GPAtlas🧭 When to suspect
Cervical radiculopathy is compression, irritation or inflammation of a cervical nerve root, producing lower motor neurone (LMN) symptoms in the corresponding distribution. The usual cause is degenerative – osteophytes and foraminal narrowing from cervical spondylosis in older patients – or an acute disc prolapse in younger ones. It must be distinguished from cervical myelopathy, where narrowing of the spinal canal compresses the cord and produces upper motor neurone (UMN) signs; myelopathy is rarer but is the surgical priority hiding among common neck presentations.
Suspect it in unilateral neck, shoulder or arm pain following a dermatomal pattern, usually with paraesthesia (pins and needles, tingling or numbness) and sometimes weakness in a myotomal distribution. The C6 and C7 roots are most often involved, with C7 the single most frequently affected; sensory symptoms are more common than weakness, and the relevant reflex is often diminished. The annual incidence is roughly 100 per 100,000 men and 60 per 100,000 women.
The key primary-care task is threefold: recognise the dermatomal pattern, exclude myelopathy and other serious pathology, and manage conservatively while safety-netting – because the large majority of cases settle on their own.
| Root (disc level) | Pain / sensory area | Motor (myotome) | Reflex |
|---|---|---|---|
| C5 (C4/5) | Neck to shoulder, lateral upper arm | Shoulder abduction, elbow flexion | Biceps |
| C6 (C5/6) | Lateral forearm, thumb and index finger | Elbow flexion, wrist extension | Biceps / supinator |
| C7 (C6/7) – most common | Middle finger, dorsal forearm | Elbow extension, wrist & finger extension | Triceps |
| C8 (C7/T1) | Medial forearm, ring and little finger | Finger flexion, thumb extension | (Finger flexion) |
| T1 (T1/2) | Medial upper arm, axilla | Finger abduction & adduction (intrinsics) | – |
Raise particular concern with increasing age, manual or repetitive neck work, prolonged static posture, smoking (a risk factor for disc degeneration), previous episodes, or a history of neck trauma.
Source: BJGP 2018
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