How to diagnose cervical radiculopathy | Medmastery (2023)

Learn how to recognize the signs and symptoms of cervical radiculopathy in your patients. Click here now!

Gary R. Simonds, MD MHCDS FAANS

9m read

Editors:Shelley Jacobs, PhD

Peer reviewers:Franz Wiesbauer, MD MPH Internist

Last update7th Jan 2021

Painful compression of a nerve root in the neck is known as cervical radiculopathy. The pain can be extreme, and the syndrome is often associated with an array of neurological signs and symptoms.

Cervical radiculopathy is commonly caused by an intervertebral disc fragment prolapsing onto a nerve root and causing irritation. Overgrown bone in a nerve root region may also precipitate an identical syndrome.

Figure 1. A herniated disc is the most common cause of cervical radiculopathy.

Compression of a nerve root may be totally asymptomatic, which is a very common occurrence. If you were to acquire magnetic resonance imaging (MRI) of your patient’s neck, you may find multiple areas of nerve root compression and perhaps even some stenosis—all without symptoms. Compression is a normal part of aging, but radiculopathy occurs when the nerve root becomes irritated from the compression and signals the brain that all is not well.

Remember that nerve roots carry both motor and sensory fibers, so compression can result in both motor and sensory symptoms. Motor and sensory findings should correspond to the specific nerve root that is irritated.

Figure 2. Nerve roots carry sensory and motor fibers.

What should you do if you suspect cervical radiculopathy?

Follow three standard steps when evaluating a patient for cervical radiculopathy:

  1. Obtain a thorough history and record signs and symptoms
  2. Check the range of motion
  3. Perform a neurological exam

Obtain a thorough history and record signs and symptoms

Begin by obtaining a thorough history of the patient. Record the duration and nature of symptoms and treatments that have been attempted so far, and be alert for red flag conditions.

There are several common sensory presentations seen in patients with cervical radiculopathy:

  • Severe pain radiating from the neck down the arm
  • Intrascapular pain
  • Paresthesia and dysesthesia in a dermatome pattern
(Video) CERVICAL RADICULOPATHY: Common Symptoms and Treatment Options - Dr. Javier Reto

Figure 3. Common presentations associated with cervical radiculopathy include severe radiating pain, intrascapular pain, and paresthesia.

In typical cervical radiculopathy, the patient will develop fairly severe radiating pain that runs from the neck and down the arm. The onset can be sudden or progressive over days or weeks. The pain can be extreme and of a sharp, deep, aching, or burning character.

This arm pain generally follows a pattern that can be tied to the distribution of the corresponding, compressed nerve root. However, the pain often becomes generalized to the entire arm or the bones of the arm and hand.

Nerves carry messages about pain from the periphery to the brain, so irritated nerves can give the brain all sorts of bad information. Any sort of painful scenario can be reproduced; the patient may feel like their arm is on fire, is being chopped up, or nails are being driven into it.

Alongside the radiating arm pain, intrascapular pain is quite common. Severe pain is usually accompanied by other sensory symptoms. Paresthesia and dysesthesia findings can include reports of prickly, tingling, or crawling sensations.

Any sensory symptoms should present in a dermatomal pattern. In other words, the pain should radiate into the dermatome of the affected nerve root. However, patients tend to generalize the region of pain and paresthesia beyond the defined dermatomes, so don’t let that mislead you!

Check range of motion

When evaluating a patient for cervical radiculopathy, check neck and shoulder range of motion. It is not uncommon to see dislocated and fractured shoulders misdiagnosed as cervical radiculopathy!

Figure 4. Range of motion testing can help rule out shoulder dislocation and fracture for patients presenting with cervical radiculopathy symptoms.

Perform a neurological exam

Perform a focused neurological exam—but don’t neglect a quick brain and cranial nerve evaluation. Do a detailed examination of upper extremity motor and sensory function as well as a reflex exam.

(Video) Neck Tornado Test / Choi's Test | Cervical Radiculopathy

Figure 5. Aspects of a neurological exam for cervical radiculopathy such as brain and cranial nerve evaluations, upper body motor and sensory exam, and a reflex exam.

