C3 – C4 Nerve Root Compression

C3–C4 nerve root compression refers to the pinching or irritation of the third and fourth cervical spinal nerve roots as they exit the spinal canal between the C3 and C4 vertebrae. This condition falls under the broader category of cervical radiculopathy, which most frequently results from age-related degeneration or trauma leading to disc herniation or bony overgrowth that presses on these nerve roots. Left untreated, C3–C4 compression can lead to persistent pain, sensory changes, and muscle weakness in the neck, shoulder, and upper chest regions, significantly impacting daily activities and quality of life sportsmedicine.mayoclinic.orgNCBI.

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Anatomy

Structure & Location

The C3 and C4 nerve roots emerge from the cervical spinal cord at the levels just above the C3 and C4 vertebral bodies. Each root exits the spinal canal through its corresponding intervertebral foramen—C3 through the foramen above the third cervical vertebra, and C4 above the fourth vertebra. Although there are only seven cervical vertebrae, eight cervical nerve roots exist, with C8 exiting below C7 PhysiopediaRadiopaedia.

Origin

Motor (ventral) and sensory (dorsal) fibers of the C3 and C4 roots originate from the gray matter of the spinal cord segments at the foramen magnum level and course laterally to exit through the vertebral foramina. The dorsal root ganglion houses the sensory neuron cell bodies, whereas the ventral root fibers carry motor commands from the anterior horn cells PhysiopediaNCBI.

Distribution (Insertion)

After emerging, the ventral rami of C3 and C4 join the cervical plexus—a network of nerves that innervates the anterolateral neck and portions of the shoulder. Some fibers from C3–C5 form the phrenic nerve, which descends into the thorax to supply the diaphragm for breathing. The remaining fibers split into smaller branches supplying muscles and skin over the neck and upper chest PhysiopediaRadiopaedia.

Blood Supply

C3 and C4 nerve roots receive arterial blood via small radicular arteries that arise from the vertebral, ascending cervical, and deep cervical arteries. These radicular arteries accompany the nerve roots through the intervertebral foramina, supplying both the roots and adjacent spinal cord segments. A small pial plexus (vasocorona) further supports this region KenhubWikipedia.

Nerve Supply

The C3 and C4 roots carry mixed motor and sensory fibers. Sensory fibers form part of the C3 (neck lateral region) and C4 (over the shoulder and top of chest) dermatomes. Motor fibers innervate muscles such as the levator scapulae, scalene group, and contribute to the phrenic nerve for diaphragmatic function PhysiopediaRadiopaedia.

• Sensory (Dorsal Rami): The dorsal rami of C3 and C4 supply cutaneous sensation to the lower neck, upper chest, and upper back (C3–C4 dermatome)Cleveland ClinicSpine-health.

• Motor (Ventral Rami): The ventral rami contribute fibers to the cervical plexus and to the phrenic nerve (via C3–C5), which innervates the diaphragm. They also supply deep neck muscles such as the longus capitis and parts of the levator scapulae and scalenesNCBI.

Key Functions

1. Neck Lateral Flexion (C3) – bending the head toward the shoulder

2. Shoulder Elevation (C4) – shrugging the shoulders

3. Head Stabilization – maintaining upright posture of head and neck

4. Diaphragm Control – via phrenic nerve (C3–C5) for breathing

5. Sensory Transmission – feeling light touch, pain, and temperature in neck/shoulder skin

6. Reflex Regulation – controlling deep tendon reflexes in the neck region PhysiopediaRadiopaedia.

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Types of C3–C4 Compression

• Disc Herniation (Soft Disc Protrusion): Nucleus pulposus pushes through the annulus fibrosus, pressing on the nerve root sportsmedicine.mayoclinic.orgNCBI.

• Osteophytic (Bone Spur) Compression: Bony growths from cervical spondylosis encroach on the foramen Mayo ClinicNCBI.

