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Cervical Radiculopathy

Original Editor - Stéphanie Dartevelle

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Introduction

Cervical radiculopathy is a clinical syndrome in which a cervical nerve root is compressed or irritated, most often by a herniated intervertebral disc or by degenerative (spondylotic) change such as osteophyte formation. It typically presents with neck and arm pain, frequently accompanied by sensory loss, weakness or reflex change in the distribution of the affected root.[1]

Root dysfunction may result from compression, irritation, traction or direct injury of the nerve, caused by disc herniation, foraminal narrowing or degenerative change that narrows the intervertebral foramen.[2] [3]

Most cases involve a single nerve root, most often C7, followed by C6.[4] Radiating pain, paraesthesia or weakness can be traced back to the affected root level.[2]

Clinically Relevant Anatomy

Nerve root numbering

The cervical spine has seven vertebrae but eight pairs of spinal nerves. Roots C1 to C7 exit above the vertebra of the same number, the C8 root exits between C7 and T1, and from T1 downwards each root exits below its vertebra.[2]

Intervertebral foramina

Tanaka et al. examined 18 cadaveric cervical spines under a surgical microscope to describe the relationship between the nerve roots, foramina and discs.[5] The foramen is funnel-shaped, with its entrance zone the narrowest part, and this is where root compression is considered to occur. Anteriorly, the root can be compressed by a protruding disc or by osteophytes of the uncovertebral region. Posteriorly, the superior articular process, ligamentum flavum and periradicular fibrous tissue can encroach on it.

The same study found that the C5 root leaves over the middle of the disc, the C6 and C7 roots cross its proximal part, and the C8 root overlaps little with the C7–T1 disc. The authors suggested that these relationships, together with connections between the dorsal rootlets of C5 to C7, may help explain the variable clinical picture of root compression.

Vulnerability of the nerve root

Nerve roots have less connective tissue protection than peripheral nerves and a more vulnerable blood supply, so they are susceptible to mechanical and ischemic injury even under low loads.Experimental work suggests that pressures of only a few millimetres of mercury can impair venous flow and axonal transport, that higher pressures increase vascular permeability and intraneural oedema, and that sustained high pressures block conduction.[5]

The rate of onset appears to matter. Sudden compression, such as an acute disc herniation, tends to produce more pronounced symptoms. Gradually progressive stenosis may allow neural tissue to accommodate, so symptoms can be milder for a given degree of compression.[5]

Epidemiology / Aetiology

Cervical radiculopathy is a dysfunction of a nerve root in the cervical spine, is a broad disorder with several mechanisms of pathology and it can affect people of any age,[6] with peak prominence between the ages of 40-50.[2][7][8] Reported prevalence is 83 people per 100,000 people.[8] Annual incidence has been reported to be 107,3 per 100.000 for men and 63,5 per 100.000 for women.[9][10]

Basic Picture of a Cervical Vertebral Body

The two main mechanisms of the nerve root irritation or impingement are:[9]

  1. Spondylosis leading to stenosis or bony spurs - more common in older patients
  2. Disc herniation - more common in younger patients

Mechanical compression from spondylosis can affect the neuroforamen from all directions, which limits nerve root excursion. Cytokines released from damaged intervertebral discs can also cause this disorder.[9]

There is increasing evidence that inflammation itself and/or in association with root compression is the main cause of symptoms and signs. This is proved by the presence of interleukins and prostaglandin in herniated discs and the spontaneous recovery within weeks or months in the majority of patients.[11]

Level of Compression

  • Most common level of root compression is C7 (reported percentages 46.3–69%)
  • Followed by C6 (19–17.6%)
  • Compression of roots C8 (10– 6.2%)
  • Compression of roots C5 (2–6.6%)

One possible explanation is that intervertebral foramina are largest in the upper cervical region and progressively decrease in size in the middle and lower cervical areas, with an exception of the C7-Th1 foramen (C8).[11][12]

Clinical Presentation

Typical Dermatomal Pattern of the Upper Limb

Typical symptoms of cervical radiculopathy include:[2][6][3][13][14]

  • Radiating arm pain corresponding to a dermatomal pattern
  • Neck pain
  • Paraesthesia
  • Muscle weakness in a myotomal pattern
  • Reflex impairment/loss
  • Headaches
  • Scapular pain
  • Sensory and motor dysfunction in upper extremities and neck.

