C6 Radiculopathy Caused by Disc Herniation

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C6 Radiculopathy Caused by Disc Herniation

Cervical radiculopathy is a common neurological condition caused by the compression or irritation of nerve roots in the cervical spine. Although it can affect any cervical nerve root, the C7 nerve root is the most frequently involved, accounting for more than half of all cases. The C6 nerve root is affected in approximately one-quarter of cases, while the remaining cases involve the C1 to C5 nerve roots and the C8 nerve root.

In the cervical spine, nerve roots exit above their corresponding vertebrae, with the exception of the C8 nerve root, which exits above the T1 vertebra. Consequently, a herniated disc typically compresses the nerve root at the level of the affected disc. For example, the C6 nerve root, which exits between the C5 and C6 vertebrae, is most commonly affected by a herniation of the disc between these two vertebrae.

According to the North American Spine Society (NASS), cervical radiculopathy should be considered in patients presenting with symptoms such as arm pain, neck pain, scapular or periscapular pain, paresthesias, numbness, sensory changes, weakness, or abnormal deep tendon reflexes in the arm. These are among the most common clinical findings. Additionally, atypical symptoms may include headaches, chest or deep breast pain, scapular winging, and weakness in the intrinsic muscles of the hand and deltoid.

The NASS Clinical Guidelines for cervical radiculopathy reference a study indicating that muscle weakness typically corresponds with a single nerve root level in 77% of cases. Pain and paresthesias correspond with the affected nerve root in 70% of cases, while reductions in muscle stretch reflexes are less correlated, occurring in only 11% of cases. Useful diagnostic tests include the Shoulder Abduction test (Bakody’s sign), the Axial Cervical Compression test, and the Maximum Cervical Compression test (Spurling’s test).

Causes of Cervical Spinal Stenosis and Radiculopathy

The following are examples of cervical spine pathologies that may lead to spinal stenosis and radiculopathy:

• Facet Arthropathy
• Ligamentum Flavum Hypertrophy
• Uncovertebral Joint Hypertrophy
• Disc Herniation
• Spinal Cord Tumor

Patterns of Cervical Radicular Pain and Neurological Deficits

Cervical radiculopathy affects the nerve roots in the cervical spine, potentially causing a range of symptoms, including neck, shoulder, arm, and hand pain, muscle weakness, sensory disturbances, and reduced deep tendon reflexes. Symptoms may appear individually or in combination, and their presentation can vary significantly between individuals. The following guide provides an overview of common patterns of pain and neurological deficits associated with the C5 to T1 nerve roots.

Muscle Strength Testing – Muscle strength (motor) testing for the spinal nerves in the neck is a crucial component of neurological examination to assess the functional integrity of the cervical nerve roots. This evaluation measures the strength of specific muscle groups innervated by these nerve roots. Through systematic muscle testing, clinicians can pinpoint the presence and location of nerve root impingement or damage, aiding in accurate diagnosis and treatment planning.

Sensory Testing – Key sensory points in the upper extremities indicate specific cervical nerve roots. Sensory testing is performed on both sides simultaneously to assist with comparison. With the patient’s eyes closed, touch each key sensory point and ask the patient to report if they can feel the touch and whether they experience the same sensation on both sides.

Muscle Stretch Reflexes – Muscle stretch reflexes are used to assess the C5, C6, and C7 nerve roots. Each reflex is compared with the opposite side. If a reflex is difficult to obtain, the test can be repeated with the patient clenching their teeth or pressing their knees together.

• Neck Pain: Often localized to the cervical spine, but may also radiate.
• Pain Distribution: Commonly radiates to the shoulder, lateral arm, and down the lateral forearm into the thumb and index finger.
• Sensory Changes: Includes numbness or tingling in the lateral forearm and thumb, extending into the index finger.

• Sensory Loss: Reduced sensation over the dorsal surface of the thumb at the proximal phalanx (key sensory point).
• Weakness: Notable weakness in wrist extension.
• Reflexes: Diminished brachioradialis reflex.
• Pain Exacerbation: Increased pain on Axial Cervical Compression, Maximum Cervical Compression, and Shoulder Depression tests.
• Pain Reduction: Relief of pain with Cervical Distraction and Shoulder Abduction (Bakody’s) tests.

• Plain Radiography: Used to evaluate osseous causes of radiculopathy, such as osteophyte formation. It is helpful for initial assessment but limited in showing soft tissue details.
• MRI (Magnetic Resonance Imaging): Preferred for its sensitivity in identifying a range of pathologies, including inflammatory, malignant, and vascular conditions. MRI does not involve ionizing radiation and provides detailed images of both soft tissues and nerve roots.
• CT (Computed Tomography): Offers superior visualization of bony structures compared to plain radiography and MRI. While CT is effective for assessing bone abnormalities, it has limitations in depicting soft tissue details and nerve roots.

Ice or Heat

Some practitioners advocate using moist heat in the subacute or chronic phase of a musculoskeletal condition. However, we have found that patients often benefit from a continued application of ice for pain management and inflammation control.

Upper Back Pain in Patients with Cervical Disc Herniation

When patients have a lower cervical disc herniation, they may also present with pain in the upper thoracic or scapular region. There is an increased likelihood of upper thoracic or scapular pain associated with lower cervical nerve root involvement, suggesting that the lower the affected cervical nerve root, the greater the probability of upper thoracic or scapular pain. The upper thoracic or scapular pain in patients with herniated discs may indicate that this pain is referred from the disc rather than originating directly from the nerve root.