-heading\">Prevalence<\/h4>\n\n\n\n<p class=\"wp-block-paragraph\">Studies report radicular arm pain has an annual incidence of 63 to 107 cases per 100,000, and incidence peaks in the fourth and fifth decades.<\/p>\n\n\n\n<h4 class=\"wp-block-heading\">Risk Factors<\/h4>\n\n\n\n<ul class=\"wp-block-list\">\n<li>White race<\/li>\n\n\n\n<li>Cigarette smoking<\/li>\n\n\n\n<li>Prior lumbar\/cervical radiculopathy<\/li>\n\n\n\n<li>Other risk factors that have been proposed include lifting heaving objects, frequent diving from a board and driving equipment that vibrates.<\/li>\n<\/ul>\n\n\n\n<h4 class=\"wp-block-heading\">Prognosis<\/h4>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Episodes of radicular arm pain are usually transient, with improvements in pain and disability seen within a few weeks to a few months<\/li>\n\n\n\n<li>Half of people recover spontaneously within 6 weeks<\/li>\n\n\n\n<li>reoccurence&nbsp;of symptoms is common<\/li>\n<\/ul>\n\n\n\n<h4 class=\"wp-block-heading\">Factors associated with a poorer prognosis<\/h4>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Workplace factors &#8211; time off work, problems or dissatisfaction at work, heavy work, or working unsociable hours<\/li>\n\n\n\n<li>Psychological factors &#8211; low or negative moods, stress, overprotective family, lack of support, social withdrawal, the belief that pain and activities are harmful, belief that the problem will last a long time and inappropriate expectations of treatment.<\/li>\n<\/ul>\n\n\n\n<h4 class=\"wp-block-heading\">Differential diagnosis<\/h4>\n\n\n\n<p class=\"wp-block-paragraph\">The differential diagnosis is broad but includes trauma and non-musculoskeletal disease processes that can be classified as neoplastic, inflammatory, infectious, vascular, endocrinological or neurological.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">For example, you may wish to consider;<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Shoulder\/elbow\/wrist pathology<\/li>\n\n\n\n<li>Acute trauma \u2013 eg whiplash<\/li>\n\n\n\n<li>Cervical myelopathy<\/li>\n\n\n\n<li>Non MSK causes of neck\/arm pain<\/li>\n\n\n\n<li>Vascular conditions (thoracic outlet syndrome)<\/li>\n\n\n\n<li>Connective tissue disorders like polymyalgia rheumatica<\/li>\n<\/ul>\n\n\n\n<h2 class=\"wp-block-heading\">Non-specific radiating arm pain<\/h2>\n\n\n\n<h4 class=\"wp-block-heading\">Patient resources<\/h4>\n\n\n\n<ul class=\"wp-block-list\">\n<li><a href=\"https:\/\/www.nhsinform.scot\/illnesses-and-conditions\/muscle-bone-and-joints\/neck-and-back-problems-and-conditions\/neck-problems\" target=\"_blank\" rel=\"noreferrer noopener\">NHS Inform &#8211; Neck problems self-management-advice<\/a><\/li>\n\n\n\n<li><a href=\"https:\/\/www.nhsinform.scot\/illnesses-and-conditions\/muscle-bone-and-joints\/neck-and-back-problems-and-conditions\/exercises-for-neck-problems\" target=\"_blank\" rel=\"noreferrer noopener\">NHS Inform &#8211; Exercises for neck problems<\/a><\/li>\n<\/ul>\n\n\n\n<h4 class=\"wp-block-heading\">Definition<\/h4>\n\n\n\n<p class=\"wp-block-paragraph\">Non-specific or somatic radiating arm pain can describe pain referred into the shoulder or arm from the cervical spine that is not related to irritation or compression of a nerve root.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">It is often characterised by an absence of objective physical findings and symptoms that do not correspond with objective spinal pathophysiology.<\/p>\n\n\n\n<h4 class=\"wp-block-heading\">Typical signs &amp; symptoms<\/h4>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Pain is described as dull, aching, gnawing and pressure with or without paraesthesia.<\/li>\n\n\n\n<li>Often activity related<\/li>\n\n\n\n<li>Usually felt deep and rarely cutaneous.<\/li>\n\n\n\n<li>It covers a wide area, is difficult to localise or put into words, and non-dermatomal.<\/li>\n\n\n\n<li>It can be in the shoulder area, upper arm, occasionally the whole arm.<\/li>\n\n\n\n<li>Often disproportionate pain and disability<\/li>\n<\/ul>\n\n\n\n<h4 class=\"wp-block-heading\">Prevalance<\/h4>\n\n\n\n<p class=\"wp-block-paragraph\">Variable from limited research available. In a 16-year study in Sweden, the prevalence of self-reported neck-shoulder-arm pain rose gradually, from 23% to 25% in women and from 13% to 15.% in men<\/p>\n\n\n\n<h4 class=\"wp-block-heading\">Risk Factors<\/h4>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Psychological factors such as catastrophic thinking, symptoms of depression or anxiety, and heightened illness concern.