“It was just occasional neck pain that went down to my arm. The numbness slowly developed about two months ago — it ran down my palm and my fingers, but I could live with it. Last week, I noticed my arm was getting weak. I wasn’t able to lift the grocery bag, which I had no issue lifting the week before.”

Does this sound like you? First and foremost — this is not the end. It does not necessarily lead to surgery.

This is a commonly encountered case in our centre. In the other article — “Why Is My Neck Pain Spreading to My Arm?”, you learned how an impinged nerve leads to pain down the arm (radicular pain). In this article, we talk about how a nerve impingement causes weakness in your arm, how we diagnose it, and what can be done.

 

How does my neck pain make my arm weak? 

Let’s first understand the underlying mechanism of how neck pain weakens your arm. This is known as cervical radiculopathy — it is caused by compression and inflammation of a nerve root, related to:

• Disc-related issues. Among the most commonly seen disc-related issues are:
• Disc herniation — the intervertebral disc is made up of a gel-like substance that helps with weight distribution and supports spinal movement. When the spine is subjected to mechanical stress, such as repeated torsional strain, heavy lifting, or poor posture, it puts excessive pressure on the disc, causing it to push backward at its weakest point (Figure 1), compressing the nerve root. This is more common in young adults, where the disc still has high gel-like content.

Figure 1: Herniated (slipped) disc causing nerve compression.

Image source: Image source: Cleveland Clinic (2024).Used for educational purposes.

• Disc desiccation – ‘drying up’ of disc content. The gel-like substance of the disc also provides height between two segments of the vertebral bodies, creating a safe passage for the nerve to exit the foramen. As we age, this gel-like substance in the intervertebral disc loses its height, and the nerve root exit narrows. The desiccated discs appear darker, as seen in Figure 2, and can also shift backward or sideways into the vertebral foramen, further compressing the nerve root. This is commonly observed in a degenerated spine of an older adult. 

Figure 2: Cervical spine MRI showing disc desiccation at C5/6.
Image source: ResearchGate (Rissardo, J.)

• cervical spondylosis: 

• refers to bone spurs around the foramen, a ‘canal’ where the nerve roots exit the vertebrae. Bone spurs form in our vertebrae due to the ageing process or repetitive overuse / overload such as poor posture. Trauma, such as an accident that impacts the neck, is also one of the contributing factors to early degenerative changes that lead to bone spur formation.

Degenerative changes in disc height and bone spurs cause narrowing of the intervertebral foramen, compressing the nerve root, known as stenosis — a more severe form of disruption to your nerve as compared to just irritation like what we discussed earlier in the other article. Stenosis leads to mechanical compression, reduced blood supply (ischaemia), and also chemical irritation of the nerve. It then presents as pain, numbness, and weakness in your arm.

About 4 in 5 people with cervical radiculopathy are found to have cervical spondylosis, while 1 in 5 people are affected by intervertebral disc-related issues.

Do you need an MRI?

If you are already experiencing weakness in the arm or forearm, we recommend that you see a spine surgeon for further assessment and imaging investigation. MRI is the gold standard for diagnosing stenosis in the spine, where the affected segments, the pathology, and the severity can be clearly visualised. The imaging helps medical professionals rule out any potentially dangerous diagnoses and ascertain which segments of the neck and the nerves are affected. The MRI findings that correlate with the physical examination findings by your physiotherapist help to pin-point which segment of the neck to focus the treatment on, which mechanism of neck pain to modify to offload the nerve mechanically, and what can be done with the muscles to ease the loading on the spine and disc.

How We Diagnose It

 

Similar to what you learned earlier in the other article – ‘Is My Neck Pain Coming from a Muscle or a Nerve?’, we go through similar steps to come to a diagnosis.

Step 1: A thorough assessment of your case history 

• We discuss your symptoms, daily activities, previous injuries, what aggravates the pain, and what eases it. We also need to look into the history and the progression of the pain and other problems related to it.

Step 2: Palpation & Movement testing, neurological assessment 

• We assess your neck range of motion, assessing your posture, and examining all segments of your cervical spine, assess your neck muscle length.

For cervical radiculopathy, we emphasise on neurological assessment as seen in Figure 3 below.  We assess both sides of your arm and forearm to compare:

• Tendon reflexes – tendon reflexes tell us how bad the nerves are compressed. A trained physiotherapist is able to grade the response of your reflexes when testing  different nerves at different areas in your upper limb. If the reflex is delayed below normal grade, it reflects that the tested nerve is compressed.
• Sensation – the skin sensation is tested with light touch using a tissue paper, and pinprick using a paper clip. If the sensation reduced as compared to the unaffected arm, it indicated a positive sign that the nerve functions are compromised.
• Muscle strength – when inflammation in the nerve disrupts its functions, one of the positive signs is muscle weakness. We perform resisted muscle tests to assess the strength of the affected muscles. In most cases, the muscle weakness correlates to the level of nerve root stenosis in the neck, while other muscles supplied by nerves from other unaffected levels of the neck preserve their strength, or minimally affected. 

