08/01/2026
Cervical Radiculopathy
(Diagnosis + Treatment )( Clinical Summary )
1. Overview and Causes
Cervical radiculopathy occurs when a nerve root in the neck is compressed or inflamed as it exits the spinal column. While it can be painful, the prognosis is excellent, with 80%–90% of patients improving without surgery.
2. Primary Causes:
Disc Herniation: Wear and tear of the intervertebral discs.
Spondylosis: Formation of bone spurs (osteophytes) due to aging.
Hypertrophy: Thickening of the facet joints.
Degeneration: Loss of disc height that distorts surrounding ligaments.
Symptoms and Anatomy
Symptoms typically appear on one side of the body and radiate from the neck down the arm.
Pain: Burning or shooting sensations, often in the trapezius or shoulder blade area.
Sensory/Motor: Numbness, tingling, or weakness in a specific "dermatomal" (skin area) or "myotomal" (muscle group) distribution.
Common Sites: The C6 and C7 nerve roots are the most frequently affected. Note that C1–C7 roots exit above their matching vertebrae, while C8 exits between C7 and T1.
3. Diagnosis and Examination
Spurling Test: A physical exam maneuver where the head is extended and turned toward the painful side to reproduce symptoms.
Neurological Exam: Checking reflexes (like the Hoffman sign), muscle power, and skin sensation.
Imaging: MRI is the gold standard for visualizing soft tissue and nerve compression. CT is used if MRI is contraindicated or to plan surgery for bony obstructions.
4. Treatment Pathway
Because the condition is usually self-limiting, a conservative approach is prioritized for the first several months.
Non-Operative (First-Line)
Medication: Paracetamol, NSAIDs, and occasionally neuropathic pain meds (like Gabapentin) for chronic cases.
Physiotherapy:
Prognosis and Education
Natural History: Highly favorable. Most cases resolve within 4 weeks without surgery.
Patient Education: Clarifying the diagnosis and "signposting" (directing to self-management resources) reduces anxiety and encourages movement.
Therapeutic Exercise
Mobility: Focuses on improving cervical range of movement through active exercises.
Strength: Includes specific stretching and strengthening to support the neck and upper back.
Postural Re-education: Training to optimize spinal alignment and reduce repetitive strain on nerve roots.
Specialized Nerve & Manual Therapy
Neurodynamic Exercises: Uses "gliding" and "sliding" techniques to move the nerve through its pathway, reducing sensitivity and improving blood flow.
Manual Therapy: Includes joint and soft tissue mobilizations to decrease muscle guarding and improve joint mechanics.
Injections: Steroid injections can provide temporary relief or help confirm which specific nerve is causing the problem.
Operative (Surgery)
Surgery is reserved for failed conservative management (persistent pain) or progressive neurological deficits (increasing weakness).
ACDF: Anterior Cervical Discectomy and Fusion (removing the disc from the front).
Laminoforaminotomy: A posterior approach to decompress the nerve from the back.