<\/li>\n\n\n\n<li>Dissatisfaction with support from colleagues or supervisors&nbsp;<\/li>\n\n\n\n<li>Ineffective stress management, poor sleep and social factors such as lack of social support and poor relationships.<\/li>\n<\/ul>\n\n\n\n<h4 class=\"wp-block-heading\">Differential diagnosis<\/h4>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Fibromyalgia<\/li>\n\n\n\n<li>Complex regional pain syndrome<\/li>\n\n\n\n<li>Shoulder pain<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>M.A &amp; P.A &#8211; 14-05-26<\/strong><\/p>\n\n\n\n<div class=\"wp-block-getwid-tabs\" data-active-tab=\"0\"><ul class=\"wp-block-getwid-tabs__nav-links\"><\/ul>\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\"><strong>Referral Guidelines<\/strong><\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<h4 class=\"wp-block-heading\">Who can refer: <\/h4>\n\n\n\n<ul class=\"wp-block-list\">\n<li>All primary care clinicians i.e. GPs, Primary care MSK advanced practice physiotherapists, advanced nurse practitioners <\/li>\n\n\n\n<li>Patient self referral (resident of East Lothian HSCP, Edinburgh HSCP and West Lothian HSCP <a href=\"https:\/\/services.nhslothian.scot\/musculoskeletal\/where-to-find-us\/\" target=\"_blank\" rel=\"noreferrer noopener\">Where To Find Us \u2013 Musculoskeletal Physiotherapy<\/a>)<\/li>\n\n\n\n<li>Secondary care consultants and associated teams<\/li>\n\n\n\n<li>MSK physiotherapists are able to escalate\/refer to advanced practice physiotherapists underpinned by agreed pathways and processes<\/li>\n<\/ul>\n\n\n\n<h4 class=\"wp-block-heading\">Who to refer:<\/h4>\n\n\n\n<ul class=\"wp-block-list\">\n<li>All routine cases of cervical spine pain and cervical spine related arm symptoms who have not responded to initial primary care management within a 4-6 week period and&nbsp;do not have the presence of significant red flags nor have suspected inflammatory spinal pain \u2013 see sections serious cervical spine conditions and other considerations and inflammatory spinal pain<\/li>\n\n\n\n<li>Cervical Spine related arm symptoms-&nbsp; Consider earlier referral in cases intractable symptoms and\/ or developing motor deficit but without significant red flags<\/li>\n\n\n\n<li>Non-specific cervical spine pain in the absence of a dominant psychological component who have not received recent physiotherapy for their condition or who have received physiotherapy previously for their condition but;<ul><li>have experienced a substantial change in their presentation<\/li><\/ul><ul><li>require assistance with achieving a functional goal<\/li><\/ul><ul><li>wish further assessment and considerations of management options<\/li><\/ul>\n<ul class=\"wp-block-list\">\n<li>have clinical features suggestive of an underlying specific cause for their cervical spine&nbsp; pain, in which further investigation would guide management (other than serious spinal pathology).<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li>Additional information regarding imaging available for xray and MRI found at radiology ref help spine <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/radiology\/plain-x-rays\/\" target=\"_blank\" rel=\"noreferrer noopener\">Plain X-Rays \u2013 RefHelp<\/a><\/li>\n<\/ul>\n\n\n\n<h4 class=\"wp-block-heading\">Who not to refer:<\/h4>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Patients who have the presence of significant red flags\/ suspicion of serious cervical spine condition or have suspected inflammatory spinal pain&nbsp;<\/strong>\u2013 see&nbsp;<a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/serious-cervical-spine-conditions-red-flags\/\" target=\"_blank\" rel=\"noreferrer noopener\">Serious cervical spine conditions (Red Flags) \u2013 RefHelp<\/a><\/li>\n\n\n\n<li><strong>Age &lt;16<\/strong><\/li>\n\n\n\n<li>Chronic cervical spine pain with a significant psychological \/ psychiatric \/ drug addiction element\/ pain causing significant distress &amp; disability, no planned referral to another speciality for diagnosis or treatment of pain \u2013 see Chronic pain&nbsp;<a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/chronicpain\/\" target=\"_blank\" rel=\"noreferrer noopener\">Chronic Pain \u2013 RefHelp<\/a>.<\/li>\n<\/ul>\n\n\n\n<h4 class=\"wp-block-heading\">How to refer:<\/h4>\n\n\n\n<ul class=\"wp-block-list\">\n<li>For all cases of routine cervical spine pain \/ spine related arm symptoms\u2013 refer via&nbsp;<strong>SCI Gateway Referral \u201cAHP-Physiotherapy\u201d then choose local site.<\/strong><\/li>\n\n\n\n<li>Please include all relevant details on your referral to allow the appropriate initial triage of the patient. Initial triage will occur within MSK Physiotherapy and if appropriate will be passed to spinal advanced practice physiotherapy service.