C5–C6 radiculopathy is a type of cervical radiculopathy in which the nerve roots exiting the spinal canal between the fifth and sixth cervical vertebrae (C5 and C6) become compressed or irritated. This “pinched nerve” leads to neck pain that radiates into the shoulder, arm, and hand, and can cause muscle weakness, numbness, or tingling in the areas these roots serve. The condition often develops gradually as spinal structures wear down, but it can also follow sudden injury or disc herniation Cleveland ClinicOrthoInfo.
Anatomy of the C5–C6 Region
Structure & Location
Intervertebral Disc and Foramen: Between C5 and C6 vertebral bodies sits an intervertebral disc; nerve roots exit through the neural foramen just behind this disc.
Facet Joints: Two small joints on each side of the vertebrae near the back help guide and limit neck motion.
Ligaments & Muscles: The anterior longitudinal ligament runs along the front of the vertebral bodies; deep neck muscles (e.g., longus colli) lie in front, while traps, levator scapulae, and splenius capitis lie posteriorly Cleveland Clinic.
Origin & Insertion
Nerve Roots: Each spinal nerve root emerges from the spinal cord, travels laterally through the foramina, then joins with other roots to form peripheral nerves.
Muscle Attachments: The C5 nerve root contributes to the phrenic nerve (origin C3–C5) and directly innervates muscles like the deltoid (insertion on humerus) and biceps brachii (insertion on radial tuberosity) Wikipedia.
Blood Supply
Segmental Arteries: The vertebral artery gives off small branches (radicular arteries) that run beside each nerve root, supplying blood to the nerve and adjacent spinal structures.
Venous Plexus: A network of veins around the vertebrae drains blood from the nerve roots and disc PMC.
Nerve Supply
C5 Root: Primarily motor to deltoid and part of biceps; sensory to lateral shoulder/upper arm (dermatome C5).
C6 Root: Motor to wrist extensors and biceps; sensory to lateral forearm and thumb (dermatome C6) Spine-health.
Key Functions
Shoulder Abduction: Deltoid muscle, via C5, lifts the arm away from the body.
Elbow Flexion: Biceps contraction, supported by C6, bends the elbow.
Wrist Extension: C6-driven extensor carpi radialis helps lift the back of the hand.
Sensory Feedback: Thumb and lateral arm sensation allow you to feel touch, pressure, and temperature.
Reflex Arcs: Biceps (C5/6) and brachioradialis (C6) reflexes help maintain muscle tone.
Postural Control: Deep neck muscles stabilize the head and allow precise movements.
Types of C5–C6 Radiculopathy
Acute vs. Chronic: Sharp onset (disc herniation) versus gradual wear-and-tear (spondylosis).
Foraminal vs. Central Canal: Nerve pinched at the side exit (foramen) or in the central canal.
Unilateral vs. Bilateral: Affecting one side of the neck/arm versus both.
Monoradiculopathy vs. Polyradiculopathy: Single-root involvement (C5 or C6) versus multiple roots.
Causes
Cervical Disc Herniation: Inner disc gel pushes on the nerve root.
Cervical Spondylosis: Age-related bone spur formation narrows the foramina.
Degenerative Disc Disease: Loss of disc height increases stress on facet joints and ligaments.
Osteoarthritis: Wear of facet joints leads to joint enlargement and impingement.
Trauma: Fracture or dislocation can compress nerve roots.
Spinal Stenosis: General narrowing of the spinal canal.
Rheumatoid Arthritis: Inflammatory swelling of joints and ligaments.
Tumors: Benign or malignant growths in or near the spinal canal.
Infections: Epidural abscess or osteomyelitis causing inflammation.
Ligamentous Hypertrophy: Thickening of the ligamentum flavum.
Disc Calcification: Hardening of the disc pressing on the nerve.
Congenital Stenosis: Naturally narrow spinal canal.
Metastatic Disease: Cancer spreading to vertebrae.
Vascular Malformations: Abnormal blood vessels compressing the root.
Post-surgical Scar Tissue: Fibrosis following neck surgery.
Idiopathic Inflammation: Nerve root inflammation without clear cause.
Diabetes Mellitus: Glycemic damage lowers nerve resilience.
Poor Posture: Chronic forward head posture increases disc stress.
Repetitive Strain: Occupational neck extension or rotation.
Obesity: Increased mechanical load on cervical spine PMC.
Symptoms
Neck Pain: Often sharp or burning around C5–C6 level.
