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Cervical radiculopathy and degenerative cervical myelopathy
Compression of a nerve root in the neck causes pain and a deficit in one arm by root (radiculopathy), and compression of the cord causes clumsy hands, gait disturbance and upper motor neuron signs (myelopathy) — the first usually recovers with conservative care, the second progresses and is often operated on.
Why it matters in the exam
Questions present pain radiating from the neck into the arm with numbness in a particular finger and a reduced reflex, asking you to name the root; or an older patient with trouble doing up buttons, falls, brisk reflexes and Hoffmann's sign, asking you to recognise myelopathy, order MRI and operate. They test root mapping C5 to C8, the difference between radiculopathy and myelopathy, when to image (progressive deficit, red flags, symptoms beyond 6 weeks), and when myelopathy is operated on (moderate or severe). Common distractors are blaming clumsy hands and falls on age, manipulating a myelopathic neck, or diagnosing ALS without excluding cord compression. An "inverted brachioradialis reflex" — finger flexion instead of elbow flexion — suggests compression at C5 to C6. Spurling's test (tilting and turning the head to the painful side with downward pressure) reproduces radicular pain. In myelopathy, worsening can follow even minor trauma, so early diagnosis matters.
Key points
- Cervical radiculopathy is arm pain and deficit by root; C7 is the most common.
- Map: C5 shoulder, C6 thumb, C7 middle finger, C8 little finger.
- Most radiculopathies improve with conservative care; MRI for progressive deficit or after 6 weeks.
- Myelopathy: clumsy hands, unsteady gait, brisk reflexes and Hoffmann's sign.
- Moderate or severe myelopathy is treated with decompressive surgery.
Summary table
| Root or condition | Sensation | Weakness | Reflex or next step |
|---|---|---|---|
| C5 | Shoulder and outer upper arm | Deltoid, elbow flexors | Biceps reflex |
| C6 | Thumb and index | Elbow flexors, wrist extensors | Brachioradialis reflex |
| C7 (the most common) | Middle finger | Triceps, finger extensors | Triceps reflex |
| C8 | Little finger and inner forearm | Finger flexors and intrinsic hand muscles | No defined reflex |
| Degenerative cervical myelopathy | Diffuse numbness in the hands | Clumsy hands, unsteady gait, brisk reflexes, Hoffmann sign, Babinski | MRI; surgery for moderate or severe myelopathy, and for mild — surgery or close follow-up with rehabilitation |
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Sources
- AO Spine/CSRS Clinical Practice Guideline for the Management of Degenerative Cervical Myelopathy, 2017 — Surgical and non-operative management by severity
- NASS Evidence-Based Clinical Guideline: Diagnosis and Treatment of Cervical Radiculopathy From Degenerative Disorders, 2010 — Natural history and treatment
Sources are given for further reading; the text is written afresh and not copied from them.
Reviewed by the Examqo AI Professor · 2026-11-06. The text may contain errors; when in doubt, check the source.