Upper limb movements that are affected:

  • C1/C2- Neck flexion/extension
  • C3- Neck lateral flexion
  • C4- Shoulder elevation
  • C5- Shoulder abduction
  • C6- Elbow flexion/wrist extension
  • C7- Elbow extension/wrist flexion
  • C8- Thumb extension
  • T1- Finger abduction

The absence of radiating pain does not exclude nerve root compression. The same appears with sensory and motor dysfunction that might be present without significant pain.[2]

Symptoms are generally amplified with movements that may be unidirectional or multidirectional reduce the space available for the nerve root to exit the foramen causing impingement.[2] This often causes the patient to present with a stiff neck and a decrease in cervical spine ROM, secondary musculoskeletal problems, decrease in muscle length of the cervical spine musculature (upper fibres of trapezius, scaleni, levator scapulae), weakness, joint stiffness, capsule tightness, and postural defects which can go on to affect movement mechanisms of the rest of the body.

Specifics

  • The locality of sensory impairments associated with symptomatic C6 and C7 nerve root compression overlap to the extent that care should be exercised when diagnosing compression of either the C6 or C7 nerve roots based on locations of impaired sensation.
  • Distal forearm impaired sensation is more common in C6 radiculopathies.[15]

Differential Diagnosis

Differentiating from cervical radiculopathy is derived from a combination of a patient's history, physical examination, and radiological findings.[16] Pathologies which mimic the signs and symptoms of radiculopathy.[17]

Diagnostic Procedures

The most common diagnostic methods used to assess the presence of possible compression are radiographs, MRI and electrophysiologic studies (EMG + Nerve Conduction Studies) to examine the nerve root and nerve conduction velocity.[18][2][6]

Root compression seen on an MRI may confirm cervical radiculopathy, but to detect foraminal stenosis, which causes a bony compression on the nerve, spiral CT is described as the best way to detect this.[11]

There still is no consensus on whether conventional needle myography (EMG) has a strong diagnostic value for cervical radiculopathy. Several unblinded studies have reported sensitivities ranging from 30-95%.[11]

A subjective history and mechanism of Injury can be integral to an accurate diagnosis and the cause of radiating arm pain. More frequently acute radiating arm pain is caused by a disk herniation, while chronic bilateral axial neck and radiating arm pain is usually caused by cervical spondylosis.[2]

Outcome Measures

Neck disability index NDIPatient Specific Functional Scale PSFS

Numerical Pain Rating Scale NPRS

Neck Pain and Disability Scale (NPAD)

Clinical Examination

Provocative tests are used to reproduce or relieve arm symptoms and to support the diagnosis of cervical radiculopathy, but the evidence for their diagnostic accuracy is limited. A 2018 systematic review of five diagnostic accuracy studies concluded that, when consistent with the patient's history, a combination of Spurling's test, axial traction and the Arm Squeeze test may increase the likelihood of cervical radiculopathy, whereas four negative neurodynamic tests together with a negative Arm Squeeze test may help to rule it out.[19] The same review found no studies of the diagnostic accuracy of strength testing, tendon reflexes or sensory examination.[19] A 2025 scoping review similarly reported varying definitions of radiculopathy, suboptimal reference standards and heterogeneous examination procedures, and noted that the components of the neurological examination have high specificity but low sensitivity.[20]

Clinical prediction cluster

Wainner et al. developed a cluster of four findings and compared it with electrodiagnostic studies:[21]

With three of the four findings present, the post-test probability of cervical radiculopathy was 65%, rising to 90% when all four were present.[21] This cluster comes from a single derivation study, and subsequent reviews rate the overall certainty of evidence for physical examination tests as limited.[19] It should therefore support, not replace, clinical reasoning.

