C6 Dermatome Tingling: Understanding Cervical Herniated Disc Symptoms

27.07.202306.07.2023 by alexxlab

What are the signs and symptoms of a cervical herniated disc. How does a herniated disc in the neck affect different nerve roots. What treatment options are available for cervical disc herniation.

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The Anatomy of Cervical Disc Herniation

A cervical herniated disc occurs when the soft inner material of an intervertebral disc in the neck protrudes through the tough outer layer. This can lead to inflammation and compression of nearby nerve roots or the spinal cord, resulting in various symptoms.

The cervical spine consists of seven vertebrae, labeled C1 to C7. Between each pair of vertebrae lies an intervertebral disc, named after the vertebrae it separates. For instance, the C5-C6 disc is located between the C5 and C6 vertebrae.

How does a herniated disc affect surrounding structures?

When a disc herniates, it can impact nearby structures in several ways:

Nerve root compression: The protruding disc material may directly compress a nerve root, leading to radiating pain, numbness, or weakness.
Inflammation: The leaked disc material can cause inflammation of surrounding tissues, including nerve roots and the spinal cord.
Chemical irritation: Inflammatory proteins from the disc’s inner material can irritate nearby nerves, causing pain and other symptoms.

Common Signs and Symptoms of Cervical Disc Herniation

Cervical disc herniation can manifest through various symptoms, often affecting the neck, shoulders, arms, and hands. Here are some of the most common signs and symptoms:

Neck Pain

Neck pain is a primary symptom of cervical disc herniation. It typically occurs at the back or side of the neck and can range from mild tenderness to sharp, burning pain. The intensity of the pain may vary depending on the severity of the herniation and the affected structures.

Radicular Pain

Radicular pain refers to pain that radiates from the neck down into the shoulder, arm, hand, or fingers. This pain results from compression or irritation of a nerve root and often feels hot or electric shock-like. The specific pattern of pain distribution depends on which nerve root is affected.

Cervical Radiculopathy

Cervical radiculopathy involves numbness, weakness, or altered sensation that radiates from the neck into the upper extremities. It may occur alongside radicular pain or independently. The symptoms of radiculopathy follow the distribution of the affected nerve root.

Symptom Aggravation with Specific Activities

Pain and other symptoms associated with a cervical herniated disc often worsen during certain activities or head positions. These may include:

Sports or physical exertion
Lifting heavy objects
Twisting the neck to one side
Tilting the head forward

Neck Stiffness

The pain and inflammation caused by a cervical herniated disc can lead to neck stiffness and reduced range of motion. This stiffness may make it difficult to perform everyday activities or maintain certain head positions for extended periods.

Specific Nerve Root Involvement and Associated Symptoms

The location of the herniated disc determines which nerve root is affected, leading to specific patterns of pain and neurological deficits. Understanding these patterns can help in diagnosing and treating cervical disc herniation.

C4-C5 Disc Herniation (C5 Nerve Root)

When the C4-C5 disc herniates and affects the C5 nerve root, symptoms may include:

Pain, tingling, or numbness radiating into the shoulder
Weakness in the deltoid muscle and other shoulder muscles

C5-C6 Disc Herniation (C6 Nerve Root)

A herniation of the C5-C6 disc, one of the most common locations for cervical disc herniation, can lead to:

Pain, tingling, or numbness on the thumb side of the hand
Weakness in the biceps muscles
Weakness in the wrist extensor muscles

C6-C7 Disc Herniation (C7 Nerve Root)

The C6-C7 disc is considered the most likely to herniate in the cervical spine. Symptoms of a C6-C7 herniation may include:

Pain, tingling, or numbness radiating into the hand and middle finger
Weakness in the triceps muscles
Weakness in the finger extensor muscles

C7-T1 Disc Herniation (C8 Nerve Root)

A herniation at the C7-T1 level affecting the C8 nerve root can cause:

Pain, tingling, or numbness in the outer forearm and pinky side of the hand
Weakness in finger flexor muscles (affecting handgrip)

Diagnosing Cervical Disc Herniation

Accurate diagnosis of cervical disc herniation is crucial for effective treatment. The diagnostic process typically involves several steps:

Medical History and Physical Examination

A thorough medical history and physical examination are essential first steps in diagnosing cervical disc herniation. The healthcare provider will ask about symptoms, their onset, and any aggravating or relieving factors. The physical exam may include assessing neck range of motion, muscle strength, and sensation in the arms and hands.