• Foraminal Stenosis: Narrowing of the intervertebral foramen often due to uncovertebral joint degeneration WikipediaMayo Clinic.

• Central Canal Stenosis: General spinal canal narrowing that may secondarily compress the exiting root NCBIsportsmedicine.mayoclinic.org.

• Ligamentum Flavum Hypertrophy: Thickening of ligamentum flavum bulges into the canal or foramen NCBIWikipedia.

• Facet Joint Cysts: Synovial cysts from facet joints press on adjacent roots NCBIAAFP.

• Tumoral Compression: Masses such as meningiomas, schwannomas, or metastases WikipediaNCBI.

• Infectious Lesions: Epidural abscess or vertebral osteomyelitis causing inflammatory compression Cleveland ClinicDOCS Spine Orthopedics.

• Traumatic Injury: Fracture fragments or hematoma after trauma/jump injury WikipediaPMC.

• Congenital/Developmental: Abnormalities like Klippel–Feil syndrome WikipediaNCBI.

• Iatrogenic Scar Tissue: Postoperative fibrosis or scarring after neck surgery NCBIAAFP.

• Metabolic Bone Disorders: Paget’s disease causing bony overgrowth Mayo ClinicPubMed.

• Ligament Ossification: Ossification of the posterior longitudinal ligament (OPLL) NCBIMayo Clinic.

• Vascular Malformations: Rarely arteriovenous malformations in the canal NCBIOpenAnesthesia.

• Epidural Hematoma: Bleeding into the epidural space pressing on the root WikipediaNCBI.

• Rheumatoid Pannus: Rheumatoid arthritis pannus formation at C3–C4 facet joints Mayo ClinicNCBI.

• Ankylosing Spondylitis: Inflammatory fusion with bony bridges compressing foramina Mayo ClinicNCBI.

• Cervical Rib: Extra rib above C7 causing altered biomechanics and compression NCBIRadiopaedia.

• Psoriatic Arthritis: Inflammatory joint enlargement affecting the foramen Mayo ClinicNCBI.

• Chronic Disc Degeneration: Progressive disc height loss leading to foraminal narrowing Mayo ClinicNCBI.

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Causes

1. Herniated Cervical Disc – nucleus pulposus bulge pressing on C3–C4 sportsmedicine.mayoclinic.org

2. Cervical Spondylosis – age-related disc degeneration Mayo Clinic

3. Osteophyte Formation – bone spurs narrowing the foramen Mayo Clinic

4. Foraminal Stenosis – uncovertebral joint arthritis Wikipedia

5. Central Canal Stenosis – canal narrowing from ligament or bone NCBI

6. Ligamentum Flavum Hypertrophy – thickened ligament encroaching root NCBI

7. Whiplash Injury – soft tissue damage after sudden neck flexion/extension Wikipedia

8. Cervical Fracture – bony fragments from trauma Wikipedia

9. Facet Joint Hypertrophy – enlarged facets reducing foraminal space Mayo Clinic

10. Rheumatoid Arthritis – pannus eroding joint margins Mayo Clinic

11. Tumors – meningioma, schwannoma, metastasis Wikipedia

12. Spinal Infections – osteomyelitis, discitis Cleveland Clinic

13. Epidural Abscess – pus collection compressing root DOCS Spine Orthopedics

14. Paget’s Disease – disorganized bone overgrowth Mayo Clinic

15. OPLL – ligament ossification NCBI

16. Epidural Hematoma – bleeding in epidural space Wikipedia

17. Congenital Fusion – Klippel–Feil syndrome Wikipedia

18. Iatrogenic Scar – post-surgical fibrosis AAFP

19. Cervical Rib – accessory rib altering biomechanics Radiopaedia

20. Psoriatic Arthritis – inflammatory joint changes Mayo Clinic

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 Symptoms

• Neck pain, often sharp or burning sportsmedicine.mayoclinic.orgCleveland Clinic

