Neck pain that travels into the arm, with pins and needles, numbness or weakness, usually indicates irritation of a nerve root in the neck. This is called cervical radiculopathy. Which finger goes numb and which muscle is weak tells you which level is involved, because each nerve root supplies a predictable area. Pain alone rarely changes management. Progressive weakness does.
I am Dr Alex Freeman (chiropractor) and I practise in Victoria Park, Perth. Arm symptoms are one of the presentations I take most seriously, partly because the assessment is genuinely informative and partly because it is the group where getting the documentation right changes what happens next for the patient.
What is actually happening
Eight pairs of nerve roots leave the cervical spine, each exiting through a bony opening called the intervertebral foramen. Each one carries sensation from a specific patch of skin and supplies a specific group of muscles.
When one of those roots is compressed or chemically irritated, you get symptoms in that root's territory rather than vaguely all over the arm. That specificity is what makes the examination useful. The pattern points at the level.
Two things cause it most often, and they tend to split by age. In younger people it is more commonly a disc protrusion pressing on the root. In people over about fifty it is more commonly narrowing of the foramen itself, from a combination of disc height loss, facet enlargement and bony spurring. The symptoms can look similar. The behaviour and the timeline often differ.
The map: which level does what
Broadly, and with the caveat that people vary:
C5. Pain over the shoulder and outer upper arm, weakness of the deltoid in raising the arm out to the side, and sometimes the biceps.
C6. Pain down the outer arm into the thumb and index finger, weakness of elbow flexion and wrist extension, reduced biceps or brachioradialis reflex.
C7. Pain into the middle finger, weakness of elbow extension and wrist flexion, reduced triceps reflex. The most commonly affected level.
C8. Symptoms into the ring and little fingers, weakness of finger flexion and grip.
T1. Symptoms along the inner forearm, weakness of the small intrinsic muscles of the hand, with difficulty spreading the fingers.
If you can tell me which fingers are affected and what has become awkward with your hand, I already have a reasonable idea of where to look before I touch you.
The things that mimic it
Not every arm symptom is a neck problem, and this is where careful examination earns its keep.
Carpal tunnel syndrome compresses the median nerve at the wrist. Typically thumb, index and middle finger, classically worse at night, often relieved by shaking the hand.
Cubital tunnel syndrome compresses the ulnar nerve at the elbow. Ring and little finger, often worse with the elbow bent for long periods, including sleeping.
Thoracic outlet syndrome involves compression between the neck and the armpit. Often affects the whole arm, frequently worse with overhead work or carrying.
Shoulder pathology such as rotator cuff problems refers into the upper arm and can produce apparent weakness that is actually pain inhibition rather than nerve involvement.
Referred pain from cervical facet joints reaches the shoulder blade and upper arm without any nerve compression at all, and without the sensory or reflex changes.
A double crush picture, where a nerve is irritated at both the neck and further down the arm, is also more common than people expect.
Signs that need urgent medical assessment
Some of these are important enough that I want them near the top of anyone's awareness.
Symptoms in both arms, or in the legs as well
New clumsiness with the hands, such as struggling with buttons, keys or handwriting
Change in walking or balance, feeling unsteady or wide-based
Bladder or bowel changes
Rapidly progressing weakness
Severe neck pain with fever, unexplained weight loss, or a history of cancer
Symptoms following significant trauma
The first three in that list can point to compression of the spinal cord itself, rather than a single nerve root. That is called cervical myelopathy. It is a different and more serious problem, it needs a specialist opinion, and manual treatment of the neck is not the answer. I screen for it in every patient with arm symptoms, using a quick reflex test at the hand and by watching you walk.
What I examine
A first appointment here is a consultation and examination rather than treatment.
The history sets the scene: which fingers, what makes it better or worse, whether it is worse at night, what you can no longer do, and whether anything has changed over recent weeks. A useful detail is whether putting your hand on top of your head relieves it, which often points towards nerve root involvement.
Then the physical examination. I check how far your neck moves, and I use two positional tests: one that gently compresses the nerve to see if it reproduces your arm symptoms, and one that takes pressure off it to see if that relieves them. I test the nerves themselves for sensitivity to stretch.