Neurological Examination

A neurological exam helps identify specific nerve root involvement. This may include testing reflexes, muscle strength, and sensation in the upper extremities.

Imaging Studies

Various imaging techniques can be used to confirm the diagnosis and determine the extent of the herniation:

X-rays: While not able to show disc herniation directly, X-rays can rule out other conditions and show any degenerative changes in the spine.
MRI (Magnetic Resonance Imaging): This is the gold standard for diagnosing disc herniation, as it provides detailed images of soft tissues, including the intervertebral discs and nerve roots.
CT (Computed Tomography) scan: CT scans can provide detailed images of bone structures and may be used in conjunction with myelography to visualize nerve root compression.

Electromyography (EMG) and Nerve Conduction Studies

These tests can help confirm nerve root involvement and rule out other conditions that may cause similar symptoms, such as peripheral neuropathy.

Treatment Options for Cervical Disc Herniation

Treatment for cervical disc herniation typically begins with conservative measures and may progress to more invasive options if symptoms persist or worsen.

Conservative Treatment

Most cases of cervical disc herniation respond well to conservative treatment, which may include:

Rest and activity modification
Physical therapy and exercises
Pain medications (over-the-counter or prescription)
Ice and heat therapy
Cervical traction
Cervical collar (for short-term use)

Injection Therapies

If conservative measures do not provide sufficient relief, injection therapies may be considered:

Epidural steroid injections: These can help reduce inflammation and pain around the affected nerve root.
Nerve root blocks: These can provide diagnostic information and temporary pain relief.

Surgical Intervention

Surgery may be recommended in cases of persistent pain, progressive neurological deficits, or severe symptoms. Surgical options include:

Anterior cervical discectomy and fusion (ACDF)
Artificial disc replacement
Posterior cervical foraminotomy

Preventing Cervical Disc Herniation

While not all cases of cervical disc herniation can be prevented, certain measures may help reduce the risk:

Maintaining good posture, especially during prolonged sitting or computer use
Regular exercise to strengthen neck and core muscles
Using proper lifting techniques
Taking frequent breaks and stretching during repetitive activities
Quitting smoking, as it can contribute to disc degeneration

Long-term Outlook and Management

The prognosis for cervical disc herniation is generally favorable, with many patients experiencing significant improvement with conservative treatment. However, some individuals may require ongoing management or surgical intervention.

Factors Affecting Prognosis

Several factors can influence the long-term outlook for patients with cervical disc herniation:

Age and overall health
Severity and duration of symptoms
Presence of other spinal conditions
Compliance with treatment recommendations
Lifestyle factors (e.g., smoking, obesity)

Ongoing Management Strategies

Even after successful treatment, ongoing management may be necessary to prevent recurrence and maintain spinal health:

Regular exercise and stretching routines
Ergonomic adjustments at work and home
Periodic follow-up with healthcare providers
Stress management techniques
Maintaining a healthy weight

Understanding the signs, symptoms, and treatment options for cervical disc herniation is crucial for early intervention and optimal outcomes. By recognizing the specific patterns of pain and neurological deficits associated with different nerve root involvement, patients and healthcare providers can work together to develop effective management strategies. Whether through conservative measures or surgical intervention, most individuals with cervical disc herniation can expect significant improvement in their symptoms and quality of life.

Cervical Herniated Disc Signs and Symptoms

When a cervical disc herniates, its soft inner material and inflammatory proteins start to leak into the protective outer layer and possibly into the spinal column. A herniated disc commonly causes a sharp or shock-like pain in the neck and/or arm by inflaming or compressing a nearby nerve root. Other nearby structures, such as the spinal cord, may also become inflamed and painful.