<\/li>\n\n\n\n<li>Please signpost patients to&nbsp;<a href=\"https:\/\/services.nhslothian.scot\/ibps\/\" target=\"_blank\" rel=\"noreferrer noopener\">Integrated Spinal Service Webpage<\/a>&nbsp;for patient information.<\/li>\n<\/ul>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Primary Care Management<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<p class=\"wp-block-paragraph\">For further information see associated sections<\/p>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Resources and Links<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<ul class=\"wp-block-list\">\n<li>Link to NHS Lothian patient internet site including patient information resources \u2013&nbsp;<a href=\"https:\/\/services.nhslothian.scot\/musculoskeletal\/neck-pain\/\" target=\"_blank\" rel=\"noreferrer noopener\">Neck Pain \u2013 Musculoskeletal Physiotherapy<\/a><\/li>\n\n\n\n<li>Link to NHS Inform page cervical spine &nbsp;problems&nbsp;\u2013<a href=\"https:\/\/www.nhsinform.scot\/illnesses-and-conditions\/muscle-bone-and-joints\/neck-and-back-problems-and-conditions\/neck-problems\" target=\"_blank\" rel=\"noreferrer noopener\">\u200bNeck problems | NHS inform<\/a><\/li>\n\n\n\n<li>Link to NHS Inform page- neck conditions <a href=\"https:\/\/www.nhsinform.scot\/illnesses-and-conditions\/muscle-bone-and-joints\/neck-and-back-problems-and-conditions\/\" target=\"_blank\" rel=\"noreferrer noopener\">Neck and back problems and conditions | NHS inform<\/a><\/li>\n\n\n\n<li>Link to NHS Inform page- Exercises for neck problems <a href=\"https:\/\/www.nhsinform.scot\/illnesses-and-conditions\/muscle-bone-and-joints\/neck-and-back-problems-and-conditions\/exercises-for-neck-problems\" target=\"_blank\" rel=\"noreferrer noopener\">Exercises for neck muscle and joint problems | NHS inform<\/a><\/li>\n\n\n\n<li>Link to intranet site NHS Lothian Integrated Spinal Service <a href=\"https:\/\/services.nhslothian.scot\/integratedspinalservice\/\" target=\"_blank\" rel=\"noreferrer noopener\">Integrated Spinal Service \u2013 NHS Lothian | Our Services<\/a><\/li>\n<\/ul>\n<\/div><\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p>Clinical subcatergories within this category include: Cervical radiculopathy Patient resources Definitions Cervical Radiculopathy is where there is a neurological deficit within the upper limb, often occurring with radicular pain, in keeping with a single nerve root level. Typical Signs &amp; Symptoms Cervical radiculopathy can present clinically as pain, sensory loss, motor weakness and reflex deficit<\/p>\n","protected":false},"author":20,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_searchwp_excluded":"","footnotes":""},"categories":[424,1394],"class_list":["post-27933","page","type-page","status-publish","hentry","category-cervical-thoracic-spine","category-https-apps-nhslothian-scot-refhelp-cervical-spine-related-arm-symptoms"],"publishpress_future_workflow_manual_trigger":{"enabledWorkflows":[]},"rttpg_featured_image_url":null,"rttpg_author":{"display_name":"mariamazoysaavedra","author_link":"https:\/\/apps.nhslothian.scot\/refhelp\/author\/mariamazoysaavedra\/"},"rttpg_comment":0,"rttpg_category":" <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/category\/musculoskeletal-physiotherapy\/cervical-thoracic-spine\/\" rel=\"tag\">Cervical \uff06 Thoracic Spine<\/a><a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/category\/musculoskeletal-physiotherapy\/cervical-thoracic-spine\/https-apps-nhslothian-scot-refhelp-cervical-spine-related-arm-symptoms\/\" rel=\"tag\">Cervical spine related arm symptoms<\/a>","rttpg_excerpt":"Clinical subcatergories within this category include: Cervical radiculopathy Patient resources Definitions Cervical Radiculopathy is where there is a neurological deficit within the upper limb, often occurring with radicular pain, in keeping with a single nerve root level. Typical Signs &amp; Symptoms Cervical radiculopathy can present clinically as pain, sensory loss, motor weakness and reflex deficit","_links":{"self":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/27933","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/users\/20"}],"replies":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/comments?post=27933"}],"version-history":[{"count":9,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/27933\/revisions"}],"predecessor-version":[{"id":30143,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/27933\/revisions\/30143"}],"wp:attachment":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/media?parent=27933"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/categories?post=27933"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}