• Shoulder pain or aching sportsmedicine.mayoclinic.orgCleveland Clinic

• Radiating pain into upper chest or scapula sportsmedicine.mayoclinic.orgCleveland Clinic

• Tingling or “pins and needles” in neck/shoulder dermatome sportsmedicine.mayoclinic.orgCleveland Clinic

• Numbness in C3/C4 sensory distribution sportsmedicine.mayoclinic.orgCleveland Clinic

• Muscle weakness in neck flexors or shoulder elevators sportsmedicine.mayoclinic.orgCleveland Clinic

• Reflex changes (diminished biceps reflex) sportsmedicine.mayoclinic.orgCleveland Clinic

• Neck stiffness, reduced range of motion sportsmedicine.mayoclinic.orgCleveland Clinic

• Headaches at base of skull sportsmedicine.mayoclinic.orgCleveland Clinic

• Tenderness over affected foramen sportsmedicine.mayoclinic.orgCleveland Clinic

• Muscle spasms in neck/scalenes sportsmedicine.mayoclinic.orgCleveland Clinic

• Atrophy of trapezius or scalene muscles sportsmedicine.mayoclinic.orgCleveland Clinic

• Pain aggravated by neck extension or rotation sportsmedicine.mayoclinic.orgCleveland Clinic

• Pain relieved by arm lifting (relieves tension) sportsmedicine.mayoclinic.orgCleveland Clinic

• Dysesthesia (abnormal sensation) in neck sportsmedicine.mayoclinic.orgCleveland Clinic

• Sleep disturbance due to pain sportsmedicine.mayoclinic.orgCleveland Clinic

• Shoulder blade muscle tightness sportsmedicine.mayoclinic.orgCleveland Clinic

• Sensation of “electric shock” on movement sportsmedicine.mayoclinic.orgCleveland Clinic

• Possible breathing difficulty (phrenic involvement) sportsmedicine.mayoclinic.orgCleveland Clinic

• Lhermitte’s sign (rare electric sensation on neck flexion) sportsmedicine.mayoclinic.orgCleveland Clinic

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Diagnostic Tests

1. History & Physical Exam – including Spurling’s and distraction tests AAFPNCBI

2. Spurling’s Test – reproduces radicular pain on neck extension/rotation AAFPNCBI

3. Upper Limb Tension Test – nerve stretch provocation AAFPNCBI

4. Neurological Exam – motor, sensory, reflex assessment AAFPNCBI

5. Cervical X-rays – assess alignment, bony changes AAFPNCBI

6. MRI Cervical Spine – gold standard for soft tissue and nerve root visualization AAFPNCBI

7. CT Scan – excellent for bony detail (osteophytes, foraminal stenosis) AAFPNCBI

8. CT Myelography – when MRI contraindicated AAFPNCBI

9. Electromyography (EMG) – evaluates muscle denervation AAFPNCBI

10. Nerve Conduction Studies (NCS) – measures conduction velocity AAFPNCBI

11. Dynamic Flexion-Extension X-rays – assess instability AAFPNCBI

12. Discography – provocative test to pinpoint symptomatic level AAFPNCBI

13. Bone Scan – for infection or tumor workup AAFPNCBI

14. CBC, ESR, CRP – screen for infection or inflammation AAFPNCBI

15. PET Scan – for neoplastic compression AAFPNCBI

16. Ultrasound-Guided Nerve Block – diagnostic anesthetic block AAFPNCBI

17. Doppler Ultrasound – rule out vascular mimics AAFPNCBI

18. Cervical Spine CT with Contrast – evaluate neoplasm/infection AAFPNCBI

19. Somatosensory Evoked Potentials (SSEP) – assess conduction integrity AAFPNCBI

20. Myelography – rare, invasive canal imaging AAFPNCBI

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Non-Pharmacological Treatments