When evaluating the patient’s motor function, remember that nerve root compression causes lower motor neuron findings. Lower motor neurons extend from the anterior horn cells in the spinal cord out through the nerve roots. Then, the neurons join with fibers from other nerve roots to form a peripheral nerve that innervates a specific muscle or muscle group.

Motor function findings

Damage to lower motor neurons generally results in weakness, decreased tone, eventual atrophy of the innervated muscles, and sometimes loss of a deep tendon reflex.

The involved muscles can also show visible spontaneous twitching, known as fasciculations. Note that motor deficits are often subtle, and patients may be unaware of them until you find the deficits during an exam. However, some patients will have no definitive motor or sensory deficits.

So, in your evaluation, look for lower motor neuron findings in the arms. Make sure to check the legs as well, but in true cervical radiculopathy, leg function should not be affected.

Figure 6. Lower motor neuron signs common with cervical radiculopathy include muscle weakness, decreased tone, muscle atrophy, loss of a deep tendon reflex, and fasciculations.

Motor function testing considerations

Some patients will give you very poor effort throughout the affected arm upon testing. You may interpret this as weakness in multiple muscle groups, but multiple muscle groups should not be weak in cervical radiculopathy. Only the muscle groups innervated by the affected nerve root should show any signs of weakness.

The reason why some patients present with weakness in multiple muscle groups of the arm is because they are simply averse to pain and are subconsciously protecting themselves. A good motor exam can usually be obtained by repeated encouragement of the patient to engage the requested muscle groups. Be patient and remember how much pain they are in.

Sensory function findings

Your neurological exam should include checking pinprick and light touch sensation throughout the body—particularly in the affected arm. Sensory loss is often generalized by the patient. But in bonafide radiculopathy, the sensory loss follows a dermatomal pattern.

Figure 7. Loss of pinprick and light touch sensation is common in the affected arm of patients with cervical radiculopathy.

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How to differentiate between cervical radiculopathy and cervical myelopathy

As you build a case for cervical radiculopathy, always be suspicious of potential spinal cord compression and resulting myelopathy. Missing myelopathy could put a patient's neurological function in serious jeopardy.

In contrast to radiculopathies (which present with lower motor neuron signs), cervical myelopathies involve damage to upper motor neurons. Upper motor neuronal damage results in hypertonia, hyperreflexia, and late loss of strength (particularly in the lower extremities). Oftentimes, a Babinski sign can also be elicited.

Cervical myelopathy often presents with spinal cord sensory findings such as sensory levels in the trunk, loss of proprioception, and loss of balance. None of these findings should be seen in radiculopathy.

Table 1. Lower motor neuron signs are found in cervical radiculopathy, while upper motor neuron signs are found in cervical myelopathy.

How to identify the affected nerve root in cervical radiculopathy

Once you’ve determined that your patient has radiculopathy, you’ll need to identify which nerve root is affected. Remember that there are seven cervical nerve roots (C2–C8). Cervical nerve roots exit the spine above the vertebrae with the corresponding name. So, the nerve root for C4 exits between the third and fourth cervical vertebrae (C3 and C4). The C8 nerve root, which exits above T1, is the exception to this rule.

Figure 8. Like all cervical nerve roots, the C4 nerve root is named after the vertebra that lies just below it — the C4 vertebra.

Now, let’s dive into signs and symptoms that are common when nerve roots C4, C5, C6, C7, and C8 are affected by radiculopathy.

Signs and symptoms of C4 radiculopathy

Irritation of the C4 nerve root is unusual, but if present it may cause neck pain and paresthesia with no arm pain, major muscle, or reflex findings.

Figure 9. Common findings with C4 radiculopathy include neck pain and paresthesia, but no muscle or reflex findings.

Signs and symptoms of C5 radiculopathy

Irritation of the C5 nerve root will cause pain and loss of sensation in the shoulder region alongside weakness in the deltoid muscle (which is responsible for shoulder abduction). The deltoid reflex may be diminished, but this isn’t the easiest reflex to elicit.

