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Differentiating Symptoms of C6 C7 C8 radiculopathy
What are the differentiating signs and symptoms between a C6, C7, and C8 radiculopathy?
Symptoms and signs of cervical radiculopathy and mimic conditions
| Nerve root | Pain | Weakness | Reflex changes | Conditions | How to differentiate |
|---|---|---|---|---|---|
| C2–4 | Occiput, temporal area, back of the ear, upper neck | Diaphragm (paradoxical respiration) | – | Migraine | Bitemporal throbbing pain, aura (sensitivity to light), nausea and vomiting, or visual disturbance in migraine |
| C5 | Neck, suprascapular, lateral upper arm to elbow | Shoulder abduction; external rotation; elbow flexion | Biceps | Rotator cuff tear | Weakened shoulder abduction and pain on deltoid area, but no shoulder pain during passive exercise or tenderness in C5 radiculopathy; reflex intact in rotator cuff tear |
| Acute brachial-plexus neuritis (Parsonage-Turner syndrome) | Acute onset of pain in the neck, shoulder, and arm which is followed by marked numbness and weakness of arm within a few days to weeks, typically in the C5–6 area as the pain is relieved; usually pain and neurologic deficits occur simultaneously in cervical radiculopathy | ||||
| C6 | Neck, lateral forearm, thumb and index finger | Elbow flexion; forearm supination; wrist extension | Biceps, brachioradialis | CTS | Normal NCS in cervical radiculopathy, but in CTS, abnormal NCS, thenar muscle atrophy, and positive Tinel’s sign, Phalen’s maneuver, or Durkan’ test in CTS |
| C7 | Lower neck, interscapular, posterior forearm, middle finger | Elbow extension; forearm pronation; wrist flexion; finger extension | Triceps | PIN syndrome | Weakness of triceps, wrist flexors, and finger extensors in C7 radiculopathy; sensory intact, normal triceps and wrist flexors strength in PIN syndrome |
| C8 | Inter- and infra-scapular, medial forearm, 4rth and 5th finger | Hand intrinsic; finger flexion | – | Cubital tunnel syndrome | Tenderness at medial side of elbow, hypothenar muscles and adductor pollicis weakness, sensory changes in hand and 4th, 5th fingers in ulnar neuropathy; intact adductor pollicis in C8 radiculopathy |
| Pancoast syndrome | Due to compression of the brachial plexus, paresthesia and weakness in intrinsic hand muscles with ipsilateral ptosis, miosis, and anhidrosis (Horner’s syndrome) |
CTS, carpal tunnel syndrome; NCS, nerve conduction study; PIN, posterior interosseus nerve.
C6, C7, and C8 are specific spinal nerve roots that exit the spinal cord in the neck region. Radiculopathy refers to the compression, irritation, or damage to one or more of these nerve roots, leading to specific symptoms. Here’s a general overview of the differentiating symptoms of C6, C7, and C8 radiculopathy:
It’s important to note that these are general patterns of symptoms and may vary from person to person. Additionally, some individuals may experience a combination of symptoms from multiple nerve roots if there is involvement of adjacent nerve roots.
If you are experiencing any symptoms suggestive of radiculopathy, it is recommended to consult with a healthcare professional, such as a physician or a neurologist, for a proper evaluation, diagnosis, and appropriate management. They can perform a thorough examination and order additional tests if needed to determine the underlying cause and develop an individualized treatment plan.
Compression of the cervical roots typically occurs from either osteophyte or disc herniation.
Cervical radiculopathy is defined as arm pain, sensory and motor symptoms caused by irritation of a cervical nerve root.
The C6 and C7 roots are most commonly involved, and differentiating symptoms associated with each root has proven difficult.
The bicep and brachioradialis reflexes may be diminished.
Compression of the C7 nerve root results in radicular pain in the shoulder, chest, and forearm, as well as the index and middle fingers.
Weakness may occur in the triceps and flexor carpi radialis.
Paresthesias may occur in the index and middle fingers.
The triceps reflex is typically diminished.
Patients with a suspected C8 radiculopathy may have weakness involving the long finger extensors and flexors, including the flexor pollicis longus, flexor digitorum profundus, and extensor pollicis longus, thenar/ hypothenar muscles, and, to a lesser extent, the intrinsic hand muscles.
Cervical MRI allows accurate identification of nerve root compression and therefore makes it possible to explore symptom patterns that may differentiate C6 from C7 radiculopathy.
C8 nerve root compression causes a similar pattern of pain as C7 radiculopathies, but paresthesias may occur in the fourth and fifth fingers.
Compression of the C6 nerve root results in radicular pain involving the shoulder, upper arm, and lateral side of the forearm and thumb. Weakness may occur in the deltoids, biceps, and pronator teres.
Weakness may occur in the intrinsic muscles of the hand and finger extensors.
Paresthesias may be felt in the thumb and index fingers. DSM 5 diagnostic criteria for somatic symptom disorder.
Patients with a C8 radiculopathy typically present with pain radiating into digits 4 and 5, with paresthesia (numbness/ tingling) in the palmar and dorsal surface of both digits, and may present with lower cervical pain that may radiate into the medial arm and forearm.
