Radiculopathy

Definition

Pain, sensory change, weakness or reflex loss in the distribution of a spinal nerve root from compression or inflammation of that root.

Aetiology

• Disc herniation, more frequent in younger patients
• Foraminal stenosis from uncovertebral or facet osteophytes in older patients
• Tumour, infection, trauma and diabetic radiculoplexus neuropathy

Anatomy

• Cervical roots exit above the pedicle of the same numbered vertebra
• C5 to C6 disc compresses the C6 root, and C8 exits between C7 and T1
• Posterolateral L4 to L5 disc compresses the traversing L5 root
• Far lateral L4 to L5 disc compresses the exiting L4 root

Epidemiology

• C7 is the most frequent cervical root involved, followed by C6
• L5 and S1 account for most lumbar radiculopathy

Clinical Features

Root	Motor	Sensory	Reflex
C5	Deltoid, elbow flexion	Lateral arm	Biceps
C6	Wrist extension, elbow flexion	Lateral forearm, thumb and index finger	Brachioradialis
C7	Elbow extension, wrist flexion, finger extension	Middle finger	Triceps
C8	Finger flexion	Little finger, medial forearm	None
T1	Finger abduction	Medial arm	None

Root	Motor	Sensory	Reflex
L3	Hip flexion, knee extension	Anterior thigh to medial knee	Patellar, partly
L4	Knee extension, ankle dorsiflexion	Medial leg and medial malleolus	Patellar
L5	Extensor hallucis longus, hip abduction	Lateral leg, dorsum of foot	None
S1	Ankle plantarflexion and eversion	Lateral foot and sole	Achilles

• Limb pain in a dermatomal pattern, often worse than neck or back pain
• Spurling test reproduces arm pain with neck extension, rotation and axial load
• Shoulder abduction relief sign in C5 and C6 radiculopathy
• Straight leg raise between 30 and 70 degrees for L5 and S1 roots
• Crossed straight leg raise is more specific for disc herniation
• Femoral stretch test for L2 to L4 roots
• Red flags are saddle anaesthesia, sphincter change, progressive weakness and myelopathic signs

Investigations

• MRI for red flags, progressive deficit or failure of 6 weeks of non-operative care
• CT myelography when MRI is contraindicated
• Nerve conduction studies and EMG separate root from plexus or peripheral nerve lesions

Differential Diagnosis

• Carpal tunnel and cubital tunnel syndrome
• Neuralgic amyotrophy and thoracic outlet syndrome
• Pancoast tumour with C8 and T1 signs
• Shoulder or hip pathology
• Peripheral neuropathy and common peroneal nerve palsy

Management

• Non-operative care. Analgesia, activity modification and physiotherapy, with most improving without surgery
• Epidural steroid injection. Short term relief of radicular pain
• Anterior cervical discectomy and fusion. Persistent or progressive cervical radiculopathy
• Posterior foraminotomy. Foraminal soft disc or osteophyte without instability
• Lumbar microdiscectomy. Faster relief than non-operative care, with similar outcomes by 1 to 2 years
• Urgent decompression. Cauda equina syndrome or rapidly progressive motor deficit
• See cervical radiculopathy, lumbar radiculopathy, lumbar disc prolapse and cervical myelopathy

Reviewed by Professor Phong Tran, Head of Orthopaedic Surgery, Western Health. Last updated 19 October 2026.