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Figure 10. Common findings with C5 radiculopathy include loss of sensation, deltoid weakness, and diminished deltoid reflex.

Signs and symptoms of C6 radiculopathy

Irritation of the C6 nerve root will cause pain and numbness down the arm and into the thumb. The biceps may be weak, and the biceps reflex will be diminished.

Figure 11. Common findings with C6 radiculopathy include pain and numbness down the arm and into the thumb, weak biceps, and diminished bicep reflexes.

Signs and symptoms of C7 radiculopathy

Irritation of the C7 nerve root will cause pain and numbness down the arm and into the second and third fingers. The triceps may be weak, and the triceps reflex will be diminished.

Figure 12. Common findings with C7 radiculopathy include pain and numbness down the arm and into the second and third fingers, weak triceps, and diminished triceps reflex.

Signs and symptoms of C8 radiculopathy

Irritation of C8 will cause arm pain and paresthesia down the arm into the fourth and fifth fingers as well as hand weakness. You should not find any associated reflex changes.

Figure 13. Common findings with C8 radiculopathy include pain and paresthesia down the arm into the fourth and fifth fingers as well as hand weakness.

Now you should be better equipped to recognize and differentiate cervical radiculopathy from myelopathy—which is very important for your patients. You should also be more familiar with how to determine the affected nerve root, which will empower you to proceed to the next step—managing your patient’s cervical radiculopathy.

That’s it for now. If you want to improve your understanding of key concepts in medicine, and improve your clinical skills, make sure to register for a free trial account, which will give you access to free videos and downloads. We’ll help you make the right decisions for yourself and your patients.

Recommended readings

  • Devlin, VJ. 2012.Spine Secrets Plus. 2nd edition. Missouri: Mosby.
  • Kaiser, M, Haid, R, Shaffrey, C, et al. 2019.Degenerative Cervical Myelopathy and Radiculopathy: Treatment Approaches and Options. Switzerland: Springer International Publishing.
  • Louis, ED, Mayer, SA, and Rowland, LP. 2015.Merritt’s Neurology. 13thedition. Philadelphia: Wolters Kluwer.
(Video) 4 Tests to Diagnose Yourself with Cervical Radiculopathy

FAQs

How do you prove cervical radiculopathy? ›

Provocative tests to assist in the diagnosis of cervical radiculopathy include the Spurling test, the shoulder abduction test, Valsalva maneuver, Neck distraction, and Elveys upper limb tension test (ULTT) [12, 15•]. The Spurling test is the most commonly used of these examination maneuvers.

What is the gold standard for diagnosing cervical radiculopathy? ›

The diagnosis cervical radiculopathy is most commonly based on clinical signs and symptoms that concur with nerve root compression identified via medical imaging (e.g., Magnetic Resonance Imaging (MRI) or computer tomography) [4].

How do you know if you have cervical radiculopathy? ›

The main symptom of cervical radiculopathy is pain that spreads into the arm, neck, chest, upper back and/or shoulders. Often, this affects just one side of your body. A person with radiculopathy may also experience: Sensory issues, such as numbness or tingling in fingers or hands.

What is the most common site of cervical radiculopathy? ›

The C7 nerve root is the most frequently involved by cervical radiculopathy. Entrapment of the posterior interosseous nerve may be mistaken for the motor component of the C7 radiculopathy causing weakness of triceps, wrist flexors and finger extensors.

What can a neurologist do for cervical radiculopathy? ›

A neurologist can diagnose the condition as well as provide treatment options such as injections or physical therapy. If you think you have radiculopathy, contact our team of neurology experts today so we can help develop an actionable plan for reducing your symptoms and increasing your mobility.

Can you see radiculopathy on MRI? ›

Cervical radiculopathy can be diagnosed with a thorough history and physical examination in many cases, but MRI should be used to confirm the diagnosis. The affected dermatomes can both overlap and vary for a certain nerve root in cervical radiculopathy.