Patterns of nerve root compression syndromes
| Nerve root | Pain pattern | Weakness | Reflexes |
|---|---|---|---|
| C2 | Occipital, eyes | ||
| C3 | Neck, trapezius | ||
| C4 | Neck, trapezius | ||
| C5 | Shoulder, lateral UE | Deltoid | |
| C6 | Lateral forearm, first two digits | Biceps | Biceps absent |
| C7 | Posterior forearm, third digit | Triceps | Triceps absent |
| C8 | Medical forearm, fourth and fifth digit | Finger abduction, grip |
C6 radiculopathy refers to the compression or irritation of the C6 spinal nerve root, which emerges from the spinal cord in the neck region (cervical spine). Radiculopathy occurs when there is pressure on the nerve root, leading to pain, weakness, and other symptoms along the pathway of the affected nerve.
A patient with C6 radiculopathy usually feels pain or numbness from the neck to radial side of the biceps, forearm, the dorsal web space of the hand between the thumb and index finger, and to the tips of those fingers. Motor deficits of the wrist extensors and biceps are common in association with C6 radiculopathy.
Usually, when patients explain their symptoms, patients with C6 radiculopathy or CTS show the volar side of their hands, but patients with C7 radiculopathy often express symptoms by pronating the forearms.
Here are some key features and possible symptoms of C6 radiculopathy:
- Neck Pain: C6 radiculopathy often presents with pain in the neck region, typically on one side. The pain may be sharp, stabbing, or radiating down the arm.
- Shoulder and Arm Pain: The pain associated with C6 radiculopathy can radiate from the neck down the shoulder, along the upper arm, and potentially into the thumb and index finger. It may be described as a burning or electric shock-like sensation.
- Muscle Weakness: Weakness in the muscles controlled by the C6 nerve root may occur. This can result in difficulty with activities that require strength or coordination, such as lifting objects, grasping, or performing fine motor tasks with the thumb and index finger.
- Sensory Changes: Numbness, tingling, or altered sensation may be present in the shoulder, arm, thumb, and index finger. This is known as paresthesia and can be felt as a pins-and-needles sensation.
- Reflex Changes: Deep tendon reflexes, such as the biceps reflex, may be diminished or absent on the affected side.
C6 radiculopathy can arise from various causes, including disc herniation, degenerative changes in the cervical spine, spinal stenosis (narrowing of the spinal canal), trauma, or inflammatory conditions affecting the nerve roots.
The diagnosis of C6 radiculopathy involves a thorough clinical assessment by a healthcare professional, which may include a physical examination, review of symptoms, and potentially imaging studies such as an MRI or CT scan to evaluate the spinal structures.
Treatment for C6 radiculopathy aims to relieve pain, reduce inflammation, and improve functional outcomes. It may include a combination of conservative approaches such as rest, physical therapy, pain medications, nonsteroidal anti-inflammatory drugs (NSAIDs), and in some cases, corticosteroid injections. Surgery may be considered if symptoms are severe, persistent, or associated with neurological deficits.
C8 radiculopathy refers to the compression, irritation, or damage to the C8 nerve root in the spinal column. The nerve roots emerge from the spinal cord and form the peripheral nerves that control various functions and sensations in the upper limbs. In the case of C8 radiculopathy, the eighth cervical nerve root, which is located in the cervical (neck) region of the spine, is affected.
Common causes of C8 radiculopathy include:
- Herniated Disc: The gel-like material within a spinal disc may leak out and press on the C8 nerve root.
- Degenerative Disc Disease: Wear and tear of the spinal discs over time can lead to conditions such as spinal stenosis, where the space around the spinal cord narrows, putting pressure on the nerves.
- Trauma or Injury: A sudden injury or trauma to the cervical spine can result in nerve compression.
- Bone Spurs: Overgrowth of bone, known as bone spurs, can occur in the cervical spine and impinge on the nerves.
- Foraminal Stenosis: Narrowing of the passageways (foramina) through which nerves exit the spine can cause compression of the nerve roots.
Symptoms of C8 radiculopathy may include:
- Pain: This can be felt along the path of the nerve, often radiating down the arm and into the hand and fingers.
- Numbness or Tingling: Sensations of numbness or tingling may be experienced in the hand and fingers.
- Weakness: Weakness in the muscles controlled by the affected nerve may occur, making it challenging to perform certain tasks.
- Reflex Changes: Reflexes may be diminished or absent.
Treatment options for C8 radiculopathy depend on the underlying cause and the severity of symptoms. Conservative approaches may include rest, physical therapy, pain management, and anti-inflammatory medications. In more severe cases or when conservative measures fail, surgical intervention may be considered to alleviate pressure on the affected nerve.
If you suspect you have C8 radiculopathy or are experiencing symptoms suggestive of nerve compression, it’s crucial to consult with a healthcare professional for a thorough evaluation and appropriate management.
Sources
- Daffner SD, Wang JC: The pathophysiology and non-surgical treatment of lumbar spinal stenosis. Instr Course Lect 58:657-668, 2009.
- Kang KC, Lee HS, Lee JH. Cervical Radiculopathy Focus on Characteristics and Differential Diagnosis. Asian Spine J. 2020 Dec;14(6):921-930. doi: 10.31616/asj.2020.0647. Epub 2020 Dec 22. PMID: 33373515; PMCID: PMC7788378.https://pmc.ncbi.nlm.nih.gov/articles/PMC7788378/
