C4–C5 radiculopathy is a condition in which the nerve root exiting between the fourth (C4) and fifth (C5) cervical vertebrae becomes compressed or irritated. This compression leads to pain, numbness, tingling and sometimes weakness that follows the path of the C4 or C5 nerve root into the shoulder, upper arm, or chest. The most common causes include degenerative disc disease (wear-and-tear changes in the spine) and osteophyte (bone spur) formation NCBI.
Anatomy of the C4–C5 Nerve Root
Structure & Location
The C4 and C5 nerve roots emerge from the spinal cord through the intervertebral foramen between the C4 and C5 vertebrae.
They join the cervical plexus (C1–C4) and the brachial plexus (C5–T1), supplying both neck and shoulder regions NCBISpine-health.
Origin & “Insertion” (Target Tissues)
Origin: Spinal cord segments C4 and C5.
Insertion: Sensory fibers carry impulses from the skin of the shoulder and upper arm; motor fibers innervate muscles such as the deltoid, biceps, rhomboids, and levator scapulae NCBI.
Blood Supply
Small radicular arteries branch from the vertebral arteries and the ascending cervical arteries.
These vessels run alongside the nerve root, providing oxygen and nutrients.
Nerve Supply (Branches)
Dorsal scapular nerve (from C5): innervates rhomboids and levator scapulae.
Phrenic nerve contribution (C3–C5): helps control the diaphragm.
Long thoracic nerve (C5–C7): controls serratus anterior.
Key Functions
Shoulder abduction (lifting the arm sideways) via the deltoid.
Elbow flexion via the biceps.
Scapular elevation and retraction via levator scapulae and rhomboids.
Diaphragm support (partial breathing control) via phrenic contributions.
Sensation over the lateral shoulder and upper arm.
Biceps tendon reflex (C5 reflex) maintenance NCBI.
Types of C4–C5 Radiculopathy
Acute vs. Chronic
Acute: Sudden onset, often after injury.
Chronic: Gradual development from degenerative changes.
Unilateral vs. Bilateral
Unilateral: One side affected.
Bilateral: Both sides affected (rare at C4–C5).
Compressive vs. Inflammatory
Compressive: Caused by physical pressure (e.g., herniated disc, bone spur).
Inflammatory: Nerve irritation from inflammation or infection.
Isolated C4 vs. Isolated C5
C4: Shoulder pain, neck pain, possible breathing issues.
C5: Deltoid weakness, biceps reflex loss, lateral upper arm sensory loss.
Causes
Herniated cervical disc (degenerative or traumatic)
Cervical osteoarthritis (bone spur formation)
Foraminal stenosis (narrowing of nerve exit)
Degenerative disc disease (age-related disc wear)
Traumatic injury (e.g., fracture, dislocation)
Spinal tumors (benign or malignant)
Epidural abscess (infection around spinal cord)
Cervical spondylosis (overall cervical spine degeneration)
Rheumatoid arthritis (joint inflammation)
Osteoporosis-related collapse (vertebral compression)
Post-surgical scar tissue (after neck surgery)
Spinal vascular malformations (abnormal vessels)
Paget’s disease (abnormal bone remodelling)
Bone metastases (spread of cancer to vertebrae)
Inflammatory neuropathies (e.g., Guillain–Barré, Lyme disease)
Mechanical trauma (whiplash)
Poor posture (chronic forward head tilt)
Spinal cysts (synovial or Tarlov cysts)
Obesity (increased mechanical load)
Smoking (accelerates degenerative changes) WebMD.
