Cervical Radiculopathy

Pain in one or both upper limbs (usually with neck pain) from compression or irritation of a cervical nerve root, ± motor, sensory or reflex deficit. Most prevalent at 50–54 years; usually degenerative (spondylosis, disc herniation). C7 is the most commonly affected root, then C6.

Pathology

• Spondylosis — uncovertebral hypertrophy affects the anterior nerve root; facet arthritis affects the posterior root; disc-height loss narrows the neural foramen.
• Disc herniation — intraforaminal (mainly sensory symptoms), posterolateral (weakness ± atrophy), or midline (cord compression → myelopathy: upper-limb numbness/weakness, gait disturbance, ataxia, urinary incontinence).

Nerve-root patterns

Root	Pain / sensory	Motor	Reflex
C5	Lateral arm/shoulder	Deltoid, elbow flexion	Biceps
C6	Lateral forearm, thumb	Biceps, wrist extension	Brachioradialis
C7	Dorsal forearm, middle finger	Triceps, wrist flexion	Triceps
C8	Medial forearm, ulnar digits	Finger flexors	—
T1	Ulnar forearm	Finger intrinsics	—

Red flags

Condition	History	Examination
Malignancy	Fever, cancer history, night pain, weight loss	Gait abnormality, focal deficit
Myelopathy	Reduced dexterity, urinary urgency	Ataxia, clonus, hyperreflexia
Spinal abscess	Fever, IVDU, immunocompromise	Neurological deficit

Provocative tests

• Spurling’s test — lateral flexion/extension + gentle axial compression; positive = reproduction of radicular symptoms (narrows the foramen). Specific.
• Shoulder abduction (relief) test — hand on top of the head relieves symptoms.
• Upper limb tension test — the most sensitive for ruling radiculopathy out.

Differential

Includes carpal/cubital tunnel syndrome, rotator cuff disease, thoracic outlet syndrome, brachial plexopathy (Parsonage–Turner), herpes zoster, complex regional pain syndrome, and extraspinal malignancy (e.g. Pancoast tumour).

Imaging and management

• X-ray rules out instability but is non-specific (≈65% of asymptomatic 50–59-year-olds show degeneration).
• MRI only for complex radiculopathy — suspected myelopathy/abscess, progressive deficit, or failure of 4–6 weeks of conservative care (high false-positive rate otherwise). CT clarifies equivocal MRI.
• Management: most improve with conservative care (analgesia, activity modification, physiotherapy); consider a nerve-root corticosteroid injection if symptoms persist beyond 4–6 weeks; refer for progressive deficit or myelopathy.