Cervical Radiculopathy Does Not Typically Cause Tremors
Cervical radiculopathy does not cause tremors—it presents with neck and arm pain, sensory loss, motor weakness, and reflex changes in a dermatomal distribution, but tremor is not a recognized feature of nerve root compression. 1, 2, 3
Classic Presentation of Cervical Radiculopathy
Cervical radiculopathy is characterized by specific neurological dysfunction patterns that do not include tremor:
Pain distribution: Neck pain radiating to one arm in a dermatomal pattern corresponding to the compressed nerve root 2, 3
Sensory changes: Numbness, paresthesias, or sensory loss in the affected dermatome—not tremor 1, 3
Motor dysfunction: Weakness in specific muscle groups corresponding to the affected nerve root (e.g., C6 radiculopathy causes weakness in wrist extension and elbow flexion) 1, 3
Reflex changes: Diminished deep tendon reflexes, particularly triceps reflex, are the most common neurologic finding 4
Why Tremor Suggests Alternative Diagnosis
If a patient presents with left arm and hand tremors in the context of neck pain, you must investigate alternative or additional diagnoses beyond cervical radiculopathy:
Tremor indicates a central nervous system disorder (essential tremor, Parkinson's disease, cerebellar pathology) or metabolic/toxic causes—not peripheral nerve root compression 3, 5
Cervical myelopathy (spinal cord compression) can cause upper motor neuron signs including spasticity and gait instability, but tremor is still not a typical feature 1, 6
The presence of tremor with radicular symptoms should prompt evaluation for concurrent conditions or reconsideration of the primary diagnosis 3, 6
Red Flags Requiring Immediate Evaluation
When evaluating a patient with arm tremor and neck pain, assess for these concerning features that warrant urgent specialist referral:
Progressive neurological deficits, myelopathy signs (gait instability, fine motor deterioration, hyperreflexia, positive Hoffman's sign) 2, 7
Bladder or bowel dysfunction, loss of perineal sensation 7
Significant motor weakness beyond what tremor alone would explain 2, 7
History of trauma, malignancy, prior neck surgery, systemic diseases, suspected infection, or intravenous drug use 8, 2, 7
Diagnostic Approach
For a patient presenting with left arm tremor and neck pain:
Perform meticulous neurological examination to distinguish radicular patterns (dermatomal sensory loss, myotomal weakness, reflex changes) from tremor characteristics (resting vs. action, frequency, amplitude) 3, 5
Spurling test, shoulder abduction test, and upper limb tension test can confirm radiculopathy if present, but will not explain tremor 4
MRI cervical spine is the preferred imaging modality if radiculopathy is suspected, but remember that degenerative findings are common in asymptomatic patients >30 years and correlate poorly with symptoms 8, 2
Critical pitfall: MRI has high rates of false-positives and false-negatives in cervical radiculopathy—findings must correlate with clinical symptoms 8, 2, 7
Consider neurological consultation for tremor evaluation, as this requires assessment for movement disorders, not spine pathology 3, 6
Clinical Decision Algorithm
Assess tremor characteristics: Determine if resting, action, or intention tremor; this guides differential diagnosis toward movement disorders, not radiculopathy 3
Evaluate for true radiculopathy: Look for dermatomal pain, sensory loss in specific nerve root distribution, myotomal weakness, and reflex changes 2, 3, 4
If both radiculopathy AND tremor are present: These are likely separate conditions requiring parallel evaluation—cervical radiculopathy does not cause tremor 1, 3
Screen for myelopathy: If gait instability, hyperreflexia, or upper motor neuron signs are present, urgent MRI and neurosurgical evaluation are required 1, 7
If isolated tremor without radicular features: Refer to neurology for movement disorder evaluation, not spine surgery 3, 6