Cervical Radiculopathy -- Diagnosis correct? Treatment? Surgery

I'm 41 years old and suffering from what looks like cervical radiculopathy that radiates from C5-C6 nerve root down the left arm; C6-C7 down the right arm.  There are herniated discs at these points.  Also, severe foraminal shortening.  My symptoms began two months ago: aching back and shoulders; numbness in the hands, particularly in the fourth and fifth fingers; aching along the ulnar nerve path, elbow and wrists; weakness in the left triceps; weakness in the hands.  No real pain in the arms, but a sort of pulling at the elbows and fingers if I keep my forearms flexed at more than 90 degrees.  After the course of steroids, I started PT.

PT has overall been effective.  My grip is strong now; most of my arm muscles are strong.  However, I continue to worry that the diagnosis is not correct.  I mean, the MRI supports cervical radiculopathy, but tricep weakness in the left arm doesn't match the C5-C6 nerve root problems on that side.  The PT thinks the weakness is a 4+ on the left side, so not bad.  But it hasn't improved in the last couple of weeks, maybe become a little worse.  The other thing that is odd is the overlapping ulnar nerve/carpal tunnel symptoms.  I can get relief in these areas by doing chin tucks and lateral neck stretches, but I'm wary of diagnoses of radiculopathy, ulnar compression and carpal tunnel: the last two are bilateral sometimes. Such a bundle of diagnoses could signal some other, more systemic problem, I think.  Could these issues all be related to nerve compression at the shoulders?  Neck?

My neurologist described the most recent clinical exam as totally clean except for ulnar compression and carpal tunnel.  He's recommended that I continue with PT and wear wrist/ elbow braces at night. 

The triceps weakness bothers me.  It's slight and I don't notice it in daily life (unlike the ulnar pull which does make it tough to hold plates or the phone).  Do I need to see a neurosurgeon?  Should I wait until the triceps weakness becomes more significant?  Continue to work with the PT?  

Any thoughts on what I can do with the ulnar issue?  Do other folks here experience ulnar nerve issues over top of their radiculopathies?  What treatment have you gotten for those issues?

I'd appreciate any of your thoughts.   


  • SavageSavage United StatesPosts: 4,299
    edited 07/23/2019 - 1:08 PM
    hello felixa7 !
    reminder......there are no medical professionals here on discussion forums.

    curious if you asked your neurologist about getting opinion from surgeon? ...and what his opinions are at this point.

    Welcome to Veritas Health Forumplease click on link for helpful information!
  • Thanks.  Yes, I've consulted with a neurosurgeon.  He just brushed off the fact that the weakness in the tricep didn't match the specific nerve root that the MRI identified as pinched.  He just said that I should do PT for a few months and then discuss a steroid injection to the spine or surgery if things have not improved.  Thanks!
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  • Felix
    I have been diagnosed with Cervical Radiculopathy and Ulnar Nerve Neuropathy from an EMG. I have 2 discs herniated and pushing on spinal cord at C4-6 levels and an scheduled for ACDF in March.
    I was concerned the ulnar nerve problem was a separate issue and need to be addressed. But I was told it wasn't a concern, and that my cervical nerves are all irritated and inflamed causing symptoms of numbness and weakness in the pinky, 4th, and middle finger and hand (along with index and thumb). My symptoms aren't "textbook" for my cervical herniations and I guess I won't know if my ulnar issue resolved until after surgery and healing.
    I have not received treatment for the ulnar problem, just told to wrap my arm in a towel at night to keep my arm straight. I have received cervical injections, no physical therapy.
  • FelixA7FFelixA7 Posts: 5
    edited 02/01/2017 - 5:10 PM
    Thanks for the input, Daisy Flower.  That sounds extremely similar to what I'm suffering from.  You wouldn't expect C4-6 to affect fourth and fifth fingers given that C8 seems to control them.  Hopefully the ACDF will settle down the symptoms in all parts of your arms.  Has PT been a complete failure?  How about Neurontin or other medications?  Anyone else have a similar overlay of ulnar symptoms with their cervical issues? 
  • Personal experience:
    I was suffering from chronic neck and upper back pain since 1.5 years,past 6 months i was waking overall shoulder blade ,neck and upper back pain, i did alot of exercise for it no use, suddenly i got an idea i just placed a BALL instead of pillow (place on neck not it head) on my neck for support miracle next day i experienced a lot of improvement in pain now i following this since 1 week my wake pain almost gone now, thank god....

