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Cervical Transverse Nerve Root Compression at C4 – C5

Dr. Lisa S. Apfel MD - Spine and Neurosurgery Dr. Lisa S. Apfel MD - Spine and Neurosurgery
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Degenerative Bones, Joints, and Spine Care (A - Z)

Cervical transverse nerve root compression at C4–C5, often called C5 radiculopathy, occurs when the nerve fibers exiting the spinal cord between the fourth (C4) and fifth (C5) cervical vertebrae become pinched or irritated. This pressure leads to pain, numbness, or weakness along the path those nerve fibers travel—typically into the shoulder and upper arm. NCBI

Anatomy of the C5 Nerve Root

Structure & Location

The C5 nerve root begins inside the spinal canal at the level of the C4–C5 intervertebral foramen. From there, it travels outward through the bony opening (foramen) between the C4 and C5 vertebrae before branching toward muscles and skin in the shoulder region. Maryland Health Experts

Origin

These nerve fibers originate from motor (anterior horn) and sensory (posterior horn) cells in the spinal cord at the C5 segment. PMC

“Insertion” (Distribution)

Although nerves do not “insert” like muscles, the C5 root directs its motor branches into the deltoid and biceps muscles and its sensory branches into the skin over the outer shoulder and upper arm. Orthobullets

Blood Supply

Small radicular arteries—branches of the ascending cervical artery (from the thyrocervical trunk) and the deep cervical artery (from the costocervical trunk)—run alongside the C5 root through the foramen, delivering oxygen-rich blood. Turkish Neurosurgery

Nerve Supply

The C5 root itself carries both motor fibers (to muscles) and sensory fibers (from skin) as well as sympathetic (autonomic) fibers that help regulate blood vessel tone. PM&R KnowledgeNow

Key Functions

  1. Deltoid Muscle Movement: Lifts your arm away from your body (abduction).

  2. Biceps Muscle Contraction: Helps bend your elbow (flexion).

  3. Shoulder Sensation: Feels touch and temperature over the outer shoulder.

  4. Arm Proprioception: Sends position-sense signals from shoulder muscles back to the brain.

  5. Reflex Response: Triggers the biceps tendon reflex when the muscle is tapped.

  6. Sympathetic Regulation: Contributes to blood vessel control in the shoulder region. PM&R KnowledgeNow

Types of C4–C5 Nerve Root Compression

  1. Acute Traumatic: Sudden compression from injury (e.g., whiplash).

  2. Degenerative (Spondylosis): Wear-and-tear bone spurs narrow the foramen.

  3. Disc Herniation: Rupture of the disc between C4 and C5 pushes on the root.

  4. Foraminal Stenosis: Chronic narrowing of the neural exit due to arthritic change.

  5. Osteophyte Formation: Bony growths pinch the nerve over time.

  6. Ligament Thickening: Hypertrophy of the ligamentum flavum crowds the foramen.

  7. Tumors: Benign or malignant growths inside or beside the foramen.

  8. Infection/Abscess: Inflammation from infections can compress the root.

  9. Inflammatory Arthritis: Rheumatoid changes narrow the nerve exit.

  10. Iatrogenic: Post-surgical scarring or hardware misplacement causes compression.

Causes

  1. C4–C5 Disc Herniation: Gel-like disc material bulges into the nerve exit.

  2. Cervical Spondylosis: Age-related disc drying and bone spur formation.

  3. Foraminal Osteophytes: Bony outgrowths crowd the nerve channel.

  4. Hypertrophic Ligamentum Flavum: Ligament thickening reduces space.

  5. Cervical Spinal Stenosis: Generalized narrowing of the spinal canal.

  6. Facet Joint Hypertrophy: Enlarged joints press laterally on the root.

  7. Traumatic Whiplash: Sudden neck extension-flexion injures root.

  8. Cervical Fracture: Bone fragments impinge on the nerve.

  9. Tumor in Foramen: Benign (e.g., schwannoma) or malignant growth.

  10. Epidural Abscess: Pus formation compresses the root.

  11. Rheumatoid Arthritis: Synovial inflammation and pannus formation.

  12. Metastatic Cancer: Cancer spread to vertebrae encroaches the foramen.

  13. Congenital Narrowing: Birth defect of a small neural foramen.

  14. Atlantoaxial Instability: Excessive movement reduces space at C4–C5.

  15. Ossification of PLL: Posterior longitudinal ligament turns to bone.

  16. Post-Operative Scar Tissue: Surgical healing leads to fibrous bands.

  17. Cervical Disc Calcification: Disc tissue hardens and presses outward.

  18. Cervical Disc Bulge: Non-herniated but protruding disc edge.

  19. Vertebral Artery Loop: Vascular anomaly presses on the nerve root.

  20. Paget’s Disease: Abnormal bone remodeling narrows exit.

The above causes are among the most commonly identified in cervical radiculopathy NCBIPMC