Individual testing

  • Spurling's test. In one study performed before imaging, Spurling's test had a sensitivity of 30% and a specificity of 93%. It is therefore not useful for screening but may help to confirm cervical radiculopathy.[22]
  • Arm Squeeze test. Gumina et al. reported a sensitivity and specificity of 96% for distinguishing cervical nerve root compression from shoulder disease, with inter-observer and intra-observer values of 0.81 and 0.87.[23] These findings come from a single study and need independent confirmation. A later systematic review nevertheless included the test in its recommended combinations, within an overall limited evidence base.[19]

Neurological examination

The neurological examination looks for loss of sensation, weakness and reduced reflexes in the distribution of the affected root. It cannot be used alone to confirm the diagnosis (see above), and root patterns overlap and vary between individuals. Conventional patterns are shown below.[24][25]

Adapted from Childress and Becker (2016), who adapted it from Eubanks (2010).
Nerve root Pain distribution Motor Sensory Reflex
C4 Lower neck, trapezius None Cape distribution (lower neck, upper shoulder girdle) None
C5 Lateral arm, neck, shoulder Deltoid, elbow flexion Lateral arm Biceps
C6 Dorsolateral arm, neck, thumb Biceps, wrist extension Lateral forearm, thumb Brachioradialis
C7 Dorsolateral forearm, middle finger, neck Triceps, wrist flexion Dorsal forearm, middle finger Triceps
C8 Medial forearm, neck, ulnar digits Finger flexors Medial forearm, ulnar digits None
T1 Ulnar forearm Finger instrinsics Ulnar forearm None

Because peripheral nerve entrapments can mimic root involvement, simple distinguishing features are useful:

  • Carpal tunnel syndrome versus C6/C7 radiculopathy: triceps and wrist extensor weakness are absent in carpal tunnel syndrome.[24]
  • Cubital tunnel syndrome versus C8/T1 radiculopathy: thumb interphalangeal flexion weakness is absent in cubital tunnel syndrome.[24]

Medical Management

Most patients improve with nonoperative care, with 75–90% achieving symptomatic improvement. In the absence of myelopathy or significant muscle weakness, conservative treatment is recommended for at least six weeks.[4] No nonoperative modality is supported by high-quality evidence, so a multimodal approach is usual.[1][24]

Surgery

Indications for a single level surgery:[26]

  • Sensory symptoms (radicular pain and/or paraesthesia's) in a dermatomal distribution that correlates with involved cervical level
  • Motor deficit, reflex changes or positive EMG correlated to involved cervical level
  • A positive response to a selective nerve root block (SNRB).
  • Positive MRI or myelogram with computed tomography (CT) scan.
  • At least 6 weeks of conservative care such as physical therapy, epidural injections, NSAID’s, pain killers.
  • In case of clear motor deficit, 6 weeks of conservative care are not required.

Criteria for a 2nd level surgery:

  • All of the criteria previously described for a single level surgery, not including SNRB, are present at the primary level.
  • The adjacent level has radicular pain correlating with at least moderate foraminal stenosis or lateral recess herniation or EMG changes, motor deficits or reflex changes correlated to adjacent level.

Operative techniques that are frequently used as treatment for cervical radiculopathy are:

Engquist et al. found that surgery with physiotherapy resulted in a more rapid improvement during the first postoperative year, with significantly greater improvement in neck pain and the patient's global assessment than physiotherapy alone. The differences between the groups decreased after 2 years. They suggested that structured physiotherapy should be tried before surgery is chosen.[28]

Persson et al.[29] compared surgery, physiotherapy and a cervical collar and found no significant differences at one year in strength, pain or sensation. This was a small study, and a non-significant difference does not demonstrate equivalence, so it should not be read as showing that physiotherapy is as effective as surgery.

ACDF is associated with diminished ROM and strength compared to conservative treated subjects. This can, occasionally, be associated with prolonged pain.[27]

Peolsson et al.[30] concluded that ACDF did not result in additional improvements in neck active range of motion, neck muscle endurance, or hand-related function compared with a structured physiotherapy program alone in patients with cervical radiculopathy. The article suggests that a structured physiotherapy program should precede a decision for ACDF intervention in patients with cervical radiculopathy, to reduce the need for surgery.[30]

Short duration of pain, low health quality, high levels of anxiety due to neck/arm pain, low self-efficacy, and a high level of distress before treatment were associated with poor outcomes from surgery.[28]

Injections

Epidural steroid injections can also be used as treatment for cervical radiculopathy. The injections are given under the guidance of fluoroscopy or CT. There is limited evidence that transforaminal epidural steroid injections provide relief for 60% of the patients and about 25% of the patients with clear surgical indications. Steroid injections are not a causal treatment and are not a solution, although they can be considered when developing a medical/interventional treatment plan for patients with cervical radiculopathy from degenerative disorders. Trans-foraminal injections are not without risk and possible complications such as spinal cord injury and death must be considered before performing this procedure.[31][32]

