Causes / typical injury mechanism: Cervical radiculopathy (CR) refers to the combination of pain and neurologic deficits associated with compression of cervical nerve roots at the level of the spinal cord. It may be associated with pain in one or both arms along with sensory, motor, and reflex deficits. The most common cause of CR is narrowing at the cervical foramen due to degenerative changes including decreasing disk height, spondylosis, and disk herniation.

Classic history and presentation: Patients typically present with pain described as radiating from the shoulder and/or neck down to one or both arms and forearms. They may also report numbness and tingling in the arm(s). Most patients describe an insidious onset without a history of trauma or acute incident.

Prevalence:

• Age – Peak incidence occurs around the age of 50 years.
• Sex / gender – Seen in about 107 per 100 000 men and 64 per 100 000 women.

Risk factors: Higher rates are seen in White individuals and in patients with:

• History of smoking
• Obesity
• Osteoporosis
• Rheumatoid arthritis
• Osteoarthritis
• Vascular disease
• Past lumbar radiculopathy
• History of heavy lifting and activities like golf

Pathophysiology:

• Up to 75% of cases occur as a result of foraminal narrowing secondary to decreased disk height and hypertrophy of joint surfaces. Disk herniation accounts for about 25% of CR cases and therefore plays a less significant role than the lumbar spine.
• Nerve root compression occurs at C7 most frequently.
• Spinal tumors and infections are known causes but are relatively infrequent.
• Disk breakdown increases load-bearing on intervertebral joints, which leads to bony hypertrophy. These osteophytes press on nerve root(s).
• The compression of the nerve root leads to a localized inflammatory response that is believed to explain the associated pain. The numbness and weakness are a result of nerve hypoxia. Chronic processes, like degeneration and spondylosis, allow the patient to gradually adapt and therefore have a more insidious onset of pain and sensorimotor symptoms.