This case report aims to illustrate the diagnostic challenge and effective management of acute cervical radiculopathy presenting as shoulder pain, differentially diagnosed through physical examinations, and subsequently treated with acupotomy. A male patient in his late 20s with no significant medical history or comorbidities reported acute left shoulder pain upon awakening, rated at a severity of 7 on the numeric rating scale (NRS). Initial physical evaluations of the shoulder assembly revealed no abnormalities, but a positive Spurling test, relief with cervical distraction, and diminished sensation across the left C5∼C8 dermatomes pointed towards a cervical spine origin. Immediate acupotomy at identified tender points significantly reduced pain, with additional therapies enhancing recovery. Pain was eliminated after the second treatment, and this resolution was sustained at the 4-week follow-up, confirming the treatment’s effectiveness and verifying the absence of adverse effects. This case presents the critical need for precise diagnosis in cases of neck and shoulder pain. Additionally, the employment of acupotomy provided a swift and effective resolution of symptoms in acute cervical radiculopathy, showing its value in clinical practice.