Lee SH et al. researched the use of ESI (Epidural Steroid Injections) in patients diagnosed with cervical soft disc or hard disc causing nerve root compression and symptoms. In more than 80% of patients with CR who were surgical candidates, surgery was avoided using ESI. The significant factors predisposing failure of ESI were intensity of symptoms and a previous episode of CR.[33] 

Physiotherapy Management

Although a definitive treatment progression for treating cervical radiculopathy has not been developed, a general consensus exists within the literature that using manual therapy techniques in conjunction with therapeutic exercise is effective in regard to increasing function, as well as active range of movement (AROM), focusing on decreasing levels of pain and disability will most likely be the main focus of the patient[34]. Recent high level research confirms the positive outcomes of exercise therapy[35]. 

If the patient has had long-term pain, an element of pain sensitisation may have developed and chronic pain behaves differently to acute pain. Therefore education about pain and re-conceptualisation may be necessary. 

Treatment Options:

  1. Education and advice
  2. Manual Therapy - PAIVMs (Passive Accessory Intervertebral Movements) / PPIVMs (Passive Physiological Intervertebral Movements) / NAGs (Natural Apophyseal Glides) / SNAGs (Sustained Natural Apophyseal Glides)
  3. Exercise Therapy - AROM, stretching and strengthening
  4. Postural re-education

Education and Advice

Education is key to getting the patient on side and to work co-operatively with physiotherapy. If a patient understands the condition and the reason for the neck and arm pain then they are more likely to be compliant with any rehabilitation plan.

In cases of a prolapsed disc, tobacco smoking causes constriction of the vascular network surrounding the intervertebral disc (IVD), reducing the indirect exchange of nutrients and anabolic agents from the blood vessels to the disc. Nicotine down-regulates the proliferation rate and glycosaminoglycan (GAG) biosynthesis of disc cells. Nicotine mostly affects the GAG concentration at the cartilage endplate, reducing it up to 65% of the value attained in normal physiological conditions. Tobacco mostly affects the nucleus pulposus, whose cell density and GAG levels reduce up to 50% of their normal physiological levels. The effectiveness of quitting smoking on the regeneration of a degenerated IVD shows limited benefit on the health of the disc. Cell-based therapy in conjunction with smoke cessation should provide significant improvements in disc health, suggesting that, besides quitting smoking, additional treatments should be implemented in the attempt to recover the health of an IVD degenerated by tobacco smoking.[36] 

Manual Therapy

The evidence for manual therapy in cervical radiculopathy is limited and mixed. A 2016 clinical review concluded that no nonoperative modality was supported by high-quality evidence.[24] More recent systematic reviews of randomised trials report short-term reductions in pain and neck disability with manual therapy, but the trials are small and differ in diagnostic criteria and techniques, and the authors call for standardised definitions.[37][38] In a 2025 network meta-analysis of eight trials (632 participants), manual therapy ranked most likely to be the best option for neck disability and pain, but the pairwise differences against control were small and their confidence intervals included zero.[38]

Earlier reviews addressed mechanical neck disorders generally rather than radiculopathy. A Cochrane review of manipulation and mobilisation reported benefit when manual techniques were combined with exercise, but not when used alone.[39]

Boyles et al. reported that thrust and non-thrust mobilisation of the cervical and thoracic spine reduced pain and improved function, with greater effect when combined with exercise.[40]

Cervical manipulation has been associated with serious complications, including vertebral artery dissection and, in the presence of a large disc herniation, spinal cord compression.[14] The International IFOMPT Cervical Framework guides screening for vascular pathologies of the neck before manual therapy.[41]

Findings on cervical traction are mixed. In one randomised trial, 10 sessions of supervised mechanical traction over four weeks added to physiotherapy gave better outcomes than physiotherapy alone at six and 12 months.[42][24] However, in a trial of 81 patients, adding mechanical traction to manual therapy and exercise produced no significant additional benefit in pain, function or disability.[6] Several earlier systematic reviews and trials, on low-quality evidence, found traction no better than placebo.[24][43]

Muscle Energy Techniques

Cleland et al [44] utilised muscle energy techniques (MET) in 28 patients, 46% receiving positive outcomes. However details of the techniques used were insufficient and a variety of techniques were used as it was down to the practitioner to decide which technique would be used.