Should I see a neurologist for cervical radiculopathy? ›

Although radiculopathy may be suspected or diagnosed by the person's primary care physician, the condition should be treated by an experienced neurosurgeon.

Do you need MRI with contrast for cervical radiculopathy? ›

Noncontrast MRI is usually appropriate for assessment of new or increasing radiculopathy due to improved nerve root definition. MRI without and with contrast is usually appropriate in patients with new or increasing cervical or neck pain or radiculopathy in the setting of suspected infection or known malignancy.

What is the most common cause of radiculopathy? ›

Radiculopathy is caused by a pinched nerve in your spine. More specifically, it happens when one of your nerve roots (where your nerves join your spinal column) is compressed or irritated. You might see it referred to as radiculitis.

What can mimic radiculopathy? ›

The clinical findings of early stage amyotrophic lateral sclerosis (ALS) are similar to those of cervical or lumbar radiculopathy.

What does cervical radiculopathy pain feel like? ›

In cases where cervical radiculopathy involves pain, it can range anywhere from a dull, general discomfort or achiness to a sharp, shock-like or burning pain. Cervical radicular pain may be felt anywhere from neck all the way down the arm into the fingers.

What makes cervical radiculopathy worse? ›

Axial compression of the spine and rotation to the ipsilateral side of symptoms reproduces or worsens cervical radiculopathy.

What should you not do with cervical radiculopathy? ›

DO skip high-impact activities, such as running, if you have neck pain. DO exercises to maintain neck strength, flexibility, and range of motion.

What nerves do C5 C6/C7 affect? ›

From the lateral cord, C5, C6, and C7 supply the pectoralis major and minor muscles, via the lateral and medial pectoral nerves, as well as the coracobrachialis, brachialis and biceps brachii, via the musculocutaneous nerve. The musculocutaneous nerve provides sensation to the skin of the lateral forearm.

What is the primary symptom of radiculopathy? ›

The most common symptoms of radiculopathy are pain, numbness, and tingling in the arms or legs. It is common for patients to also have localized neck or back pain as well. Lumbar radiculopathy that causes pain that radiates down a lower extremity is commonly referred to as sciatica.

What is the best medication for cervical radiculopathy? ›

Some radiculopathies will respond to nonsteroidal anti-inflammatory medications (NSAIDs) alone, but a short course of oral corticosteroid medication is often prescribed as well. Medications that include gabapentin and pregabalin are frequently used to relieve radiculopathy related pain symptoms.

Which fingers are affected by cervical radiculopathy? ›

Bicep, wrist, thumb, and index finger pain

Reaching down the length of your arm, the C6 nerve affects the bicep muscle in your upper arm, your wrist, and the thumb side of your hand, which may include your index finger. Tingling or numbness in these areas may indicate cervical radiculopathy.

When do you need surgery for cervical radiculopathy? ›

Surgery for cervical radiculopathy from a herniated disc should only be considered in those cases when 6 to 12 weeks of nonsurgical treatment fails to relieve neurological deficits in the arm, such as pain, numbness, and/or weakness.

What surgery is done for cervical radiculopathy? ›

Anterior Cervical Diskectomy and Fusion (ACDF) ACDF is the most commonly performed procedure to treat cervical radiculopathy. The procedure involves removing the problematic disk or bone spurs and then stabilizing the spine through spinal fusion.

How do you treat a C5 C6 pinched nerve? ›

Both prescription and over-the-counter (OTC) medications are used to help relieve C5-C6 vertebral and nerve pain. Common medications include non-steroidal anti-inflammatory drugs (NSAIDs), pain-relieving medication such as opioids and tramadol, and/or corticosteroids.

How does a neurologist check for nerve damage? ›

Electromyography, or EMG, is used to diagnose nerve and muscle disorders, spinal nerve root compression, and motor neuron disorders such as amyotrophic lateral sclerosis. EMG records the electrical activity in the muscles. Muscles develop abnormal electrical signals when there is nerve or muscle damage.

