From the Guidelines
Cervical radiculopathy symptoms typically present with a combination of neck pain and pain in one arm, accompanied by varying degrees of sensory or motor function loss in the affected nerve-root distribution. The most common clinical presentation is neck pain that radiates down the arm in a dermatomal pattern, corresponding to the affected nerve root. Common symptoms include sharp, shooting pain, numbness, tingling, or pins and needles sensation along the affected nerve pathway 1. Muscle weakness may occur in the muscles innervated by the compressed nerve, and patients might experience diminished reflexes in the affected area. Many patients report that certain neck positions or movements worsen their symptoms, particularly extension or rotation toward the affected side. The C6 and C7 nerve roots are most commonly affected, leading to symptoms in the shoulder, arm, and into specific fingers 1. Some patients also experience neck stiffness, headaches, or difficulty sleeping due to pain. These symptoms occur because compression or irritation of the cervical nerve roots disrupts normal nerve function, causing both sensory and motor disturbances along the path of the affected nerve. Symptoms may develop gradually or appear suddenly after trauma or strain to the neck. The intensity can range from mild discomfort to severe, debilitating pain that significantly impacts daily activities and quality of life.
Key Symptoms
- Neck pain that radiates down the arm in a dermatomal pattern
- Sharp, shooting pain, numbness, tingling, or pins and needles sensation along the affected nerve pathway
- Muscle weakness in the muscles innervated by the compressed nerve
- Diminished reflexes in the affected area
- Neck stiffness, headaches, or difficulty sleeping due to pain
Commonly Affected Nerve Roots
- C6 and C7 nerve roots, leading to symptoms in the shoulder, arm, and into specific fingers
Importance of Red Flag Symptoms
It is essential to identify red flag symptoms, such as trauma, malignancy, prior neck surgery, spinal cord injury, systemic diseases, and suspected infection, as they may require immediate imaging and treatment 1. In the absence of red flag symptoms, imaging may not be required at the time of initial presentation, as spondylotic changes are commonly identified on radiographs and MRI in patients over 30 years of age and correlate poorly with the presence of neck pain 1. Imaging may be appropriate, but it is not always indicated for evaluation of cervicogenic headache without neurologic deficit.
From the Research
Cervical Radiculopathy Symptoms
- Cervical radiculopathy is characterized by pain in one or both upper extremities, often accompanied by neck pain, due to compression or irritation of nerve roots in the cervical spine 2, 3, 4, 5, 6
- Symptoms can include motor, sensory, or reflex deficits, and are most prevalent in persons 50 to 54 years of age 2
- Common examination findings include painful neck movements, muscle spasm, and diminished deep tendon reflexes, particularly of the triceps 2
- The clinical consequence of radiculopathy is arm pain or paresthesias in the dermatomal distribution of the affected nerve, which may or may not be associated with neck pain and motor weakness 4
Diagnosis and Treatment
- Diagnosis can often be made with a thorough history and physical examination, but magnetic resonance imaging (MRI) or computed tomographic myelogram can be used to confirm the diagnosis 3, 4, 5, 6
- Treatment options include nonoperative management, such as physical therapy, immobilization, anti-inflammatory medications, and epidural steroid injections 2, 3, 6
- Surgical treatment options, such as anterior cervical decompression and fusion, cervical disk arthroplasty, and posterior foraminotomy, are typically reserved for patients with significant functional deficits or persistent symptoms despite conservative treatment 3, 4