The quality of research related to testing the effectiveness of MET is poor. Studies are generally small and at high risk of bias due to methodological deficiencies.[45]

Neurodynamics - Gliding and Sliding/Tensioning


Ragonese (2009)[46] performed the neurodynamics sliding and tensioning techniques, outlined by Butler,[47] whilst having the patient in an upper limb tension positions described by Magee[48] conducted in a slow and oscillatory manner. With improvement in symptoms, the technique was progressed to a ‘tension’ technique, also described by Butler. Again, positive outcomes were observed in regards to pain and function, although treatment duration was not recorded.

Exercise Therapy

Exercise is a core component of conservative management. A literature review of 11 studies (searched to May 2014) concluded that exercise training, mainly specific strengthening and general stretching, was beneficial for body function and activity participation in cervical radiculopathy.[35] A Cochrane review found low-quality evidence supporting strengthening and stretching of the neck, shoulder, scapulothoracic and upper arm muscles in the acute phase[24][49] and a randomised trial found improvement in the first six weeks with twice-weekly supervised physiotherapy plus home exercise compared with controls.[11][24] Overall, however, the evidence is of low quality, and most patients improve regardless of treatment modality.

Once ROM increases strengthening exercises can be performed to develop stability and reduce the risk of developing nerve root irritation in the future, as long as it is not caused by a structure which cannot be influenced by physiotherapy. During the initial stages of treatment, strengthening should be limited to isometric exercises in the involved upper limb. Once the radicular symptoms have been resolved, progressive isotonic strengthening can begin. This should initially involve low weight and high repetitions (15-20 repetitions). Closed kinetic chain activities can be very helpful in rehabilitating weak shoulder girdle muscles. However, Griffiths et al. found no significant difference with the addition of specific neck stabilisation exercises to a program of general neck advice and exercise [50].

Patient should be instructed to remain as active as possible and perform exercises daily on the days between therapy sessions. Written exercise instructions should therefore be available. We suggest a 2 components program, as suggested by Fritz JM et al. 2 components: scapula strengthening and cervical strengthening.

Cervical strengthening exercises should include supine cranio-cervical flexion to elicit contraction of the deep neck flexor muscles without contraction of superficial neck muscles [51]. Feedback using an air-filled pressure sensor or tactile cues can be useful. Patient should perform three sets of 10 contractions of 10 seconds with proper muscle activation. Cranio-cervical flexion contractions were also performed with the patient seated, with the goal of 30 repetitions of 10-second contractions.

Scapular retraction against resistance using elastic bands or pulleys can be added. Scapular-strengthening exercises included prone horizontal abduction, side-lying forward flexion, prone extension of each shoulder, as well as prone push-ups with emphasis on shoulder protraction. The goal was 3 sets of 10 repetitions, with resistance added as tolerated.

Prognosis

Natural history

Most patients with symptomatic cervical disc herniation and radiculopathy initially present with intense pain and moderate disability, and most recover.[52] In the Rochester cohort, 90% of patients were asymptomatic or only mildly incapacitated at last follow-up, although recurrence occurred in about a third and about a quarter had surgery.[10] Patients can be reassured that most cases resolve whatever the treatment.[24]

Predictors of short-term success with physiotherapy

In a prospective cohort of 96 patients treated at the discretion of their therapists, Cleland et al. identified four variables associated with short-term success (28-day follow-up): age under 54, the dominant arm not being affected, looking down not worsening symptoms, and multimodal treatment (manual therapy, cervical traction and deep neck flexor strengthening) in at least 50% of visit.[53] The pre-test probability of success was 53%. With three of the four variables present the post-test probability was 85%, and with all four it was 90% (positive likelihood ratio 8.3; 95% CI 1.9–63.9).[53] This is a derivation study without randomisation, and the fourth variable is a treatment received rather than a patient characteristic, so it cannot be treated as a prognostic factor or as proof that the treatment caused the outcome.

Clinical Bottom Line

Cervical radiculopathy is a disorder in which a cervical spinal nerve root is compressed, irritated or otherwise injured, for example by disc herniation or degenerative change. It typically causes neck pain and radiating arm pain, with numbness, sensory loss or weakness in the upper limb.

Diagnosis is mainly clinical and can be made from the history and physical examination. Imaging is not required unless there is a history of trauma, persistent symptoms, or red flags for malignancy, myelopathy or infection. Degenerative findings are common in people without symptoms, so imaging must be correlated with the clinical picture.[24] Electrodiagnostic testing is not needed when the diagnosis is clear, but can help when peripheral neuropathy is a likely alternative.