After that I map three things level by level. Sensation, across what are called dermatomes, meaning the patch of skin each nerve root supplies. Reflexes. And strength, across what are called myotomes, meaning the muscles each nerve root supplies. Together those three tell me which level is involved.
I also examine your shoulder and the places further down the arm where a nerve can get pinched, because ruling those in or out matters.
Imaging is warranted more often in this group than in uncomplicated neck pain. We refer to I-MED Radiology and review the images with you at a report of findings appointment before starting care.
Why I measure strength rather than just asking about pain
This is a point of difference in how we document, and it matters for you rather than for us.
If your case ever reaches a surgical opinion, the decision about intervention turns far more on progressive loss of function or a genuine neurological deficit than on how much it hurts. Pain is what you feel. Strength and range of motion are what can be measured, tracked and compared.
So when I examine you I record specific strength figures for each nerve level and specific range of motion figures. I repeat exactly the same measures at your progress examination. And when I write to your GP or specialist, I lead with those numbers and the change in them. That is what makes a case for a trial of conservative care credible to another clinician, and equally, it is what makes it obvious and timely if you are not responding and need to escalate. We use dynamometry where reproducible figures matter.
Our practitioners follow a written standard for correspondence with medical practitioners for exactly this reason.
Where chiropractic care fits
Chiropractic care may help manage the musculoskeletal component of neck pain with arm symptoms, where examination indicates it is appropriate.
That usually involves adjusting restricted cervical and upper thoracic segments to restore movement, soft tissue work or dry needling through the scalenes, upper trapezius and the shoulder girdle, nerve gliding and postural work, and then strengthening through the deep neck flexors and scapular stabilisers once symptoms allow.
The reasoning is the same one I give lumbar patients. Where a nerve root is irritated in a narrowed space, restoring movement to the surrounding joints and settling the tissue around them reduces the mechanical and inflammatory load on that nerve. A less inflamed nerve is both less painful and in a better position to recover. I am not claiming to widen a bony foramen, and I want to be clear about that. I am addressing the things that are modifiable.
Many cases of cervical radiculopathy improve over weeks to months with conservative management. Some do not, and some should not be managed conservatively at all. Knowing which is which early is the point of a careful examination and honest reassessment.
Common questions about neck and arm pain
What does it mean if my neck pain goes into my arm?
Arm symptoms alongside neck pain usually indicate irritation of a nerve root in the neck, known as cervical radiculopathy. The distribution of the pain, numbness or weakness follows the affected nerve level, which is why an examination can often identify the level involved.
Why do I get pins and needles in my fingers?
Tingling in specific fingers often reflects irritation of a particular nerve root, for example the thumb and index finger with C6 and the middle finger with C7. It can also arise from nerve compression at the wrist or elbow, so examination is needed to distinguish them.
Is arm weakness serious?
Weakness deserves prompt assessment, particularly if it is worsening, affects both arms, or comes with hand clumsiness or changes in walking. Those features can indicate spinal cord involvement and need urgent medical assessment rather than manual treatment.
Can a chiropractor help with cervical radiculopathy?
Chiropractic care may help manage the musculoskeletal component, including restoring joint movement and reducing mechanical and inflammatory load around an irritated nerve root. Suitability depends on examination findings, and some presentations require co-management or a specialist opinion.
How long does cervical radiculopathy take to settle?
Many cases improve over several weeks to a few months with conservative management. Cases involving significant foraminal narrowing or persistent neurological deficit often take longer, and progress should be tracked with objective strength and range of motion measures rather than pain alone.
Get arm symptoms properly assessed
If your neck pain has started travelling into your arm, or if a finger has gone numb, or if your grip feels different, that combination is worth examining properly rather than waiting out. We are at 249B Albany Highway, Victoria Park, and we see patients from East Victoria Park, Kensington, South Perth, Como, Lathlain, Carlisle, Burswood, Rivervale and Belmont.
Book online or call 0493 290 505. You may also want to read about neck pain care in Perth, disc injuries, and what your MRI report actually means.
Freeman Chiropractic · Victoria Park
Neck pain travelling into your arm?
Book a consultation and examination with Dr Alex Freeman at 249B Albany Highway, Victoria Park. No GP referral needed.
This article is general information and is not a substitute for individual assessment. Dr Alex Freeman is a registered chiropractor practising in Victoria Park, Western Australia.