Yes, Moderate-to-Severe Multilevel Cervical Foraminal Stenosis with Radiculopathy Can Cause Pain When Pressing the Top and Upper Back of the Shoulder
Cervical foraminal stenosis with radiculopathy, particularly involving C5 nerve root compression, commonly produces shoulder pain that is tender to palpation in the superior and upper-posterior shoulder region.
Mechanism of Shoulder Pain in Cervical Radiculopathy
The connection between cervical foraminal stenosis and shoulder pain is well-established through specific nerve root involvement:
C5 radiculopathy specifically causes severe shoulder pain that can mimic primary shoulder pathology, with pain distribution extending to the superior and posterior shoulder regions 1.
C4/5 foraminal stenosis shows a significant association with ipsilateral shoulder symptoms, with 57.3% of patients demonstrating ipsilateral foraminal stenosis when presenting with shoulder complaints 1.
Among patients with both frozen shoulder and neck pathology, 78% experienced neck pain on the same side as their shoulder symptoms, and 44% had pain radiating directly to the shoulder 1.
Clinical Correlation Between Stenosis Severity and Pain
The severity and location of your foraminal stenosis directly correlates with symptom intensity:
Both the grade of cervical foraminal stenosis and the total count of affected levels correlate with arm pain severity on visual analogue scale measurements 2.
Arm pain occurs more frequently on the side with more grade 2 and 3 foraminal stenosis, confirming that moderate-to-severe stenosis produces clinically significant symptoms 2.
The sidedness of arm and shoulder pain significantly correlates with the side showing greater foraminal stenosis burden when comparing left versus right 2.
Why Pressure Causes Pain
When you press on the superior and upper-posterior shoulder with cervical radiculopathy:
The C5 nerve root innervates the deltoid and shoulder region, making this area tender when the nerve is compressed at the C4/5 or C5/6 foraminal level 1.
Pressure on already inflamed or sensitized tissues in the shoulder region exacerbates pain from the underlying nerve root compression, even though the primary pathology is in the cervical spine 1.
This phenomenon is so common that it can lead to misdiagnosis as primary shoulder pathology—44% of patients with C5 radiculopathy underwent nerve-targeted interventions because the shoulder pain was the dominant presenting feature 1.
Important Clinical Pitfall
A critical caveat: Do not assume all shoulder pain with cervical stenosis is purely radicular. The 2024 study found that C5 radiculopathy may be a risk factor for "neurogenic frozen shoulder," where actual glenohumeral pathology coexists with cervical pathology 1. A multidisciplinary evaluation involving both shoulder and spine assessment is warranted when symptoms are severe or persistent 1.
What This Means for Your Symptoms
Given your moderate-to-severe multilevel cervical foraminal stenosis with radiculopathy:
The tenderness you experience when pressing the top and upper back of your shoulder is consistent with C5 radiculopathy from foraminal stenosis at C4/5 or C5/6 levels 1, 2.
The severity of your stenosis (moderate-to-severe) correlates with more significant pain symptoms, including this pressure-induced tenderness 2.
Multilevel involvement increases the likelihood and severity of referred shoulder pain compared to single-level disease 2.