Question
A 47 year old dentist has neck pain and right arm pain into the middle finger, with weak elbow extension.
- Which root is involved and what does the MRI show?
- What clinical tests help?
- Outline management and the surgical options.
Answer
Root and imaging
- C7 radiculopathy, weak triceps, reduced triceps reflex, middle finger numbness
- C6 to C7 disc herniation compressing the exiting C7 root
- Cervical roots exit above the pedicle of the same numbered vertebra
Clinical tests
- Spurling test reproduces arm pain
- Shoulder abduction relief sign
- Check for myelopathy, Hoffmann sign, gait, hyperreflexia
- Exclude peripheral nerve entrapment and shoulder pathology
Management
- Most improve within 3 months without surgery
- Analgesia, neuropathic agents, physiotherapy
- Selective nerve root block for diagnosis and relief
- Surgery for persistent pain over 6 to 12 weeks, progressive deficit or myelopathy
- Anterior cervical discectomy and fusion
- Cervical disc arthroplasty for single level soft disc without facet arthropathy
- Posterior foraminotomy for foraminal soft disc, avoids fusion
- Complications include dysphagia, recurrent laryngeal nerve palsy, C5 palsy and adjacent segment disease
Related pages
Author Contributions
Orthofracs team
Reviewed by Professor Phong Tran, Head of Orthopaedic Surgery, Western Health. Last updated 10 October 2026.