Figure 3: Neurological tests help physiotherapists to determine the levels of affected nerves and the severity of the compression.

 

Step 3: Special tests 

 

• We conduct special tests such as Spurling’s test & other tests that help us rule out alternative hypotheses.

 

In a case where all the neurological tests return positive results, and the symptoms correlate with their MRI findings, we plan the treatment accordingly.

 

Can I Avoid Surgery?

 

Before answering this question, we should first ask: can the disc heal by itself without surgery?

Research shows that approximately 90% of symptomatic disc herniations resolve on their own within six months without surgical intervention (Al Qaraghli & De Jesus, 2023). Most people affected by cervical radiculopathy experience significant pain relief within 6 to 12 weeks as the body naturally absorbs the herniated disc material through a process called disc resorption.

This is the reason why spine surgeons normally recommend patients who present with mild to moderate symptoms to first go through physiotherapy before offering spinal surgery. However, in some cases, surgery is warranted where the stenosis causes severely compromised nerve function, where one may show:

• Progressive weakness in the upper limb
• Loss of coordination in the hands or difficulty with fine motor tasks such as buttoning
• Loss of balance or problems with walking
• Persistent or worsening nerve pain despite pain medications and physiotherapy
• Signs of spinal cord compression (myelopathy) on MRI
• Loss of bladder or bowel control — rare, but it is an emergency

 

Can Physiotherapy Really Help?

 

In managing cervical radiculopathy, we treatment first aim to reduce nerve pain, numbness and weakness by work on: 

1. Pain management

• The crucial step in pain management for neck pain due to cervical radiculopathy — we advise you to comply with the pain medications (NSAIDs) prescribed by the doctors. This helps to reduce inflammation, therefore reducing nerve pain.

1. Mechanical off-loading:

• Joint mobilization – we use manual therapy to mobilise the affected cervical spine segment with Passive Accessory Intervertebral Movements (PAIVMs) technique (see previous article) to increase mobility of the joint, reducing the compressive force on the nerve and easing the pain.
• Postural correction – we also guide you to find the right posture that helps to ease the symptoms in your arm. This helps you manage the symptoms well at work and in other activities of daily living.
• Muscle stretch – tight muscles around your neck contribute to more joint compressive force. We identify and stretch these muscles to ease off the pressure in the joint, giving the compressed nerve ‘a little breather’ to alleviate pain.
• Exercises – gentle stretching exercises as well as strengthening exercises start as early as session 1. We advise you to do them as tolerated, with specific instruction not to aggravate your symptoms.

1. Restoring functions:
• As you progress, we look at nerve gliding exercises to help you gently ‘stretch’ the affected nerve, restoring nerve function (see Figure 4).
• Your strengthening exercises will also progress to improve your muscle strength. In Rehab Concept, we incorporate strength training and clinical Pilates to help you achieve a faster functional recovery.

Figure 4: Nerve glides exercises.

With good compliance with pain medication and therapy sessions, within 3 to 6 sessions your arm symptoms should improve. If the improvement is guarded, we will refer you to a spine surgeon for a review.

What You Need to Know

To summarize,

• Cervical radiculopathy is commonly caused by nerve compression from disc issues or degenerative changes in the spine. 
• Arm weakness, numbness, or altered reflexes are signs that the nerve function is affected. 
• Early assessment and appropriate management can prevent worsening symptoms and reduce the need for surgery.

Frequently Asked Questions (FAQ)

 

Here’re some other FAQ you need to know:

1. Why is my arm getting weaker when my problem starts in the neck?
   The nerves in your neck control the muscles in your arm. When a nerve is compressed, it can affect muscle strength.
2. Is weakness a sign that my condition is more serious?
   Weakness suggests that nerve function is affected. It should be assessed early to prevent further progression.
3. Can nerve weakness recover?
   Yes, in many cases. With appropriate treatment, nerve function and muscle strength can improve over time.
4. How is nerve-related weakness different from muscle fatigue?
   Muscle fatigue improves with rest, while nerve-related weakness may persist and feel like a loss of strength or control.
5. Will exercise make my weakness worse?
   Not if done correctly. Specific, guided exercises are important to support recovery.
6. Do I need an MRI if I have weakness?
   An MRI may be recommended to confirm the level and severity of nerve compression, especially if weakness is present.
7. When should I consider seeing a specialist?
   If weakness is worsening, persistent, or affecting daily function, further medical assessment is recommended.
8. Can physiotherapy help regain strength?
   Yes. Treatment focuses on reducing nerve compression and progressively restoring strength and function.
9. I want to find out more about my neck pain, who should I contact?
   You can reach out to our centres by clicking on the floating WhatsApp button on the right — we’ll be happy to guide you.

 

Don’t forget to check out the two other articles:

• Is My Neck Pain Coming from a Muscle or a Nerve?

• Why Is My Neck Pain Spreading to My Arm?

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Reference:

Al Qaraghli MI, De Jesus O. Lumbar Disc Herniation. [Updated 2023 Aug 23]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026 Jan–. Available from: https://www.ncbi.nlm.nih.gov/books/NBK560878/