C3–C4 radiculopathy is a condition in which the nerve roots exiting between the third (C3) and fourth (C4) cervical vertebrae become irritated or compressed. This compression causes pain, numbness, tingling, or weakness along the pathways those nerves serve. In very simple terms, imagine the nerves between your neck bones getting “pinched,” and the signals they carry to your neck, shoulders, and upper chest getting disrupted. OrthobulletsPhysiopedia
Anatomy of the C3–C4 Intervertebral Disc
1. Structure & Location
The intervertebral disc at C3–C4 sits directly between the C3 and C4 vertebral bodies in your neck.
It is made of two main parts:
Annulus fibrosus: a tough, fibrous outer ring that holds everything together.
Nucleus pulposus: a gel-like core that cushions shocks. Kenhub
2. Origin & Insertion
The annulus fibrosus merges directly onto the endplates of the C3 and C4 vertebral bodies.
There is no separate “tendon” or “muscle” here—think of the disc as being glued between the bones.
3. Blood Supply
Intervertebral discs have no direct blood vessels inside.
Tiny capillaries reach only as far as the outer annular fibers and vertebral endplates; nutrients diffuse inward. Physiopedia
4. Nerve Supply
The sinuvertebral (recurrent meningeal) nerves supply the outermost layers of the annulus fibrosus.
These nerves carry pain signals when the disc is injured or inflamed. Radiopaedia
5. Key Functions
Shock Absorption: Cushions impacts when you move, walk, or run
Load Distribution: Spreads your body weight evenly across vertebrae
Flexibility: Allows bending, twisting, and turning of the neck
Stability: Helps keep the spine aligned under pressure
Height Maintenance: Keeps proper spacing between vertebrae
Joint Protection: Prevents bone-on-bone contact
Types of C3–C4 Radiculopathy
Acute vs. Chronic
Acute: Sudden onset (hours to days)
Chronic: Persists beyond three months
Compressive vs. Inflammatory
Compressive: Physical pressure on the nerve (e.g., herniated disc)
Inflammatory: Swelling around the nerve root
Unilateral vs. Bilateral
Unilateral: One side of the neck/shoulder
Bilateral: Both sides (rare at a single level)
Isolated vs. Multilevel
Isolated: Only C3–C4 root involved
Multilevel: Other cervical levels also affected
Motor-Predominant vs. Sensory-Predominant vs. Mixed
Common Causes
Herniated (bulging) C3–C4 disc
Cervical spondylosis (bone spur formation)
Foraminal stenosis (narrowing of the nerve exit)
Degenerative disc disease
Whiplash or neck trauma
Osteoarthritis of the facet joints
Rheumatoid arthritis affecting the cervical spine
Ankylosing spondylitis
Tumors (benign or cancerous)
Spinal infections (osteomyelitis)
Epidural abscess
Inflammatory conditions (e.g., sarcoidosis)
Congenital spinal canal narrowing
Post-surgical scarring or fibrosis
Metastatic cancer invasion
Rheumatologic ligament calcification
Trauma-induced fracture or subluxation
Endplate sclerosis
Radiation-induced fibrosis
Iatrogenic (procedure-related) nerve irritation Physiopedia
Typical Symptoms
Neck pain localized to C3–C4
Shoulder blade discomfort
Pain radiating into the upper chest
Stiffness when turning the head
Tingling or “pins & needles” in the neck/shoulder
Numbness over the lower neck or top of the shoulder
Weakness in neck muscles
Difficulty lifting the shoulder
Dull ache between the shoulder blades
Headaches at the base of the skull
Sleep disturbance due to discomfort
Reduced range of motion in the neck
Muscle spasms in the upper trapezius
Tenderness to touch over the spine
Dizziness with neck movement (cervicogenic)
Difficulty swallowing (rare, if severe)
Sensitivity to cold or heat
Fatigue from constant muscle guarding
Audible crackling (crepitus) when moving
Phantom sensations of “tight band” around neck
Diagnostic Tests
Clinical History & Exam: Detailed symptom review
Spurling’s Test: Neck compression to elicit pain
Neck Distraction Test: Relief of symptoms when lifted
MRI Scan: Visualizes soft tissues and nerves
CT Scan: Sharp image of bones and foramina
X-Rays: Alignment, disc height, bone spurs
Electromyography (EMG): Detects nerve-muscle signals
Nerve Conduction Study: Measures signal speed
Myelography: Dye injection to outline spinal cord
CT Myelogram: CT after dye for detailed view
Diagnostic Nerve Root Block: Confirms pain source
Ultrasound: Guides injections or rules out soft-tissue masses
Bone Scan: Detects infection or tumor
Single-Photon Emission CT (SPECT): Functional bone imaging
Somatosensory Evoked Potentials (SSEP): Nerve pathway testing
Blood Tests: Rule out infection or inflammation
Visual Analog Scale (VAS): Quantify pain level
Disability Questionnaires: Neck Disability Index
Postural Assessment: Identify mechanical contributors
Videofluoroscopy: Dynamic X-ray of neck motion
Non-Pharmacological Treatments
Physical therapy stretches & strengthening
Cervical traction (manual or device)
Soft cervical collar (short-term)
Heat application (warm packs)
Cold therapy (ice packs)
Transcutaneous electrical nerve stimulation (TENS)
Massage therapy
Posture correction & ergonomics
Core stability exercises
Scapular stabilization work
Acupuncture
Dry needling
Chiropractic adjustments
Yoga for neck mobility
Pilates for spinal control
Tai chi for gentle movement
Nerve gliding exercises
Aquatic therapy
Mindfulness meditation
Biofeedback for muscle relaxation
Ergonomic pillows & mattresses
Activity modification (avoid aggravating tasks)
Cervical stabilization taping