Radiating Arm Pain: Down the lateral arm into thumb/index finger.
Numbness: Loss of sensation in C5/C6 dermatome.
Tingling (Paresthesia): “Pins and needles” in shoulder or hand.
Muscle Weakness: Difficulty lifting arm or extending wrist.
Reflex Changes: Diminished biceps and brachioradialis reflexes.
Muscle Atrophy: Wasting of deltoid or forearm muscles over time.
Drop Attacks: Sudden arm weakness causing objects to fall.
Positional Pain: Worse when looking up or turning head.
Headaches: Radiating pain into the base of skull.
Pain with Cough/Sneeze: Increases intracanal pressure.
Sleep Disturbance: Pain waking from sleep.
Grip Weakness: Difficulty holding objects.
Shoulder Pain: Aching at deltoid insertion.
Scapular Muscle Spasm: Tightness around shoulder blade.
Unsteady Hand Movements: Fine motor control loss.
Allodynia: Pain from normally non-painful touch.
Hyperalgesia: Exaggerated pain response.
Gait Changes: Rare, if severe spinal cord involvement.
Autonomic Symptoms: Rare sweating or vasomotor changes in arm Spine-health.
Diagnostic Tests
History & Physical Exam: Dermatomal sensory testing, motor strength, reflexes.
Spurling’s Test: Neck extension and rotation with axial load reproduces pain.
Cervical Compression Test: Direct downward force for pain reproduction.
Cervical Distraction Test: Relief of pain when pulling head gently.
MRI of Cervical Spine: Gold standard for soft-tissue and disc pathology.
CT Myelogram: For patients who can’t have MRI.
EMG/Nerve Conduction Studies: Assess nerve function and rule out other neuropathies.
X-Rays (AP/Lateral/Oblique): Detect bone spurs, alignment, disc space narrowing.
Flexion-Extension X-Rays: Identify instability.
Ultrasound: Dynamic assessment of nerve swelling.
Provocative Discography: Reproduces pain via disc injection (rare).
Bone Scan: Detect infection or tumor.
Laboratory Tests: ESR/CRP for infection/inflammation.
CT Scan: Detailed bone imaging.
Fundoscopic Exam: Rule out papilledema if myelopathy suspected.
TENS Trial: Diagnostic relief with transcutaneous stimulation.
Analgesic Block Injection: Nerve block to confirm pain source.
Quantitative Sensory Testing: Measures thresholds for temperature and vibration.
Thermography: Local temperature changes from sympathetic involvement.
Videofluoroscopy: Dynamic spinal motion study Expert Health Maryland.
Non-Pharmacological Treatments
Activity Modification: Avoid aggravating movements.
Cervical Collar: Short-term immobilization.
Physical Therapy: Targeted neck and shoulder exercises.
Traction: Mechanical or manual to decompress nerve root.
Posture Training: Ergonomic workspace adjustments.
Heat/Cold Therapy: Alternate to reduce pain and spasm.
Ultrasound Therapy: Deep tissue heating.
Electrical Stimulation (TENS): Pain modulation.
Soft-Tissue Mobilization: Manual myofascial release.
Joint Mobilization: Gentle facet release techniques.
Dry Needling/Acupuncture: Trigger point relief.
Laser Therapy: Low-level laser for inflammation reduction.
Yoga/Pilates: Gentle stretching and core strengthening.
Massage Therapy: Relaxation of paraspinal muscles.
Cervical Stabilization Exercises: Deep neck flexor strengthening.
Mindfulness/Meditation: Stress reduction to decrease muscle tension.
Biofeedback: Teach muscle relaxation techniques.
Ergonomic Assessment: Chair, keyboard, monitor positioning.
Aquatic Therapy: Low-load cervical exercises.
Cognitive Behavioral Therapy: Pain coping skills.
Nutritional Optimization: Anti-inflammatory diet.
Weight Management: Reduce cervical load.
Smoking Cessation: Improves disc health.
Vitamin D/Calcium Supplementation: Bone health support.
Prolotherapy: Ligament strengthening injections.
Osteopathic Manipulative Treatment: Whole-body alignment.
Chiropractic Adjustments: Mobilize restricted segments.
Kinesio Taping: Postural support.
Graded Motor Imagery: Neurological pain desensitization.
Ergonomic Driving Support: Headrest and seat adjustments Cleveland Clinic.