Symptoms

  1. Neck Pain: Local discomfort that worsens with movement.

  2. Shoulder Pain: Deep ache over the top or outside of the shoulder.

  3. Arm Pain: Sharp, stabbing pain radiating down the upper arm.

  4. Numbness: “Pins and needles” over the lateral upper arm.

  5. Weakness: Difficulty lifting the arm or bending the elbow.

  6. Reflex Loss: Diminished biceps tendon reflex.

  7. Muscle Atrophy: Shrinkage of deltoid over time with chronic compression.

  8. Tingling: Electrical “buzz” sensation in the shoulder or arm.

  9. Burning: Shooting, fire-like pain down the arm.

  10. Position-sensory Loss: Difficulty sensing shoulder position.

  11. Headache: Typically at the base of the skull.

  12. Radiating Chest Pain: Occasional referral of pain into chest.

  13. Stiffness: Reduced neck mobility, especially turning or tilting.

  14. Fatigue: Tiring easily when using the affected arm.

  15. Grip Weakness: Less firm in one hand due to biceps weakness.

  16. Muscle Spasm: Involuntary contractions in the neck and shoulder.

  17. Sleep Disturbance: Pain wakes you at night.

  18. Clumsiness: Dropping objects due to arm weakness or numbness.

  19. Balance Issues: Mild unsteadiness if multiple levels are affected.

  20. Autonomic Changes: Rare sweating or color changes in the arm.

Patients may experience some or all symptoms depending on severity PMCCleveland Clinic