A cluster of four findings (a positive Spurling’s test, a positive upper limb tension test 1, a positive distraction test, and cervical rotation of less than 60° towards the involved side) has been proposed to support the diagnosis. When all four were present, the post-test probability was 90% in the derivation study.[21] The evidence for physical examination tests is limited, so they should be interpreted alongside the history and other findings.[19]

Most patients improve with nonoperative care, and conservative treatment is usually recommended for at least six weeks unless there is myelopathy or significant weakness.[4] Management aims to reduce pain and disability and restore function. Progressive or persistent neurological deficit warrants imaging and referral for a surgical opinion.[24] The Neck Disability Index and Numeric Pain Rating Scale are commonly used outcome measures. In cervical radiculopathy both showed fair test-retest reliability and adequate responsiveness, with minimal clinically important differences of 8.5 (NDI) and 2.2 (NPRS).[54]

References

  1. ↑ 1.0 1.1 Eubanks J. Cervical Radiculopathy: Nonoperative Management of Neck Pain and Radicular Symptoms. Am Fam Physician. 2010 Jan 1;81(1):33-40.
  2. ↑ 2.0 2.1 2.2 2.3 2.4 2.5 2.6 2.7 2.8 Eubanks, JD.Cervical Radiculopathy:Nonoperative Management of Neck Pain and Radicular Symptoms.American Family Physician 2010;81,33-40
  3. ↑ 3.0 3.1 Kenneth A. Olson. Manual physical therapy of the spine.Saunders Elsevier 2009.p 253, 257, 258
  4. ↑ 4.0 4.1 4.2 Woods BI, Hilibrand AS. Cervical radiculopathy: epidemiology, etiology, diagnosis, and treatment. J Spinal Disord Tech. 2015;28(5):E251-9.
  5. ↑ Tanaka N. et al, The anatomic relation among the nerve roots, intervertebral foramina, and intervertebral discs ofthe cervical spine. Spine. 2000 February; 25(3): 286-291
  6. ↑ 6.0 6.1 6.2 6.3 Young IA,Michener LA,Cleland JA,Aguilera AJ,Snyder AR.Manual therapy, exercise, and traction for patients with cervical radiculopathy: a randomize clinical trial.Physical Therapy 2009;89:632-642
  7. ↑ Radhakrishnan K, Litchy WJ, O'Fallon M, et al. Epidemiology of cervical radiculopathy: A population-based study from Rochester, Minnesota, 1976 through 1990. Brain 1994; 117:325-335.
  8. ↑ 8.0 8.1 Bogduk N. Twomey CT. Clinically Relevant Anatomy for the Lumbar Spine. 2ed. Edinburgh UK: Churchill Livingston. 1991
  9. ↑ 9.0 9.1 9.2 Barrett I. et al. Cervical Radiculopathy Epidemiology, Etiology, Diagnosis, and Treatment. Journal of Spinal Disorders &Techniques. April 2015; 28:5.
  10. ↑ 10.0 10.1 Radhaknshnank et al. Epidemiology of Cervical Radiculopathy. A Population Based Study. Brain. 1994: 117; 325-335
  11. ↑ 11.0 11.1 11.2 11.3 11.4 Kuijper B. et al. Degenerative cervical radiculopathy: diagnosis and conservative treatment: A review. European journal of neurology. 2009; 16(1): 15-20
  12. ↑ Ellenberg M, Honet J, Treanor W. Cervical Radiculopathy. Arch Phys Med Rehabil. 1994; 75:342-352.
  13. ↑ Kenneth W. Lindsay, Ian Bone.Neurology and neurosurgery illustrated.4th ed. Churchill Livingstone.p408
  14. ↑ 14.0 14.1 Kuijper B, Tans JT, Beelen A, Nollet F, de Visser M.Cervical collar or physiotherapy versus wait and see policy for recent onset cervical radiculopathy : randomised trial.BMJ 2009;p1-7
  15. ↑ Rainville J, Laxer E, Keel J, Pena E, Kim D, Milam RA, Carkner E. Exploration of sensory impairments associated with C6 and C7 radiculopathies. The Spine Journal. 2016 Jan 1;16(1):49-54. Available:https://pubmed.ncbi.nlm.nih.gov/26253986/ (accessed 26.9.2022)
