Cervical Disc Herniation

Symptoms vary by level and whether a nerve root or the spinal cord is involved. **Common radiculopathy patterns:**

• C5 root (C4–C5 disc): Shoulder pain, deltoid weakness, decreased biceps reflex
• C6 root (C5–C6 disc): Lateral forearm pain, thumb and index finger numbness, biceps and wrist extensor weakness, decreased brachioradialis reflex — the most common presentation
• C7 root (C6–C7 disc): Posterior arm/forearm pain, middle finger numbness, triceps weakness and decreased triceps reflex — the second most common
• C8 root (C7–T1 disc): Medial forearm, ring and small finger numbness, intrinsic hand weakness
• Bilateral hand weakness or difficulty with fine motor tasks (buttoning, writing)
• Wide-based or unsteady gait
• Electric shock sensation down the spine with neck flexion (Lhermitte sign)
• Bowel or bladder dysfunction

Call us at (301) 515-0900. Same-day appointments available at our Bethesda and Germantown locations. If you are experiencing any myelopathy symptoms, seek evaluation promptly.

Clinical examination is the starting point. The Spurling test (axial compression with lateral flexion toward the symptomatic side) reproduces radicular arm pain with reasonable specificity for cervical nerve root compression. The shoulder abduction relief sign (raising the arm above the head reduces arm pain) can corroborate the diagnosis.

Neurological examination documents motor strength, sensory deficits, and reflex changes across cervical myotomes and dermatomes. Myelopathy is assessed with Hoffman sign (flicking the middle finger nail produces thumb/index flexion) and finger escape sign.

Imaging:

• MRI of the cervical spine is the standard diagnostic study, providing detailed visualization of disc morphology, nerve root compression, and cord signal change. It is typically ordered when symptoms persist beyond 4–6 weeks or when neurological deficits are present.
• X-rays assess alignment, disc height loss, and osteophyte formation.
• CT myelography is reserved for patients with contraindications to MRI or when surgical planning requires detailed bony anatomy.

Electrodiagnostic studies (EMG/NCS) can confirm the involved level when clinical and imaging findings are discordant and may rule out peripheral nerve entrapment syndromes (carpal tunnel, cubital tunnel) that mimic radiculopathy.

Most patients with acute cervical radiculopathy experience significant improvement within 6–12 weeks of conservative treatment. A structured PT program and, when indicated, one to three cervical ESIs, allow the majority of patients to return to full activity. Recurrence is possible given the underlying degenerative process, and ongoing home exercise and posture habits are the best long-term strategies for prevention. Patients with mild myelopathy who are managed non-operatively require periodic re-evaluation (typically every 3–6 months) to detect neurological progression.