Diagnostic Tests

  1. Spurling’s Test: Head tilt + gentle pressure reproduces arm pain.

  2. Neck Distraction Test: Lifting head eases pain if nerve root is compressed.

  3. Shoulder Abduction Relief Test: Hand on head reduces symptoms.

  4. Range of Motion (ROM): Measures stiffness in neck flexion/extension.

  5. Biceps Reflex Test: Tapping tendon assesses C5 reflex arc.

  6. Manual Muscle Testing: Grades deltoid and biceps strength (0–5 scale).

  7. Sensory Exam: Pin-prick or light touch to map numbness.

  8. X-ray (Cervical Spine): Detects bone spurs, alignment, and disc height.

  9. MRI: Gold standard to visualize nerve root compression.

  10. CT Scan: Detailed bone imaging, often with myelogram for nerve detail.

  11. EMG (Electromyography): Measures electrical activity in muscles.

  12. Nerve Conduction Study (NCS): Checks speed of nerve signals.

  13. CT Myelography: Dye highlights spinal canal and nerve exits.

  14. Ultrasound: Visualizes superficial nerves and soft-tissue masses.

  15. Selective Nerve Root Block: Diagnostic injection to confirm pain source.

  16. Provocative Discography: Pressure test inside disc to replicate pain.

  17. Bone Scan: Rules out tumors or infection in vertebrae.

  18. Blood Tests: Inflammatory markers (ESR, CRP) if infection or arthritis suspected.

  19. Electrophysiological Testing: Assesses nerve-muscle junction function.

  20. Posture Analysis: Identifies mechanics that contribute to compression.

Combining clinical tests with imaging ensures accurate diagnosis MedscapeAAFP

Non-Pharmacological Treatments

  1. Physical Therapy Exercises: Targeted stretches and strengthening.

  2. Posture Correction: Ergonomic advice for sitting and standing.

  3. Cervical Traction: Gently separates vertebrae to relieve pressure.

  4. Heat Therapy: Warm packs relax muscles and improve blood flow.

  5. Cold Therapy: Ice packs reduce inflammation and numb pain.

  6. Transcutaneous Electrical Nerve Stimulation (TENS): Mild electrical pulses block pain signals.

  7. Ultrasound Therapy: Sound waves enhance tissue healing.

  8. Manual Therapy (Mobilization): Gentle joint movements by a therapist.

  9. Soft Tissue Massage: Relieves muscle spasm around the neck.

  10. Myofascial Release: Focused pressure to release connective tissue tension.

  11. Acupuncture: Thin needles inserted to modulate pain pathways.

  12. Chiropractic Adjustments: Spinal manipulations to improve alignment.

  13. Yoga & Pilates: Core-stabilizing and flexibility routines.

  14. Ergonomic Workstation: Proper desk/chair setup to reduce neck strain.

  15. Neck Bracing (Short-term): Cervical collar to limit harmful motion.

  16. Home Exercise Program: Daily routines tailored to your symptoms.

  17. Postural Taping/Kinesio Tape: Supports neck muscles and posture.

  18. Hydrotherapy: Warm water exercises to gently mobilize the neck.

  19. Proprioceptive Neuromuscular Facilitation (PNF): Stretch-and-contract techniques.

  20. Biofeedback: Teaches muscle-relaxation control via monitoring devices.

  21. Cognitive-Behavioral Therapy (CBT): Tricks to manage pain perception.

  22. Ergonomic Pillows/Supports: Proper head/neck alignment during sleep.

  23. Weighted Cervical Pillow: Gentle traction while sleeping.

  24. Activity Modification: Avoiding movements that worsen symptoms.

  25. Progressive Resistance Training: Gradually builds shoulder strength.

  26. Neuromobilization Techniques: Gentle nerve gliding exercises.

  27. Postural Awareness Training: Habits to maintain a neutral neck.

  28. Balance Training: Helps if nerve compression affects coordination.

  29. Stress-Reduction Techniques: Mindfulness, meditation to ease muscle tension.

  30. Lifestyle Education: Teaching safe lifting and carrying techniques.

These approaches can be combined for best results under professional guidance AAFP

Commonly Used Drugs

  1. Ibuprofen (NSAID): Reduces inflammation and pain.

  2. Naproxen (NSAID): Longer-acting anti-inflammatory.

  3. Diclofenac (NSAID): Topical or oral option for localized pain.

  4. Celecoxib (COX-2 Inhibitor): Less stomach irritation than traditional NSAIDs.

  5. Acetaminophen: Mild pain relief without anti-inflammatory effect.

  6. Gabapentin: Treats nerve pain by calming over-active nerves.

  7. Pregabalin: Similar to gabapentin for neuropathic pain.

  8. Amitriptyline (TCA): Low doses ease chronic nerve pain.

  9. Duloxetine (SNRI): Works on nerve pain and mood.

  10. Cyclobenzaprine: Muscle relaxant for spasms.

  11. Methocarbamol: Another option for muscle relaxation.

  12. Tizanidine: Short-acting muscle relaxant.

  13. Prednisone (Steroid): Short-term oral course for severe inflammation.

  14. Methylprednisolone (Medrol Dose Pack): Tapered steroid regimen.

  15. Lidocaine Patch: Topical anesthetic to numb focal pain.

  16. Capsaicin Cream: Depletes local pain-transmitting substances.

  17. Opioids (e.g., Tramadol): Reserved for severe, short-term pain.

  18. Ergots (e.g., Dihydroergotamine): Rarely used for vascular component.

  19. Steroid Injection (Epidural): Direct steroid into the foramen.

  20. Botulinum Toxin (Off-label): Occasional use for focal spasm relief.

Medication choice depends on pain type, severity, and individual risk factors AAFP

 Surgical Options

  1. Anterior Cervical Discectomy & Fusion (ACDF): Remove the disc and fuse C4–C5 to stabilize.

  2. Posterior Cervical Foraminotomy: Widen the foramen from the back to relieve the nerve.

  3. Laminectomy: Remove the back part of the vertebra to decompress multiple levels.

  4. Laminoplasty: Reconstruct the lamina to expand the spinal canal.

  5. Artificial Disc Replacement: Replace the damaged disc to preserve motion.

  6. Microdiscectomy: Minimally invasive removal of herniated disc material.

  7. Endoscopic Discectomy: Tiny camera and tools remove disc bits through a small incision.

  8. Posterior Cervical Laminoforaminotomy: Combined posterior removal of bone and disc.

  9. Anterior Cervical Corpectomy & Fusion: Remove part of the vertebra for wide decompression.

  10. Spinal Fusion with Instrumentation: Plates and screws stabilize after decompression.

Surgeries are reserved when conservative care fails or neurological deficits progress Spine

