CERVICAL RADICULOPATHY
Arm pain that starts in your neck follows a map most people have never heard of, and that map is how we find the level.
Which finger goes numb, and which arm muscle has gone quietly weaker, tells us which nerve root in your neck is involved before a single image is taken. The exam reads that map first.
What is actually happening
A cervical nerve root is being compressed and chemically irritated where it exits the spine, usually by a herniated disc or a narrowed foramen from arthritic change. Two biological drivers do the work: mechanical pressure on the root, and inflammation from the leaked disc material itself, which sensitizes the nerve independent of how hard it is being pinched. A third, behavioral driver is common in this population — hours spent with the neck flexed forward over a phone or a low screen narrows the same foramina mechanically, adding load onto a nerve that is already inflamed. A 2025 scoping review in BMC Musculoskeletal Disorders confirms that a careful neurological exam, built around exactly this pattern, remains the backbone of diagnosis even in the MRI era.
The map, in plain terms
Each cervical root reports from a specific territory, and which one is affected changes what you actually notice.
C5 AND C6
C5 reports through the shoulder and upper arm, weakening the deltoid and the ability to hold your arm out to the side. C6 continues down to the thumb and index finger, along with the biceps and the wrist-extension muscles — numbness in the thumb specifically is a classic C6 signal.
C7 AND C8
C7 runs to the middle finger and weakens the triceps, the muscle that straightens your elbow — a common one to miss because people rarely test elbow extension on themselves. C8 reports through the ring and little fingers and weakens the small muscles of the hand, showing up as clumsiness with buttons or a zipper before it shows up as obvious weakness on exam.
Confirming it, and when EMG helps
The exam includes reflex testing, strength testing muscle by muscle, and Spurling’s maneuver — tilting and compressing the neck toward the painful side to see if it reproduces the arm pain. A 2025 meta-analysis in the American Journal of Physical Medicine & Rehabilitation found Spurling’s test performs well as a rule-in tool when positive, though a negative test does not rule the diagnosis out on its own. Where the pattern is ambiguous, or a peripheral entrapment like carpal tunnel or cubital tunnel syndrome is a competing explanation for numbness in the same fingers, electromyography and nerve conduction studies localize the problem to the root rather than to a nerve further down the arm — a distinction that changes which structure gets treated entirely.
Cervical ESI as a window
A cervical epidural steroid injection, placed transforaminally under fluoroscopic guidance at the confirmed level, quiets the inflammatory component around the root. A 2020 systematic review and meta-analysis in Pain Medicine found meaningful pain reduction from fluoroscopically guided cervical transforaminal injections for radicular pain, consistent with the same window-not-repair logic used everywhere else on this site: the injection does not decompress the foramen, it buys the interval in which inflammation settles and, in many cases, the disc material resorbs.
The terrain underneath it
Posture is only part of the story. Systemic inflammation and insulin resistance raise the baseline the nerve root’s own chemical irritation is already elevated from and slow the recovery of the small vessels the nerve depends on, which is why bloodwork and the behavioral piece of this practice’s protocol — delivered in-house through Acceptance and Commitment Therapy — are part of the plan alongside the injection. Sleep, movement and behavior covers how posture, screen habits and sleep position are addressed directly.
When surgery enters the conversation
For most cervical radiculopathy, surgery is not part of the plan — a 2013 systematic review in the European Spine Journal comparing surgical to conservative care for neck pain found outcomes converge over time for many patients, favoring a conservative and interventional trial first where it is safe to give one. What changes the calculation is a motor deficit that is new or progressing — a triceps or hand grip getting measurably weaker over days to weeks, not just pain that is severe — because nerve function lost to ongoing compression does not reliably return once decompressed later. When that is the picture, or when conservative and interventional options have been exhausted without resolution, this practice coordinates the surgical conversation directly rather than leaving a patient to find their own way there.
Red flags, in plain terms
GET SEEN URGENTLY
- An arm or hand getting weaker over days, not just staying painful.
- Trouble with balance, fine hand coordination, or a change in bladder or bowel control alongside neck pain — suggests the spinal cord itself, not just a root.
- Neck pain with fever, or that began after a significant fall or collision.
Read the full list on when it is an emergency.
Common questions
Could this be carpal tunnel instead?
Possibly — both can numb the thumb and index finger, which is exactly why the exam checks for neck-specific findings and, when ambiguous, an EMG separates a root problem from a wrist-level entrapment; see what to expect for how the first visit is structured.
Do I need an MRI right away?
Not always — the exam and symptom map often establish the level with enough confidence to begin treatment, and imaging is reserved for cases that are unclear or not improving, similar to the approach on sciatica.
Will a cervical epidural help my neck pain or just my arm?
It is aimed at the nerve root, so it primarily targets the arm pain and the neurological symptoms; axial neck pain alone, without an arm component, is more often a facet joint question.
How long until I know if treatment is working?
Local anesthetic effect is evident within the hour; the steroid effect builds over several days and is typically reassessed at two weeks, the same interval used across epidural steroid injection generally.
Is surgery ever the first step?
Rarely, and only with a progressive motor deficit or spinal cord involvement; otherwise conservative and interventional care are tried first, a decision point also covered on when injections stop working.
Related reading
We will tell you which root we think is involved before we treat it
The map of your symptoms tells us where to look first, and we will show our reasoning before any needle is near your neck.
4479 Woodson Rd, Suite 401
St. Louis, MO 63134
Next to St. Louis Lambert International Airport, off I-70 at Woodson Road.
Sources
- Yousif MS et al. Neurological examination for cervical radiculopathy: a scoping review. BMC Musculoskeletal Disorders, 2025. PubMed 40188056
- Lin LH et al. Diagnostic Performance of Spurling’s Test for the Assessment Subacute and Chronic Cervical Radiculopathy: A Systematic Review and Meta-analysis. American Journal of Physical Medicine & Rehabilitation, 2025. PubMed 39938056
- Conger A et al. The Effectiveness of Fluoroscopically Guided Cervical Transforaminal Epidural Steroid Injection for the Treatment of Radicular Pain; a Systematic Review and Meta-analysis. Pain Medicine, 2020. PubMed 31181148
- van Middelkoop M et al. Surgery versus conservative care for neck pain: a systematic review. European Spine Journal, 2013. PubMed 23104514