Does EMG always show radiculopathy? ›

Radiculopathy is a commonly missed diagnosis with EMG and also commonly associated with pain. The missed diagnoses may occur because unless the radiculopathy affects the muscle, and therefore causes areas of denervation, the needle EMG may be normal even though the nerve is compressed leading to pain.

What is the best imaging for neck pain? ›

In chronic neck pain, x-rays are usually appropriate as initial imaging. MRI without contrast may be appropriate. If x-rays show degenerative changes, MRI without contrast is usually appropriate. CT without contrast or CT myelography may be appropriate.

Can you diagnose radiculopathy without imaging? ›

A physical exam and physical tests may be used to check your muscle strength and reflexes. If you have pain with certain movements, this may help your doctor identify the affected nerve root. Imaging tests, such as an X-ray, CT scan or MRI scan, are used to better see the structures in the problem area.

What is similar to cervical radiculopathy? ›

Cervical myelopathy results when the spinal cord within the neck is injured or compressed. Cervical radiculopathy is similar, but rather than affecting the spinal cord, it affects the nerve roots in the cervical spine. Stanford Medicine Spine Center provides the most advanced care available for both conditions.

Do muscle relaxers help cervical radiculopathy? ›

Muscle relaxers, such as Flexeril or Skelaxin, are used to treat spasm often associated with radiculopathy. Nerve membrane stabilizers, such as Neurontin or Lyrica, help reduce the irritability of pinched nerves that are causing radiculopathy. Opioids are used when pain symptoms are severe.

Which imaging is best for nerves? ›

MRI is a well-established imaging technique that can be used to differentiate injured peripheral nerves from healthy nerves.

Will an EMG show cervical radiculopathy? ›

To definitively diagnose cervical radiculopathy, one paraspinal muscle and two muscles from a different peripheral nerve innervated by the same root must have positive EMG findings.

How do you test for nerve damage in the neck? ›

Electromyography (EMG).

An EMG can determine whether neck pain might be related to a pinched nerve. It involves inserting fine needles through the skin into a muscle. The test measures the speed of nerve conduction to determine whether nerves are working properly.

What causes cervical radiculopathy flare ups? ›

Causes of cervical radiculopathy

Changes to the tissues surrounding the nerve roots in the cervical spine is the most common cause of a cervical radiculopathy. Degenerative changes to the vertebrae, tendons, or intervertebral discs can cause compression or irritation of the nerve roots.

Is radiculopathy a red flag? ›

A radiculopathy is a conduction block in the axons of a spinal nerve or its roots, with impact on motor axons causing weakness and on sensory axons causing paraesthesia and/or anaesthesia.
...
Clinical Features.
Red FlagAssociated Disorder
History of malignancyMetastatic disease
5 more rows

Can cervical radiculopathy be caused by stress? ›

Cervical radiculopathy in younger people is more often caused by physical trauma or repetitive stress, resulting in a herniated disc. This places pressure on a nerve root, causing pain to radiate out to the affected areas.

Does radiculopathy show up on xray? ›

In most cases, radiculopathy can be diagnosed with a thorough medical examination. However, further testing may be necessary to determine the cause of the radiculopathy. Possible tests include: X-ray (also known as plain films): test that uses invisible electromagnetic energy beams (X-rays) to produce images of bones.

What is the difference between neuropathy and radiculopathy? ›

Neuropathy and radiculopathy are similar in that they are both conditions that relate to nerve damage, and their symptoms are similar. However, while radiculopathy is caused by the pinching of root nerves of the spinal column, neuropathy is damage or malfunction of peripheral nerves.

Why is cervical radiculopathy so painful? ›

Different nerve roots along your spine extend to different parts of your body. When a nerve root becomes pinched, it can affect the nerves that are attached to it. This is why a pinched nerve (cervical radiculopathy) in your neck can cause pain that radiates down your arm.

What are the symptoms of nerve compression in the neck? ›

Numbness or decreased sensation in the area supplied by the nerve. Sharp, aching or burning pain, which may radiate outward. Tingling, pins and needles sensations (paresthesia) Muscle weakness in the affected area.

