20/04/2026
𝗖5‑𝗧1 𝗿𝗮𝗱𝗶𝗰𝘂𝗹𝗮𝗿 𝗽𝗮𝗶𝗻 𝘄𝗶𝘁𝗵𝗼𝘂𝘁 𝗮𝗿𝗺 𝗽𝗮𝗶𝗻
Lower cervical levels (C4–C5, C5–C6, C6–C7, C7–T1) are the most common sites for disc herniations and spondylosis. Given that all the roots exiting at these levels form the brachial plexus, it is common to have radiating pain down the arm or numbness and weakness in the upper extremities.
Patients with one of these painful radiculopathies might have neck pain, arm pain or both. When both are present, the identification of the pathologic level should be easier since they tend to follow dermatomal and myotomal distribution of symptoms.
🤷 In cases of isolated neck pain, the diagnosis becomes much more challenging because of the lack of a typical pain distribution.
📘 A new scoping review by Carmichael and colleagues of (https://www.sciencedirect.com/science/article/pii/S2666548425000393) 86 studies (1957–2022) demonstrates that scapular pain is a common feature of cervical radiculopathy (72% of studies), ranking third behind neck (88%) and arm (85%) pain. Findings challenge the clinical assumption that arm symptoms are necessary for diagnosis, as evidence suggests scapular pain may precede arm pain by weeks. The C7 nerve root shows the strongest association with scapular pain. These insights could enable earlier diagnosis of cervical radiculopathy when isolated scapular pain is present.
Neck pain is a vast entity and patients tend to label it “neck pain” even when the pain is located in-between the scapulae or near the shoulder and axilla.
📘 According to a recent publication by Redaelli and colleagues, there are typical pain locations which correlate with a specific root in the majority of cases (https://pubmed.ncbi.nlm.nih.gov/38191741/, s. also Tanaka et al. https://pubmed.ncbi.nlm.nih.gov/16924193/)
👉 C5 nerve root impingement causes pain on top of the shoulder radiating to the deltoid.
👉 C6 causes pain radiating to the supraspinous fossa.
👉 C7 causes pain medial to the spine of the scapula and can also cause pain in the axilla and the pectoral region, just below the clavicle.
👉 C8 causes pain along the medial border of the scapula, below the spine of the scapula and the pain can also radiate into the anterior chest but lower in the axilla than with C7 radiculopathy.
👉 Finally, T1 typically causes pain medial to the tip of the scapula, lower in the axilla than with C7 or 8 and into the lower anterior chest and is frequently described as a stabbing sensation . These pains, when present on the left side, can be mistaken for angina and have been called “cervical angina” 🖤 (https://pubmed.ncbi.nlm.nih.gov/33108845/).
❌So, if your patient has pain in their shoulder blade, remember: "𝗔𝘀𝘀𝗲𝘀𝘀, 𝗱𝗼𝗻’𝘁 𝘁𝗿𝗶𝗴𝗴𝗲𝗿" (;-).
📸 Adapted from: Typical patterns of pain in (a) C5; (b) C6, (c) C7; (d) C8 and (e) T1 radiculopathies. https://pubmed.ncbi.nlm.nih.gov/38191741/
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