Soft-tissue mobilization
Myofascial release
Graston Technique
Proprioceptive neuromuscular facilitation
Kinesiology taping
Cognitive behavioral therapy for pain coping
Workplace ergonomic assessment
Commonly Used Drugs
NSAIDs: Ibuprofen, Naproxen, Diclofenac
Acetaminophen: Pain relief
Oral Corticosteroids: Prednisone taper
Muscle Relaxants: Cyclobenzaprine, Methocarbamol
Neuropathic Agents: Gabapentin, Pregabalin
Tricyclic Antidepressants: Amitriptyline
SNRIs: Duloxetine
Topical NSAIDs: Diclofenac gel
Topical Lidocaine Patch
Capsaicin Cream
Short-Acting Opioids: Tramadol
Long-Acting Opioids: Oxycodone (rarely)
Oral Muscle Spasmodic: Tizanidine
Alpha-2 Agonists: Clonidine patch
Anticonvulsants: Carbamazepine
Ketamine Nasal Spray (off-label)
Biologics (for arthritis)
Bisphosphonates (if osteoporotic changes)
Calcitonin (rare)
Epidural Steroid Injections (in procedure list)
Surgical Options
Anterior Cervical Discectomy & Fusion (ACDF)
Posterior Cervical Foraminotomy
Posterior Cervical Discectomy
Cervical Disc Replacement (arthroplasty)
Cervical Laminoplasty
Cervical Laminectomy & Fusion
Endoscopic Foraminotomy
Microdiscectomy
Corpectomy (vertebral body removal)
Posterior Cervical Fusion
Prevention Strategies
Maintain good neck posture
Use an ergonomic workstation
Perform regular neck and shoulder stretches
Strengthen neck-supporting muscles
Avoid prolonged static head positions
Use a supportive pillow for sleep
Lift objects with proper mechanics
Stay hydrated for disc health
Quit smoking to improve disc nutrition
Manage weight to reduce spinal load
When to See a Doctor
Severe or worsening neck pain
Progressive weakness in arms or shoulders
Loss of bladder/bowel control (urgent)
Numbness/tingling that spreads or intensifies
Unresponsive to conservative care after 4–6 weeks
Signs of infection: fever, chills, night sweats
History of cancer or unexplained weight loss
FAQs
1. What exactly is radiculopathy?
Radiculopathy means a problem with a spinal nerve root. When that nerve root is irritated or compressed, it disrupts normal nerve signals, causing pain or numbness along the nerve’s path.
2. Why does C3–C4 radiculopathy cause shoulder pain?
The C4 nerve carries sensation to the top of the shoulder and trapezius muscle. Pressure on C4 can refer pain into that area.
3. Can good posture alone prevent radiculopathy?
While posture is important, it can’t prevent all causes—like sudden injury or genetic degeneration—but it does reduce strain on the discs.
4. How long does recovery take without surgery?
Mild cases often improve within 6–12 weeks with rest, therapy, and medications. Chronic or severe cases may take months.
5. Are epidural steroid injections safe?
Yes, they are generally safe when performed by an experienced clinician, but carry small risks like bleeding or infection.
6. Is surgery always necessary?
No. Most people improve with non-surgical care. Surgery is reserved for severe or persistent cases.
7. Can radiculopathy return after treatment?
Recurrence can happen, particularly with ongoing degenerative changes. Preventive exercises help reduce risk.
8. Do disc replacements last forever?
Artificial discs are designed to last many years, but their long-term durability beyond 10–15 years is still under study.
9. Will an MRI always show radiculopathy?
An MRI may show disc bulges or stenosis, but some people have these findings without symptoms. Clinical correlation is crucial.
10. Can physical therapy worsen my symptoms?
If exercises are done incorrectly or too aggressively, they can aggravate pain. Always follow a trained therapist’s guidance.
11. What role does smoking play?
Smoking reduces blood flow to the discs and slows healing, increasing degeneration risk.
12. Can nerve gliding exercises help?
Yes, they gently mobilize the nerve root to reduce adhesions and improve mobility.
13. Are alternative therapies like acupuncture effective?
Some patients find relief; evidence varies, but they are low-risk when provided by certified practitioners.
14. What is the difference between myelopathy and radiculopathy?
Myelopathy involves spinal cord compression, causing widespread signs like gait disturbance; radiculopathy affects a single nerve root.
15. How do I know if I need surgery or not?
A spine specialist will evaluate the severity, imaging findings, and response to non-surgical care to make that decision.
Disclaimer: Each person’s journey is unique, treatment plan, life style, food habit, hormonal condition, immune system, chronic disease condition, geological location, weather and previous medical history is also unique. So always seek the best advice from a qualified medical professional or health care provider before trying any treatments to ensure to find out the best plan for you. This guide is for general information and educational purposes only. Regular check-ups and awareness can help to manage and prevent complications associated with these diseases conditions. If you or someone are suffering from this disease condition bookmark this website or share with someone who might find it useful! Boost your knowledge and stay ahead in your health journey. We always try to ensure that the content is regularly updated to reflect the latest medical research and treatment options. Thank you for giving your valuable time to read the article.
The article is written by Team Rxharun and reviewed by the Rx Editorial Board Members
Last Updated: May 04, 2025.
