Table 3.
Symptoms and signs of cervical radiculopathy and mimic conditions
| Nerve root | Pain | Weakness | Reflex changes | Conditions | How to differentiate |
|---|---|---|---|---|---|
| C2–4 | Occiput, temporal area, back of the ear, upper neck | Diaphragm (paradoxical respiration) | - | Migraine | Bitemporal throbbing pain, aura (sensitivity to light), nausea and vomiting, or visual disturbance in migraine |
| C5 | Neck, suprascapular, lateral upper arm to elbow | Shoulder abduction; external rotation; elbow flexion | Biceps | Rotator cuff tear | Weakened shoulder abduction and pain on deltoid area, but no shoulder pain during passive exercise or tenderness in C5 radiculopathy; reflex intact in rotator cuff tear |
| Acute brachial-plexus neuritis (Parsonage-Turner syndrome) | Acute onset of pain in the neck, shoulder, and arm which is followed by marked numbness and weakness of arm within a few days to weeks, typically in the C5–6 area as the pain is relieved; usually pain and neurologic deficits occur simultaneously in cervical radiculopathy | ||||
| C6 | Neck, lateral forearm, thumb and index finger | Elbow flexion; forearm supination; wrist extension | Biceps, brachioradialis | CTS | Normal NCS in cervical radiculopathy, but in CTS, abnormal NCS, thenar muscle atrophy, and positive Tinel’s sign, Phalen’s maneuver, or Durkan’ test in CTS |
| C7 | Lower neck, interscapular, posterior forearm, middle finger | Elbow extension; forearm pronation; wrist flexion; finger extension | Triceps | PIN syndrome | Weakness of triceps, wrist flexors, and finger extensors in C7 radiculopathy; sensory intact, normal triceps and wrist flexors strength in PIN syndrome |
| C8 | Inter- and infra-scapular, medial forearm, 4rth and 5th finger | Hand intrinsic; finger flexion | - | Cubital tunnel syndrome | Tenderness at medial side of elbow, hypothenar muscles and adductor pollicis weakness, sensory changes in hand and 4th, 5th fingers in ulnar neuropathy; intact adductor pollicis in C8 radiculopathy |
| Pancoast syndrome | Due to compression of the brachial plexus, paresthesia and weakness in intrinsic hand muscles with ipsilateral ptosis, miosis, and anhidrosis (Horner’s syndrome) |
CTS, carpal tunnel syndrome; NCS, nerve conduction study; PIN, posterior interosseus nerve.