Synopsis
Localise cervical nerve-root disease, distinguish it from degenerative cervical myelopathy and peripheral nerve lesions, select management-changing imaging, and escalate progressive neurological dysfunction safely.
- Cervical radiculopathy causes arm pain or paraesthesia with root-pattern sensory, motor or reflex change, usually from foraminal disc or osteophyte disease; neck pain may coexist but does not localise a root.
- C5 affects shoulder abduction/elbow flexion, C6 often thumb sensation and wrist extension with biceps/brachioradialis reflex change, C7 middle-finger sensation and elbow extension with triceps change, and C8 finger flexion or ulnar-hand sensation.
- Always screen for myelopathy: gait disturbance, clumsy or weak hands or legs, brisk reflexes, extensor plantars and new bladder or bowel disturbance require specialist escalation under NICE NG127.
Key red flags
Gait disturbance, clumsy or weak hands or legs, brisk triceps or lower-limb reflexes, extensor plantar responses or new bladder or bowel dysfunction are NICE referral triggers in a person labelled with cervical radiculopathy.
Rapidly progressive motor weakness, multilevel deficit or respiratory compromise requires urgent assessment even without established long-tract signs.
Trauma, destructive bone pain, fever, immunosuppression, cancer history or unexplained weight loss raises fracture, infection or malignant compression.
Severe neck pain with thunderclap headache, Horner syndrome, cranial deficit or posterior-circulation symptoms raises vascular pathology rather than routine root compression.
Age under 20 with persistent cervical radicular symptoms is an explicit NICE reason not to leave the patient on the routine stable-adult pathway.
Bilateral hand numbness with gait change should not be labelled carpal tunnel syndrome until cervical cord disease has been assessed.
Ask about gait, falls, loss of hand dexterity, leg stiffness and bladder or bowel change; examine lower limbs, reflexes and plantar responses. Any progressive cord pattern warrants specialist assessment.
Document power in reproducible positions and distinguish pain inhibition from true weakness. Rapid or functionally important progression requires urgent spinal advice.
Investigation priorities
Localise a cervical root and, critically, detect cord involvement that changes urgency.
Management branches
An adult has a stable cervical root syndrome without trauma, systemic red flags, progressive weakness or myelopathy.
- Explain the likely root syndrome, maintain tolerable activity and offer structured exercise or physiotherapy with ergonomic and functional advice; document baseline power, reflexes and gait.
- Review within a defined interval and escalate sooner for weakness or cord features; if symptoms remain disabling, obtain non-contrast cervical MRI when it will guide specialist treatment.