What does C5 nerve pain feel like? ›

C4-C5 (C5 nerve root): Pain, tingling, and/or numbness may radiate into the shoulder. Weakness may also be felt in the shoulder (deltoid muscle) and other muscles. C5-C6 (C6 nerve root): Pain, tingling, and/or numbness may be felt in the thumb side of the hand.

Should I be worried about cervical radiculopathy? ›

The condition is characterized by pain, weakness, and numbness caused by the compression of one or more of the nerve roots near the cervical vertebrae. If left undiagnosed and untreated, cervical radiculopathy can cause severe neck pain that extends to the chest, arms, upper back, and/or shoulders.

Can chiropractors fix cervical radiculopathy? ›

The Treatment for Cervical Radiculopathy

One of the most effective pain relief treatments for cervical radiculopathy is chiropractic care. Chiropractors are able to offer manual manipulation to adjust the spine to increase mobility. Another effective technique for treatment is cervical traction.

What are symptoms of C5 C6 nerve compression? ›

The compression of nerve roots in the neck impacts the neck, arms, hands and shoulders with radiating pain. Often, tingling and numbness in these areas are another common symptom of C5-C6 disc bulging. This can lead to muscle weakness and spasms and additional discomfort in the digits of the hands.

How serious is a bulging disc C5 C6? ›

A bulging or herniated C5-C6 spinal disc can have far-reaching consequences, causing pain symptoms, paresthesia (numbness & tingling), weakness, and paralysis from the lower neck down to the toes!

What does disc C5 C6 control? ›

The C5 and C6 vertebrae and disc form an important motion segment near the base of the cervical spine. They serve the function of supporting the head as well as the upper extremities(arms) which attach to the spine via muscles and tendons in the neck.

Can cervical radiculopathy be seen on xray? ›

Radiography of the cervical spine is usually the first diagnostic test ordered in patients who present with neck and limb symptoms, and more often than not, this study is diagnostic of cervical disc disease as the cause of the radiculopathy.

How do you explain cervical radiculopathy? ›

Cervical radiculopathy: Cervical radiculopathy occurs when a nerve in the neck is compressed or irritated at the point where it leaves the spinal cord. This can result in pain in shoulders, and muscle weakness and numbness that travels down the arm into the hand.

Can radiculopathy be seen on xray? ›

In most cases, radiculopathy can be diagnosed with a thorough medical examination. However, further testing may be necessary to determine the cause of the radiculopathy. Possible tests include: X-ray (also known as plain films): test that uses invisible electromagnetic energy beams (X-rays) to produce images of bones.

Can you see cervical radiculopathy on MRI? ›

Cervical radiculopathy can be diagnosed with a thorough history and physical examination in many cases, but MRI should be used to confirm the diagnosis. The affected dermatomes can both overlap and vary for a certain nerve root in cervical radiculopathy.

When is MRI needed for cervical radiculopathy? ›

If x-rays show degenerative changes, MRI without contrast is usually appropriate. CT without contrast or CT myelography may be appropriate. If x-rays show hardening of the connecting fibers of the neck vertebrae, CT without contrast is usually appropriate; CT myelography or MRI without contrast may be appropriate.

When is surgery necessary for cervical radiculopathy? ›

When symptoms of cervical radiculopathy persist or worsen despite nonsurgical treatment, your doctor may recommend surgery. The primary goal of surgery is to relieve your symptoms by decompressing, or relieving pressure on, the compressed nerves in your neck. Other goals of surgery include: Improving neck pain.

Can a neurologist tell if you have a pinched nerve? ›

To determine whether you have a pinched nerve or something else, speak with a primary care doctor, neurologist or neurosurgeon. The doctor will ask you questions about your pain and medical history, and do a physical examination to determine if you have a pinched nerve or another issue.

What test shows pinched nerve in neck? ›

Electromyography (EMG).

During an EMG , your doctor inserts a needle electrode through your skin into various muscles. The test evaluates the electrical activity of your muscles when they contract and when they're at rest. Test results tell your doctor if there is damage to the nerves leading to the muscles.

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