Prevention Strategies

  1. Maintain Good Posture: Keep head aligned over shoulders while sitting or standing.

  2. Ergonomic Workstation: Screen at eye level, chair supporting natural neck curve.

  3. Regular Neck Strengthening: Gentle exercises to support cervical spine.

  4. Frequent Breaks: Change position every 30–60 minutes when working at a desk.

  5. Proper Lifting Technique: Use legs, not back or neck, when lifting heavy objects.

  6. Avoid Heavy Backpacks: Lighten loads and use both straps evenly.

  7. Sleep Ergonomics: Supportive pillow that keeps neck in neutral alignment.

  8. Stay Hydrated: Disc health depends on good hydration.

  9. Weight Management: Reduces stress on spinal structures.

  10. Quit Smoking: Improves blood flow to spinal tissues and nerves.

Healthy habits reduce wear-and-tear and lower your risk of nerve compression AAFP

When to See a Doctor

  • Severe Arm Weakness or Numbness: Especially if it worsens rapidly.

  • Loss of Bladder or Bowel Control: A medical emergency.

  • Unrelenting Night Pain: Pain that prevents all sleep despite treatment.

  • Progressive Muscle Wasting: Visible shrinkage in shoulder or arm muscles.

  • Failed Conservative Care: No improvement after 6–8 weeks of therapy.

  • Signs of Infection: Fever, chills, or redness over the spine.

Frequently Asked Questions

  1. What exactly is C5 radiculopathy?
    It’s when the nerve root at C4–C5 is pinched, causing neck and arm problems.

  2. Can it get better on its own?
    Many mild cases improve with therapy, posture changes, and time over weeks to months.

  3. Is MRI always needed?
    If simple tests don’t help or you have serious weakness, an MRI is the best next step.

  4. Will physical therapy fix it?
    Yes—targeted exercises, posture training, and hands-on care can relieve pressure.

  5. Are steroids safe?
    A short course of oral steroids or a single epidural injection is usually well tolerated.

  6. When is surgery necessary?
    If severe weakness or nerve damage shows up on tests or you don’t improve after 6–8 weeks.

  7. What are the risks of surgery?
    Infection, bleeding, nerve injury, difficulty swallowing (rare), and non-fusion.

  8. Can I exercise with a pinched nerve?
    Gentle, guided exercise is safe; avoid heavy lifting or sudden neck twists.

  9. Are there home remedies that help?
    Ice, heat, rest, gentle neck stretches, and over-the-counter pain relievers can ease symptoms.

  10. What is the prognosis?
    Most people recover fully with conservative care; surgery has high success rates when needed.

  11. Can this cause permanent damage?
    Rarely—only if left untreated with progressive nerve damage.

  12. Is it related to aging?
    Yes—degenerative changes in the spine make nerve compression more likely over age 40.

  13. How long does recovery take?
    Weeks to months for mild cases; post-surgical recovery may take 3–6 months.

  14. Will it come back?
    Good posture and regular exercise lower the risk, but degenerative changes can recur.

  15. Can stress make it worse?
    Yes—muscle tension from stress can tighten neck muscles and worsen compression.

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.

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PDF Document For This Disease Conditions

  1. https://rxharun.com/wp-content/uploads/2017/02/Nomenclature.pdf
  2. https://pubmed.ncbi.nlm.nih.gov/27887750/
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  23. https://www.niddk.nih.gov/health-information/kidney-disease
  24. https://www.kidney.org/kidney-topics/chronic-kidney-disease-ckd
  25. https://www.kidneyfund.org/all-about-kidneys/types-kidney-diseases
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  30. https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Understanding-Sleep
  31. https://www.cdc.gov/traumaticbraininjury/index.html
  32. https://www.skincancer.org/
  33. https://illnesshacker.com/
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  36. https://www.psoriasis.org/about-psoriasis/
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  39. https://cms.centerwatch.com/directories/1067-fda-approved-drugs/topic/292-skin-infections-disorders
  40. https://www.fda.gov/files/drugs/published/Acute-Bacterial-Skin-and-Skin-Structure-Infections—Developing-Drugs-for-Treatment.pdf
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  58. https://www.nia.nih.gov/health/topics
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  66. https://www.nichd.nih.gov/health/topics
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References

 

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