1. Physical therapy (strengthening) AAFPPhysiopedia

2. Stretching exercises AAFPPhysiopedia

3. Soft cervical collar AAFPPhysiopedia

4. Traction (mechanical or manual) AAFPPhysiopedia

5. Heat therapy AAFPPhysiopedia

6. Ice packs AAFPPhysiopedia

7. Ultrasound therapy AAFPPhysiopedia

8. TENS (electrical stimulation) AAFPPhysiopedia

9. Massage AAFPPhysiopedia

10. Manual therapy (mobilization) AAFPPhysiopedia

11. Spinal manipulation AAFPPhysiopedia

12. Postural education AAFPPhysiopedia

13. Ergonomic workstation adjustments AAFPPhysiopedia

14. Activity modification AAFPPhysiopedia

15. Cervical pillow AAFPPhysiopedia

16. Kinesio taping AAFPPhysiopedia

17. Yoga AAFPPhysiopedia

18. Tai chi AAFPPhysiopedia

19. Aquatic therapy AAFPPhysiopedia

20. Acupuncture AAFPPhysiopedia

21. Dry needling AAFPPhysiopedia

22. Laser therapy AAFPPhysiopedia

23. Shockwave therapy AAFPPhysiopedia

24. Mindfulness meditation AAFPPhysiopedia

25. Biofeedback AAFPPhysiopedia

26. Functional restoration program AAFPPhysiopedia

27. Cervical orthosis (brace) AAFPPhysiopedia

28. Ergonomic neck support AAFPPhysiopedia

29. Postural taping AAFPPhysiopedia

30. Education on body mechanics AAFPPhysiopedia

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Drugs

1. Ibuprofen (NSAID) AAFPCleveland Clinic

2. Naproxen (NSAID) AAFPCleveland Clinic

3. Celecoxib (COX-2 inhibitor) AAFPCleveland Clinic

4. Acetaminophen AAFPCleveland Clinic

5. Prednisone (oral steroid) AAFPCleveland Clinic

6. Gabapentin AAFPCleveland Clinic

7. Pregabalin AAFPCleveland Clinic

8. Amitriptyline (TCA) AAFPCleveland Clinic

9. Duloxetine (SNRI) AAFPCleveland Clinic

10. Cyclobenzaprine (muscle relaxant) AAFPCleveland Clinic

11. Tramadol (opioid) AAFPCleveland Clinic

12. Oxycodone AAFPCleveland Clinic

13. Codeine AAFPCleveland Clinic

14. Lidocaine (nerve block) AAFPCleveland Clinic

15. Triamcinolone (epidural injection) AAFPCleveland Clinic

16. Ketorolac (NSAID) AAFPCleveland Clinic

17. Capsaicin (topical) AAFPCleveland Clinic

18. Diclofenac (topical) AAFPCleveland Clinic

19. Carbamazepine (neuropathic) AAFPCleveland Clinic

20. Baclofen AAFPCleveland Clinic

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Surgeries

1. Anterior Cervical Discectomy & Fusion (ACDF) OrthoInfoAANS

2. Artificial Disc Replacement (ADR) OrthoInfoAANS

3. Posterior Cervical Laminoforaminotomy OrthoInfoAANS

4. Posterior Cervical Laminectomy OrthoInfoAANS

5. Posterior Cervical Laminoplasty OrthoInfoAANS

6. Endoscopic Cervical Discectomy OrthoInfoAANS

7. Posterior Foraminotomy OrthoInfoAANS

8. Anterior Cervical Corpectomy & Fusion OrthoInfoAANS

9. Posterior Instrumentation & Fusion OrthoInfoAANS

10. Microsurgical Decompression OrthoInfoAANS

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Preventions

• Maintain ergonomic neck posture during work PhysiopediaCleveland Clinic

• Regular neck strengthening exercises PhysiopediaCleveland Clinic

• Avoid prolonged head flexion/extension PhysiopediaCleveland Clinic

• Use supportive cervical pillow PhysiopediaCleveland Clinic

• Practice safe lifting techniques PhysiopediaCleveland Clinic

• Take frequent breaks during desk work PhysiopediaCleveland Clinic

• Maintain healthy weight to reduce spinal load PhysiopediaCleveland Clinic

• Quit smoking to improve disc health PhysiopediaCleveland Clinic

• Ensure adequate calcium & vitamin D intake PhysiopediaCleveland Clinic

• Stay active with low-impact exercise PhysiopediaCleveland Clinic

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When to See a Doctor