  16. ↑ Gu R., et al. Differential diagnosis of cervical radiculopathy and superior pulmonary sulcus tumor. Chinese medical journal. 2012 August; 125(15): 2755-2757
  17. ↑ C: R. Erhard et al. Cervical Radiculopathy or Parsonage-Turner Syndrome: Differential Diagnosis of a Patient With Neck and Upper Extremity Symptoms. JOSPT. OCTOBER 2005fckLRVolume 35, No. 10
  18. ↑ Partanen J, Partanen K, Oikarinen H, et al. Preoperative electroneuromyography and myelography in cervical root compression. Electromyogr Clin Neurophysiol. 1991; 31:21-26.
  19. ↑ 19.0 19.1 19.2 19.3 19.4 Thoomes EJ, Van Geest S, Van Der Windt DA, Falla D, Verhagen AP, Koes BW, Thoomes-de Graaf M, Kuijper B, Scholten-Peeters WG, Vleggeert-Lankamp CL. Value of physical tests in diagnosing cervical radiculopathy: a systematic review. The Spine Journal. 2018 Jan 1;18(1):179-89.
  20. ↑ Yousif MS, Occhipinti G, Bianchini F, Feller D, Schmid AB, Mourad F. Neurological examination for cervical radiculopathy: a scoping review. BMC Musculoskeletal Disorders. 2025 Apr 5;26(1):334.
  21. ↑ 21.0 21.1 21.2 Wainner RS, Fritz JM, Irrgang JJ, et al. Reliability and diagnostic accuracy of the clinical examination and patient self-report measures for cervical radiculopathy. Spine. 2003;28(1):52-62.
  22. ↑ Tong HC, Haig AJ, Yamakawa K.. The spurling test and cervical radiculopathy. Spine. 2002 January;27(2):156-159. LoE: 2B
  23. ↑ Gumina, S., Carbone, S., Albino, P., Gurzi, M., & Postacchini, F. (2013). Arm Squeeze Test: a new clinical test to distinguish neck from shoulder pain. European Spine Journal, 22(7), 1558–1563. http://doi.org/10.1007/s00586-013-2788-3
  24. ↑ 24.00 24.01 24.02 24.03 24.04 24.05 24.06 24.07 24.08 24.09 24.10 24.11 Childress MA, Becker BA. Nonoperative management of cervical radiculopathy. Am Fam Physician. 2016;93(9):746-54.
  25. ↑ Eubanks JD. Cervical radiculopathy: nonoperative management of neck pain and radicular symptoms. American family physician. 2010 Jan 1;81(1):33-40.
  26. ↑ 26.0 26.1 Leveque JC. Diagnosis and treatment of Cervical Radiculopathy and Myelopathy. 2015. Physical medicine and rehabilitation clinics of North America 26(3): 491-511.
  27. ↑ 27.0 27.1 Matz PG1 et al., Indications for anterior cervical decompression for the treatment of cervical degenerative radiculopathy, J Neurosurg Spine. 2009 Aug;11(2):174-82. LoE: 2A
  28. ↑ 28.0 28.1 Engquist M et al., Surgery Versus Nonsurgical Treatment of Cervical Radiculopathy: A Prospective, Randomized Study Comparing Surgery Plus Physiotherapy With Physiotherapy Alone With a 2-Year Follow-up. 15 september 2013. Spine, 38(20): 1715–1722.
  29. ↑ Persson LC1, Moritz U, Brandt L, Carlsson CA. Cervical radiculopathy: pain, muscle weakness and sensory loss in patients with cervical radiculopathy treated with surgery, physiotherapy or cervical collar. A prospective, controlled study. Eur Spine J. 1997;6(4):256-66.
  30. ↑ 30.0 30.1 Peolsson A et al. Physical Function Outcome in Cervical Radiculopathy Patients After Physiotherapy Alone Compared With Anterior Surgery Followed by Physiotherapy: A Prospective Randomized Study With a 2-Year Follow-up. 15 February 2013. Spine 38(4): 300-307
  31. ↑ Kim H, Lee SH, Kim MH. Multislice CT fluoroscopy-assisted cervical transforaminal injection of steroids: technical note. J Spinal Disord Tech 2007;20:456–61.
  32. ↑ Anderberg L, Annertz M, Persson L, et al. Transforaminal steroid injections for the treatment of cervical radiculopathy: a prospective and randomised study. Eur Spine J 2007;16:321–8
  33. ↑ Lee SH et al. Clinical Outcomes of Cervical Radiculopathy Following Epidural Steroid Injection: A Prospective Study With Follow-up for More Than 2 Years. 20 May 2012. Spine 37(12): 1041-1047.