    Try it and share your experience
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  • Hi Felix,

    We seem to have some similarity in our symptoms!  My MRI shows multilevel spondylitic changes including lots of spurring and C6-C7 "mild" spinal canal stenosis with neural foraminal stenosis left and right, but the symptoms sure do not feel mild!  My neck is constantly stiff and painful and I get a sensation of pressure/lump in the back of my throat. I've been to a couple of ENTs about this so-called "globus" sensation and they can't find anything wrong; both say my symptoms are most likely related to the cervical issues.  I also asked my spine doctor why I feel so much pain and stiffness if my MRI only indicates "mild" issues.  He said that the MRI often does not tell the whole story, and instead it is really just another tool to help flesh out the complete clinical picture.      

    For the past year I have been able to deal with the neck pain, but I started having arm issues about six months ago.  It started out very mild, and I thought that I must have carpal and/or cubital tunnel syndrome since my symptoms (aching and stiffness on the top side of my elbows, forearms, wrists and fingers)  would always get worse while sitting for long periods at my desk or whenever my arms were bent at 90 degrees or greater.  However, I recently had NCV/EMG tests that did not show any type of ulnar nerve entrapment.  That test also ruled out some truly scary stuff such as ALS or another type of motor-neuron disease.  My triceps and biceps get tired much more quickly now as well.  I have been an avid weight-lifter for many years, and while I have not lost strength I do fatigue much more quickly.  It is very frustrating and I have had to cut way back on exercise as a result. 

    To date, I have had multiple courses of PT and 4 RFA procedures covering C2-C7 bilaterally with mixed results.  In a couple weeks I we will be trying a corticosteroid injection at C6-C7 to see if it might calm things down.  If that doesn't help, I'm not sure where to go next.  I guess I will have to wait and see.  I do have a bad feeling that I am heading toward surgery in the future if my symptoms continue to worsen.    

  • Bruce EitmanBruce Eitman Akron, OH, USAPosts: 1,340

    I have found that sitting down with a spine specialist and going over the MRI images (not the written report) can be very enlightening.  So if you haven't done that, you should.  My surgeon's nurse PR practitioner actually did the best job - because she could spend time going over it fully.
  • Motor1MMotor1 Pittsburgh, PaPosts: 593
    When I first got injured at work, I was complaining of neck pain & left shoulder pain & pain going down my left arm. 
    I was told, after many X-rays & MRI's, that all my symptoms were coming from my C 4-5 herniation. I ended up having  2 neck surgeries. But my shoulder & arm pain was increasing. I couldn't sleep at night. 
    I found a new sports medicine doctor & he ordered some tests. Turns out I had a full rotator cuff tear. I had surgery for that & went through PT for almost a year. I was still having pain in my tricep & elbow. My doctor did a couple more tests & EMG. He then says I have ulnar nerve entrapment. And bicep tendinitis. I was given a big clunky brace to wear on my elbow at night. It was so uncomfortable to sleep in. I ended up wrapping my elbow in a towel at night. I was also told not to lean on my elbow or keep it bent. 
    I have no strength in my left arm now. He offered me surgery for the ulnar nerve, but I declined it. I've already had 3 surgeries from this injury. 
    Have you thought about getting a second opinion? 

  • Felix-
    I never had any PT. In fact I was told to STOP yoga. DR said if the steroid injections didn't work, then PT would probably not help either. I am on Lyrica, it does help some, but I haven't been able to increase my dose because it makes me dizzy.
    My EMG did show C7 radiculopathy, but my MRI does not show an issue there. I guess when I have my surgery, they will see if there is indeed a problem there too? I hope not.
  • Felix,
    As with others who have posted I have endured similar pain. After having an MRI which revealed C3-4 stenosis moderate - severe and C5-6 mild to moderate I consulted with a neurosurgeon. My problem was that the pain mostly radiating from the neck to the right tricep and it was excruciating. However, the MRI revealed most of the problem on the left side with severe neural foraminal narrowing along with the C3-4 problems. Dr could not quite figure why pain was so prevalent on the right side so I had pin prick nerve test on the left side which did not reveal much other than some carpal tunnel problems, yet the right side was the problem.

    Only within the last month did the pain begin to increase to the left side making it quite impossible to get a good night's rest. My triceps on both arms ache constantly as I have dealt with considerable weakness in both arms. Recently I have had issues with carpal tunnel syndrome in right hand, but have also experienced pain in fourth and fifth fingers which is usually not associated with cts. Still trying to figure all this out as well.

    Most recently stopped taking high doses of tylenol and muscle relaxants as I just did not feel well when taking them. Instead I began to take herbal capsules (tumeric and valerian) and for some reason pain has greatly decreased thankfully. 

    The neurosurgeon had stated that surgery was an option at my last appointment a month ago, but she wanted to find out why the pain was more intense on the right side. I have not had any treatment for any of the above symptoms and am not comfortable with any type of medication which inhibits my mental capacity as I teach. So I can sympathize with the confusion. 
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