Symptoms
Neck pain (local discomfort at C4–C5)
Radiating shoulder pain (follows the nerve path) Physiopedia
Arm tingling or “pins and needles”
Numbness in lateral upper arm
Deltoid muscle weakness (difficulty lifting arm)
Biceps weakness (difficulty bending elbow)
Reduced biceps reflex
Scapular pain (blade-area ache)
Shoulder blade muscle spasm
Muscle twitching (fasciculations)
Neck stiffness (reduced range of motion)
Headaches (base of skull)
Radiating chest pain (rare, misdiagnosed as cardiac)
Fatigue (from chronic pain)
Sleep disturbance (pain-related insomnia)
Loss of coordination (fine motor tasks)
Grip weakness (often mild)
Muscle atrophy (chronic cases)
Hypersensitivity (light touch causes pain)
Postural imbalance (compensatory leaning)
Diagnostic Tests
Detailed medical history (onset, progression)
Physical exam (strength, sensation, reflexes)
Spurling’s test (neck extension + rotation induces pain)
Shoulder abduction relief test (hand on head reduces pain)
Cervical range of motion assessment
Dermatomal mapping (sensory testing)
Myotomal testing (motor strength)
Reflex testing (biceps, brachioradialis)
Plain X-rays (alignment, bone spurs)
MRI of cervical spine (disc, nerve compression)
CT scan (bony detail)
CT myelogram (contrast assessment of spinal canal)
Electromyography (EMG) (muscle electrical activity)
Nerve conduction studies (NCS)
Ultrasound (nerve movement/dynamic)
Bone scan (tumor or infection)
ESR & CRP blood tests (inflammation/infection)
CBC (rule out infection)
Diagnostic nerve blocks (localize pain source)
Provocative discography (disc pain confirmation)
Non-Pharmacological Treatments
Physical therapy (targeted exercises) AAFP
Cervical traction
Posture correction training
Ergonomic workstation setup
Neck collar (soft)
Heat therapy
Cold packs
Transcutaneous electrical nerve stimulation (TENS)
Acupuncture
Massage therapy
Chiropractic mobilization
Yoga/stretching routines
Pilates
Aerobic conditioning
Neural mobilization exercises
Inversion table therapy
Ultrasound therapy
Low-level laser therapy
Shockwave therapy
Biofeedback
Mindfulness meditation
Cognitive-behavioral therapy (CBT)
Aquatic therapy
Relaxation techniques
Postural taping
Ergonomic pillow
Weighted cervical pillows
Lifestyle modification programs
Activity pacing
Patient education & self-care training
Drugs
Ibuprofen (NSAID)
Naproxen (NSAID)
Diclofenac (NSAID)
Celecoxib (COX-2 inhibitor)
Acetaminophen (analgesic)
Prednisone (oral steroid taper)
Methylprednisolone (steroid burst pack)
Gabapentin (neuropathic pain)
Pregabalin (neuropathic pain)
Amitriptyline (TCA for nerve pain)
Duloxetine (SNRI)
Carbamazepine (nerve pain)
Cyclobenzaprine (muscle relaxant)
Tizanidine (muscle relaxant)
Diazepam (muscle relaxant)
Tramadol (opioid-like)
Codeine (weak opioid)
Morphine (strong opioid, short-term)
Epidural steroid injection (interventional)
Trigger point injections (local anesthetic ± steroid)
Surgical Options
Anterior cervical discectomy and fusion (ACDF)
Cervical disc arthroplasty (artificial disc replacement)
Posterior cervical foraminotomy
Laminectomy (posterior decompression)
Laminoplasty (expand spinal canal)
Posterior fusion (stabilization)
Microdiscectomy
Osteophyte removal
Facet joint resection
Expandable cage fusion
Prevention Strategies
Maintain good posture (neutral spine)
Ergonomic work setups
Regular neck-strengthening exercises
Avoid heavy overhead lifting
Use proper lifting techniques
Maintain healthy weight
Quit smoking
Stay well-hydrated (disc health)
Take frequent activity breaks
Use supportive pillows
When to See a Doctor
Seek medical attention if you experience:
Progressive muscle weakness or difficulty lifting your arm
Loss of bowel or bladder control (rare but serious)
Severe, unrelenting pain that does not improve with rest or medication
Fever or chills (possible infection)
History of cancer or infection with new neck pain
Traumatic injury to the neck
Frequently Asked Questions
What makes C4–C5 different from other levels?
C4–C5 controls shoulder abduction (lifting the arm sideways) and biceps flexion. Compression here often causes shoulder pain and arm weakness.Can C4–C5 radiculopathy improve on its own?
Yes. Many cases resolve over 6–12 weeks with conservative care such as rest and physical therapy AAFP.Is surgery always required?
No. Surgery is reserved for severe cases with persistent pain or weakness despite 6–12 weeks of conservative treatment.How accurate is an MRI?
MRI is >90% sensitive for detecting nerve root compression but must be correlated with your symptoms.Are injections safe?
Epidural steroid injections carry small risks (infection, bleeding) but can provide significant relief.Can posture cause radiculopathy?
Poor posture increases stress on cervical discs and may accelerate degenerative changes.How soon can I return to work?
Light duties may be possible within days; heavy or overhead work may need weeks of modification.What exercises help?
Neck isometric holds, scapular retractions, gentle cervical traction, and stretching improve strength and flexibility.Does weight loss help?
Yes. Reducing body weight lessens spinal loading and may slow degeneration.Is C4–C5 radiculopathy permanent?
Most patients fully recover; a small percentage develop chronic pain or weakness.Should I wear a neck collar?
Short-term use (1–2 weeks) of a soft collar can ease pain but long-term use may weaken muscles.Are there alternatives to opioids?
Yes. NSAIDs, neuropathic agents (gabapentin), physical therapy, and injections are often effective.Can it cause headache?
Yes. Irritation of upper cervical joints can refer pain to the base of the skull.Does diabetes affect recovery?
Poorly controlled diabetes may slow nerve healing; glucose control is important.When is fusion recommended over disc replacement?
Fusion is chosen when there is instability or multiple levels involved; disc replacement preserves motion at a single level.
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.
