Can a pinched nerve in the cervical spine area cause shoulder, arm, and hand pain without neck pain?

Cervical Radiculopathy Without Neck Pain

Yes, you can absolutely have a pinched nerve in the cervical spine causing shoulder, arm, and hand pain without any neck pain—this is a well-recognized presentation of cervical radiculopathy. 1, 2

Clinical Presentation

• Cervical radiculopathy is defined as pain in one or both upper extremities secondary to compression or irritation of nerve roots in the cervical spine, and neck pain is not required for the diagnosis 2
• The condition commonly presents with pain radiating to the arm with tingling and can be accompanied by motor, sensory, or reflex deficits, regardless of whether neck pain is present 1, 3
• Pain perceived in the upper limb alone, caused by irritation or compression of a cervical spine nerve root, is sufficient to diagnose cervical radicular pain 4

Diagnostic Approach

The American College of Radiology recommends MRI of the cervical spine without contrast as the appropriate initial imaging study for patients with cervical radiculopathy, even when presenting only with arm symptoms. 1

• MRI is the most sensitive imaging modality for assessing soft tissue abnormalities, including disc herniations and nerve root compression 1
• The presence of radicular symptoms (arm radiation and hand tingling) distinguishes cervical radiculopathy from simple mechanical neck pain and warrants advanced imaging 1
• Contrast is not necessary unless there is concern for infection or malignancy 1

Physical Examination Findings

• The most common examination findings in cervical radiculopathy are painful neck movements and muscle spasm, though these may be absent in your case 2
• Diminished deep tendon reflexes, particularly of the triceps, are the most common neurologic finding 2
• The Spurling test (neck extension with rotation and axial compression toward the symptomatic side) and shoulder abduction test (relief of symptoms with arm elevation) can confirm the diagnosis 2, 4

When to Obtain Imaging

Imaging is indicated if you have: 2

• Persistent symptoms beyond 4-6 weeks
• Progressive motor weakness or neurological deficits 1
• Red flag symptoms (bilateral symptoms, bladder/bowel dysfunction, symptoms in both upper and lower extremities suggesting myelopathy) 1

Prognosis and Management

• The American College of Radiology states that cervical radiculopathy is frequently self-limiting, with 75-90% of patients achieving symptomatic relief with nonoperative therapy 1
• Most cases will resolve regardless of the type of treatment, and patients should be reassured of this favorable prognosis 2
• A multimodal approach including physical therapy (strengthening, stretching, potentially traction), NSAIDs, and muscle relaxants is recommended 2, 5

Critical Pitfall to Avoid

• Do not assume that absence of neck pain rules out cervical spine pathology—the nerve root compression can produce isolated upper extremity symptoms without local cervical discomfort 2, 4
• Degenerative findings on MRI are common in asymptomatic individuals and must be correlated with your specific clinical symptoms 6, 7