Etiology — what causes it

Compression or inflammation of a cervical nerve root, most commonly from a foraminal disc protrusion or degenerative foraminal stenosis from facet and uncovertebral joint osteophytes. C6 and C7 roots are most often involved.

Epidemiology — who gets it

Annual incidence is roughly 83 per 100,000 (Radhakrishnan et al., Brain). Peak age is 40–60. Outcomes are favorable with conservative care for the majority — Thoomes et al. (systematic reviews) support a conservative-first approach.

Clinical signs

Positive Spurling test (high specificity), positive cervical distraction test (relief with traction), positive upper limb neurodynamic test (ULNT), dermatomal sensory deficit, myotomal weakness, diminished reflex (biceps for C5–C6, brachioradialis for C6, triceps for C7). Wainner cluster (4 of 4 positive) yields high specificity.

Symptoms

Arm-dominant pain following a dermatomal pattern — sharp, shooting, burning. Numbness or paresthesia in the involved distribution. Often worse with neck extension and ipsilateral side bending (Spurling position), relieved by abducting the arm overhead (shoulder abduction relief sign).

Best evidence for chiropractic treatment

Thoomes et al. systematic reviews and the JOSPT 2017 cervical CPG (Blanpied et al.) support conservative care including manual therapy, neural mobilization, traction in select cases (positive on Wainner cluster), deep cervical flexor training, and graded scapular and upper limb loading. Surgery is reserved for progressive deficit, myelopathy, or persistent disabling radicular pain after structured conservative care.

Subtypes

  • C5 radiculopathy. Deltoid and biceps weakness; lateral arm pain.
  • C6 radiculopathy. Biceps and wrist extensor weakness; lateral forearm and thumb pain.
  • C7 radiculopathy. Triceps and wrist flexor weakness; posterior arm and middle finger pain. Most common.
  • C8 radiculopathy. Hand intrinsic weakness; medial forearm and small finger pain.

When to seek emergency care

Some symptoms need urgent medical attention — not a chiropractic visit. Call 911 or go to the nearest emergency department for: progressive limb weakness, loss of bowel or bladder control, saddle anesthesia (numbness in the groin/inner thighs), severe unrelenting pain unrelieved by position, signs of fracture after significant trauma, chest pain, stroke-like symptoms (face drooping, arm weakness, speech changes), or any rapidly worsening or unusual symptom.

Bottom line

Most cervical radiculopathies improve substantially with conservative care over 6–12 weeks. Neural mobilization, manual therapy, and graded loading do most of the work.