Drugs
NSAIDs (Ibuprofen, Naproxen): First-line for pain and inflammation.
Acetaminophen: Analgesic for mild pain.
Oral Corticosteroids: Short course for severe inflammation.
Muscle Relaxants (Cyclobenzaprine): Reduce spasm.
Gabapentinoids (Gabapentin, Pregabalin): Neuropathic pain relief.
Tricyclic Antidepressants (Amitriptyline): Low-dose for nerve pain.
SNRIs (Duloxetine): Neuropathic pain and mood improvement.
Opioids (Tramadol): Short-term for intense pain.
Topical NSAIDs (Diclofenac gel): Local application.
Topical Lidocaine Patches: Nerve desensitization.
Capsaicin Cream: Depletes substance P over time.
IV Steroids (Methylprednisolone): In-hospital acute relief.
Calcitonin: Rare, for refractory pain.
Bisphosphonates: If vertebral involvement.
Vitamin B12: Nerve health support.
Alpha-Lipoic Acid: Antioxidant nerve support.
Magnesium Supplements: Muscle relaxation.
Cannabinoids: Emerging neuropathic pain therapy.
Ketamine Infusions: Refractory neuropathic pain.
Botulinum Toxin Injections: Targeted muscle spasm reduction Home.
Surgeries
Anterior Cervical Discectomy and Fusion (ACDF): Remove herniated disc and fuse vertebrae.
Cervical Disc Replacement: Maintain motion by inserting an artificial disc.
Posterior Foraminotomy: Widen the nerve exit channel from the back.
Laminectomy: Remove part of the vertebral arch for canal decompression.
Laminoplasty: Reconstruct lamina to enlarge canal while preserving stability.
Posterior Cervical Fusion: Stabilize multiple levels from the back.
Microsurgical Discectomy: Minimally invasive disc removal.
Endoscopic Cervical Discectomy: Tiny incisions with endoscope guidance.
Osteophyte Removal: Excise bone spurs pressing on nerve.
Odontoidectomy: Rare, if C2 involvement encroaches on adjacent levels.
Prevention Strategies
Ergonomic Workstation: Head neutral, shoulders relaxed.
Regular Neck Exercises: Strengthen deep flexors and extensors.
Postural Awareness: Avoid constant forward head tilt.
Weight Control: Reduce excess cervical load.
Smoking Cessation: Promotes disc nutrition.
Proper Lifting Techniques: Avoid neck flexion under load.
Frequent Breaks: Every 30–60 minutes in static postures.
Sleep Support: Use cervical-support pillow.
Balanced Diet: Rich in anti-inflammatory foods.
Hydration: Maintains disc health.
When to See a Doctor
Progressive Weakness: Any worsening motor loss in arm/hand.
Severe Pain Unresponsive to 4–6 Weeks of Conservative Care
Loss of Bladder/Bowel Control: Signs of spinal cord involvement.
Severe Neck Stiffness with Fever: Rule out infection.
Trauma: Recent neck injury with neurological signs. Cleveland Clinic.
Frequently Asked Questions
What’s the difference between C5 and C6 radiculopathy?
C5 often causes shoulder weakness; C6 affects wrist extension and thumb sensation Spine-health.Can it resolve without surgery?
Yes—up to 90% improve with conservative care within 6–12 weeks Cleveland Clinic.Are steroids safe?
Short courses are generally safe if monitored; long-term use has risks.Will physical therapy help?
Yes—targeted exercises reduce pain and improve function.Is cervical traction effective?
It provides short-term pain relief but should be combined with exercises.Can I use a cervical collar long-term?
No—prolonged use can weaken neck muscles.What activities should I avoid?
Heavy lifting, extreme neck extension, and high-impact sports until cleared.When is surgery recommended?
For severe, persistent pain or progressive weakness not improving with 6–12 weeks of care.Is disc replacement better than fusion?
Disc replacement preserves motion; fusion may be better for instability.What are surgical risks?
Infection, bleeding, nerve injury, and adjacent-level disease.Can C5–C6 radiculopathy cause headaches?
Yes—referred pain can radiate to the back of the skull.Does it affect driving?
Pain and weakness may impair ability; follow your doctor’s guidance.Is it hereditary?
Spinal degeneration has genetic components but lifestyle is also key.How can I improve posture at work?
Use monitor at eye level, support arms, and take frequent breaks.What’s the long-term outlook?
Most people recover fully; a small percentage may have chronic pain.
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.