Seek medical attention if you experience severe or worsening arm weakness, persistent numbness, loss of bladder or bowel control (suggesting spinal cord involvement), or pain that does not improve after 6 weeks of conservative care. Other red flags include fever, unintentional weight loss, or a history of cancer, which may indicate infection or malignancy Mayo ClinicAANS.

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Frequently Asked Questions

1. What is C3–C4 nerve root compression?
   It’s when the nerve roots exiting at the C3 and C4 levels of your neck become pinched by nearby discs, bones, or ligaments, leading to pain or sensory changes sportsmedicine.mayoclinic.orgNCBI.

2. What causes it?
   Common causes include herniated discs, bone spurs from cervical spondylosis, and ligament thickening that narrow the exit for the nerve roots Mayo ClinicNCBI.

3. What are the main symptoms?
   You may feel neck pain, shoulder pain, tingling, numbness, or weakness in muscles controlled by C3/C4, such as those lifting your shoulder sportsmedicine.mayoclinic.orgCleveland Clinic.

4. How is it diagnosed?
   Diagnosis relies on your history, physical tests like Spurling’s, X-rays, MRI, and sometimes EMG or nerve conduction studies to confirm the affected level AAFPNCBI.

5. Can it improve without surgery?
   Many cases respond to non-surgical care—physical therapy, medications, and injections—though severe or progressive cases may need surgical decompression AAFPMayo Clinic.

6. What exercises help?
   Gentle neck stretches, isometric strengthening of the deep neck flexors, and scapular stabilization exercises under professional guidance are most beneficial AAFPPhysiopedia.

7. Are steroid injections effective?
   Transforaminal epidural steroid injections can reduce inflammation and pain around the compressed nerve root, often providing significant short-term relief AAFPMayo Clinic.

8. How long does recovery take?
   With conservative treatment, many improve within 6–12 weeks; post-surgical recovery may take 3–6 months for full symptom resolution AAFP.

9. Will I need imaging?
   Yes—MRI is the gold standard to visualize soft tissues like discs and nerves; CT is used when MRI is contraindicated AAFPNCBI.

10. Can I play sports?
    Low-impact activities like swimming are usually safe; contact sports may need to be avoided until full recovery to prevent re-injury AAFPPhysiopedia.

11. Is surgery risky?
    All surgeries carry risks (infection, nerve injury), but complications are relatively low (<5%) when performed by experienced surgeons AANS.

12. Will it cause permanent damage?
    Most recover fully; prolonged compression can lead to muscle wasting or persistent sensory changes if left untreated NCBIsportsmedicine.mayoclinic.org.

13. How is C3–C4 different from C5 radiculopathy?
    C3–C4 affects neck lateral flexion and shoulder elevation, while C5 more commonly affects deltoid muscle strength and lateral arm sensation PhysiopediaRadiopaedia.

14. Can it cause headaches?
    Yes—irritation of upper cervical roots (especially C3) can refer pain to the back of the head and around the skull base sportsmedicine.mayoclinic.orgCleveland Clinic.

15. How can I prevent recurrence?
    Maintain good posture, strengthen neck muscles, take ergonomic breaks, and avoid repetitive neck strain PhysiopediaCleveland Clinic.

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The article is written by Team Rxharun and reviewed by the Rx Editorial Board Members

Last Updated: May 04, 2025.

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