Cervical disc herniation and numbness in the hands
In the reference population study, which followed 561 people for almost five years, 74 per cent never needed surgery and 90 per cent ended up with no symptoms or only mild discomfort. Only 15 per cent could recall a strain or an injury before it began.
Most people do not arrive at this page searching for "cervical disc herniation". They arrive searching for "why does my hand keep going numb". Someone wakes up with tingling fingers, then a pain starts that runs down the shoulder and the arm, and at some point an MRI puts a name to it.
What it actually is
In the neck, the nerve roots that supply the arms and the hands emerge between one vertebra and the next. Each root has its own territory: C6 goes to the thumb and the index finger, C7 to the middle finger, C8 to the ring finger and the little finger. That is why the tingling is not vague. It tells you which root is involved.
That root can be compressed for two reasons. One is a disc herniation, the same as in the lower back. The other, more common after fifty, is spondylosis: the wear that gradually forms spurs of bone and narrows the opening the nerve leaves through. In the reference population study, only 22 per cent of cases were due to a pure disc herniation; in the rest there was spondylosis, alone or combined.
There is a second situation, different and more serious, worth separating out from the start. When what is compressed is not the root but the spinal cord itself, the condition is called cervical myelopathy, and it does not behave in the same way. There is more on it below.
What it feels like
The typical pain starts in the neck, crosses the trapezius and runs down the arm to the hand, following a band. It gets worse when you look upwards or turn your head towards the painful side. And it has a characteristic sign that many people find on their own: the pain eases when you lift the arm and rest your hand on top of your head. That movement takes the tension off the root. If it happens to you, say so. It is a fairly specific clue.
Night-time tingling is also common, along with pain that wakes you, difficulty finding a position on the pillow, and sometimes a particular weakness: lifting the arm is hard, or opening a jar, or the hand simply gives way.
The numbers worth having
Almost all of them come from the same piece of work, a population study that followed 561 people with cervical radiculopathy for an average of five years. It is the best evidence there is on how the condition behaves left to itself:
- 74 per cent never had surgery.
- 90 per cent ended up free of symptoms or with only mild discomfort.
- Only 15 per cent had any history of a strain or an injury beforehand. In the vast majority there was no culprit: it was not the gym, or the pillow, or that awkward movement.
- The root most often affected was C7, followed by C6.
- The peak of incidence is between the ages of 50 and 54.
- About a third had some recurrence over the years.
And one figure that changes expectations: 41 per cent had already had an episode of sciatica. These things tend to be expressions of the same spine, not independent events.
When not to wait
These symptoms suggest that what is involved is the spinal cord and not a root. They are not an emergency measured in minutes, but they are one measured in days: you should be seen without letting weeks go by.
- Clumsiness in the hands that came on without pain: objects get dropped, doing up a button is hard, your handwriting has changed.
- A change in the way you walk: unsteadiness, the feeling of walking on cotton wool, tripping.
- Tingling or weakness in both hands, or in the hands and the legs at the same time.
- An electric shock running down your back when you bend your neck forwards.
- And separately from myelopathy: clear, progressive weakness of one arm, or difficulty passing urine.
Cervical myelopathy tends to progress, and surgery in that situation is done more to halt the decline than to reverse it. That is why time matters more here than in an ordinary radiculopathy.
What you will hear that is not true
"It was from lifting something heavy / from the gym / from the pillow." Only 15 per cent had a strain or an injury beforehand. Hunting for the one specific cause is nearly always a waste of time, and it sometimes creates guilt that is not warranted.
"Every cervical disc herniation needs surgery." Three in four do not.
"Tingling in the hands always comes from the neck." No. Carpal tunnel syndrome, entrapment of the ulnar nerve at the elbow and the polyneuropathies — diabetic neuropathy above all — produce a similar picture. It is one of the most frequent mix-ups, and it is settled with a proper examination and, if needed, an EMG. Before agreeing to neck surgery for tingling hands, it is worth having ruled the rest out.
"It is more serious than a lumbar disc herniation." Not as a rule. What is more serious is myelopathy, which has no lumbar equivalent. An ordinary cervical radiculopathy runs a course very much like a lumbar one.
Cervical traction devices bought online. There is no basis for using them on your own for a compressed root, and where there is myelopathy they can be frankly inadvisable.
What will happen at the appointment
Your hand will be mapped. Which fingers tingle, which reflexes are present, which muscles are weak: that locates the root. Then you will be checked specifically for myelopathy — walking, balance, brisk reflexes, a few particular signs — even if that is not what you came about.
The MRI comes after. And again the same rule as in the lower back: the images have to match the examination. In the cervical spine of healthy people over forty, degenerative findings turn up extremely often.
Questions worth writing down before you go
- Do the fingers that go numb match the level that shows up on the MRI?
- Are there signs of myelopathy on my examination?
- Has the wrist or the elbow been ruled out as the source?
- If we wait, how long for, and what would have to happen for us to reconsider?
- If I have surgery, from the front or from the back? With a disc replacement or with a fusion? Why that choice in my case?
The questions people ask most
Does a cervical disc herniation heal on its own?
In most cases, yes: 74 per cent of people with cervical radiculopathy never needed surgery, and 90 per cent ended up with no symptoms or only mild discomfort. The improvement usually comes over weeks to months.
When does a cervical disc herniation need surgery?
When there is significant weakness that is not improving, when the pain is still disabling after several weeks of proper treatment, or when there is myelopathy. That last case is the most pressing, because the aim is to prevent a decline that cannot be recovered afterwards.
What is cervical myelopathy and how do I know if I have it?
It is compression of the spinal cord rather than of a root. It shows up as clumsiness of the hands, changes in walking, symptoms in all four limbs and, characteristically, little or no pain. If you recognise yourself in that, be seen without letting time pass.
Is tingling in the hands always from the neck?
No, and mixing it up is common. Carpal tunnel gives tingling in the thumb, the index and the middle finger, is worse at night and eases when you shake the hand. Ulnar entrapment takes the ring finger and the little finger. Diabetes gives a symmetrical numbness that starts in the feet. All of that is worth ruling out.
Can I go to the gym with a cervical disc herniation?
While the problem is active it is best to avoid overhead strength work, the military press, pull-ups and anything that compresses the neck, and to avoid exercises that hold the neck in sustained extension. Walking, cycling and lower-limb work are almost always allowed.
What is the best way to sleep with a cervical disc herniation?
On your side or on your back, with a pillow that keeps the neck in line with the rest of the spine: neither too high nor too low. Face down is the worst position, because it forces you to keep your head turned for hours on end.
How long does a cervical disc replacement last?
The ten-year follow-up data are good, but the point is less the lifespan than the indication: a disc replacement aims to preserve movement at that level, and not every case is a candidate. Where there is advanced arthritis or instability, fusion is usually the option to go for.