Expected Symptoms of Moderate Right C5-C6 Neuroforaminal Narrowing
Moderate right C5-C6 neuroforaminal narrowing typically causes right-sided arm pain radiating into the lateral arm and forearm, accompanied by numbness or tingling in the thumb and index finger, and weakness in the biceps, wrist extensors, and brachioradialis muscles. 1
Primary Clinical Manifestations
Radicular Pain Pattern
- Neck pain with radiating arm pain following the C6 nerve root distribution is the hallmark presentation, extending from the neck down the lateral aspect of the arm into the thumb and radial forearm 1
- The pain typically follows a dermatomal pattern specific to the C6 nerve root distribution 1
- Importantly, 75-90% of patients with cervical radiculopathy improve with conservative management alone 1
Motor Deficits
- Weakness in biceps muscle (elbow flexion) is characteristic of C6 radiculopathy 2, 1
- Weakness in wrist extensors affecting the ability to extend the wrist dorsally 2
- Weakness in brachioradialis affecting forearm supination 3
- Motor weakness typically presents as grade 3-4/5 strength in affected muscle groups 3
Sensory Changes
- Numbness and tingling in the thumb and index finger following C6 dermatomal distribution 1
- Paresthesias (burning, pins-and-needles sensations) in the lateral forearm and radial hand 2, 1
- Decreased light touch appreciation in the affected dermatome 1
Important Clinical Caveats
Imaging-Clinical Correlation
- Imaging findings correlate poorly with symptoms in many cases, as spondylotic changes and neuroforaminal narrowing are commonly identified in asymptomatic patients over 30 years of age 1
- Physical examination has limited predictive value for correlating with MRI evidence of nerve root compression 1
- Always correlate imaging findings with clinical symptoms before attributing radiculopathy to degenerative findings 1
Positional Variation
- Symptoms typically worsen with neck extension and improve with flexion, as neuroforaminal dimensions decrease by 30-40% with extension 4, 5
- The C5/C6 level shows significant dimensional changes during dynamic neck motion 5
Atypical Presentations
- Rarely, patients may present with painless progressive motor weakness and muscular atrophy without radiating pain (occurring in approximately 3.9% of surgical cases), though this is uncommon 3
- This painless variant predominantly affects smokers and diabetic patients 3
What You Should NOT Expect
Red Flags Suggesting Alternative Diagnosis
- Bilateral hand weakness, gait disturbance, or hyperreflexia suggest spinal cord compression (myelopathy) at C4/C5 rather than isolated C5-C6 radiculopathy 2
- Involvement of multiple bilateral muscle groups indicates cord pathology, not foraminal stenosis 2
- Lower extremity weakness or sensory level suggests myelopathy requiring urgent evaluation 2