  34. ↑ Boyles, Robert; Toy, Patrick; Mellon, James; Hayes, Margaret; Hammer, Bradley.Effectiveness of manual physical therapy in the treatment of cervical radiculopathy: a systematic review Journal of Manual and Manipulative Therapy 19 (2011) 135-142.
  35. ↑ 35.0 35.1 Cheng CH, Tsai LC, Chung HC, Hsu WL, Wang SF, Wang JL, Lai DM, Chien A. Exercise training for non-operative and post-operative patient with cervical radiculopathy: a literature review. 2015 Sep. J Phys Ther Sci. 27(9): 3011-8.
  36. ↑ Elmasry S, Asfour S, de Rivero Vaccari JP, Travascio F. Effects of Tobacco Smoking on the Degeneration of the Intervertebral Disc: A Finite Element Study. PLoS One. 2015 Aug 24;10(8):e0136137. LoE: 4
  37. ↑ Borrella-Andrés S, Marqués-García I, Lucha-López MO, Fanlo-Mazas P, Hernández-Secorún M, Pérez-Bellmunt A, Tricás-Moreno JM, Hidalgo-García C. Manual therapy as a management of cervical radiculopathy: a systematic review. BioMed research international. 2021;2021(1):9936981.
  38. ↑ 38.0 38.1 Xu X, Ling Y. Manual therapy for cervical radiculopathy: effects on neck disability and pain–a systematic review and network meta-analysis. Journal of Pain Research. 2025 Dec 31:2035-45.
  39. ↑ Gross AR, Hoving JL, Haines TA, Goldsmith CH, Kay T, Aker P, Bronfort G, Cervical Overview Group. A Cochrane review of manipulation and mobilization for mechanical neck disorders. Spine. 2004 Jul 15;29(14):1541-8.
  40. ↑ Boyles R. Toy P. Mellon J. Hayes M.Hammer B. Effectiveness of manual physical therapy in the treatment of cervical radiculopathy a systematic review. Journal of Manipulative therapy. 19 (3) 2011
  41. ↑ Rushton A, Carlesso LC, Flynn T, Hing WA, Rubinstein SM, Vogel S, Kerry R. International framework for examination of the cervical region for potential of vascular pathologies of the neck prior to musculoskeletal intervention: international IFOMPT cervical framework. Journal of Orthopaedic & Sports Physical Therapy. 2023 Jan;53(1):7-22.
  42. ↑ Fritz JM, Thackeray A, Brennan GP, Childs JD.Exercise only, exercise with mechanical traction, or exercise with over-door traction for patients with cervical radiculopathy, with or without consideration of status on a previously described subgrouping rule: a randomized clinical trial. J Orthop Sports Phys Ther. 2014 Feb;44(2):45-57.
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  45. ↑ Franke H, Fryer G, Ostelo RW, Kamper SJ .Muscle energy technique for non-specific low-back pain. Cochrane Database Syst Rev. 2015 Feb 27;2:CD009852. LoE: 1A.
  46. ↑ Ragonese J. A randomized trial comparing manual physical therapy to therapeutic exercises, to a combination of therapies,for the treatment of cervical radiculopathy. Orthop Prac 2009;21(3):71–7.
  47. ↑ Butler, 0 (1991). Mobilisation of the Nervous System, Churchill Livingstone, Edinburgh
  48. ↑ Magee DJ. Orthopedic physical assessment. 5th ed. St. Louis,MO: Saunders Elsevier; 2008.
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  52. ↑ Wong JJ, et al. The course and prognostic factors of symptomatic cervical disc herniation with radiculopathy: a systematic review of the literature. Spine J. 2014;14(8):1781-9. doi:10.1016/j.spinee.2014.02.032.
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  54. ↑ Young IA, Cleland JA, Michener LA, Brown C. Reliability, construct validity, and responsiveness of the neck disability index, patient-specific functional scale, and numeric pain rating scale in patients with cervical radiculopathy. American journal of physical medicine & rehabilitation. 2010 Oct 1;89(10):831-9.


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