Watch: Cervical Spine Anatomy Video

A cervical herniated disc can cause pain that radiates throughout the neck, shoulders, arms, and hands. Watch: Cervical Radiculopathy Interactive Video

Some common signs and symptoms of a cervical herniated disc include:

Neck pain. This pain is typically felt toward the back or side of the neck. It can range from a mild pain that feels tender when touched to a sharp or burning pain.
See All About Neck Pain
Radicular pain. This pain can radiate from a pinched nerve in the neck down through the shoulder, arm, hand, and/or fingers. It can sometimes feel hot or electric shock-like.
See Radiculopathy, Radiculitis and Radicular Pain
Cervical radiculopathy. A pinched nerve or nerve root inflammation may also cause numbness and/or weakness to radiate down into the shoulder, arm, hand, and/or fingers. Radicular pain may also accompany radiculopathy in some instances.
See Cervical Radiculopathy from a Herniated Cervical Disc
Symptoms worsen with specific head positions or activities. A herniated disc’s pain tends to flare-up and feel worse during activities, such while playing a sport or lifting a heavy weight. Certain head positions—such as twisting to one side or tilting the head forward—may also worsen the pain.
Neck stiffness. Pain and inflammation from a cervical herniated disc may restrict certain neck movements and reduce range of motion.
See Stiff Neck Causes, Symptoms, and Treatment

The specific pain patterns and neurological deficits are largely determined by the location of the herniated disc.

Typical pain areas for cervical disc herniation. Symptoms vary depending on which nerve root is compressed.

The cervical spine contains 7 vertebrae stacked atop each other, labeled C1 down to C7. The intervertebral discs are located between adjacent vertebral bodies. For example, the C5-C6 disc sits between the C5 and C6 vertebrae. If the C5-C6 disc herniates, it can compress a C6 nerve root. The signs and symptoms caused by a cervical herniated disc can vary depending on which nerve root is compressed. For example:

C4-C5 (C5 nerve root): Pain, tingling, and/or numbness may radiate into the shoulder. Weakness may also be felt in the shoulder (deltoid muscle) and other muscles.
See All About the C2-C5 Spinal Motion Segments
C5-C6 (C6 nerve root): Pain, tingling, and/or numbness may be felt in the thumb side of the hand. Weakness may also be experienced in the biceps (muscles in the front of the upper arms) and wrist extensor muscles in the forearms. The C5-C6 disc is one of the most common to herniate.
¹
Rainville J, et al. Comparison of symptoms from C6 and C7 radiculopathy. Spine (Phila Pa 1976). 2017; 42(20):1545-51. doi: 10.1097/BRS.0000000000002353.
See C5-C6 Treatment
C6-C7 (C7 nerve root): Pain, tingling, and/or numbness may radiate into the hand and middle finger. Weakness may also be felt in the triceps (muscles in the back of the upper arm), finger extensors, and other muscles. The C6-C7 disc is commonly considered the most likely to herniate in the cervical spine.
¹
Rainville J, et al. Comparison of symptoms from C6 and C7 radiculopathy. Spine (Phila Pa 1976). 2017; 42(20):1545-51. doi: 10.1097/BRS.0000000000002353.
See All About the C6-C7 Spinal Motion Segment
C7-T1 (C8 nerve root): Pain, tingling, and/or numbness may be felt in the outer forearm and pinky side of the hand. Weakness may also be experienced in finger flexors (handgrip) and other muscles.
See All About the C7-T1 Spinal Segment (Cervicothoracic Junction)

These are typical pain patterns associated with a cervical disc herniation, but they are not absolute. Some people are simply wired differently than others, and therefore their arm pain and other symptoms will be different.

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Cervical Radiculopathy Symptoms | Spine-health

Cervical radiculopathy signs and symptoms typically include pins-and-needles tingling, numbness, and/or weakness in the areas served by the affected nerve root. In addition to these neurological deficits, pain is also present in most cases. These signs and symptoms may be felt in one area only, such as the shoulder, or progress along the entire arm and into the hand and fingers.

Cervical radiculopathy is caused when a nerve root in the cervical spine becomes inflamed or damaged, resulting in neurological deficits (and commonly pain) radiating down the arm and/or hand. Read Understanding Hand Pain and Numbness

Cervical radiculopathy signs and symptoms are most commonly on just one side of the body, but they can be on both sides. If neurological deficits become severe or go into the hand, they can reduce the ability to perform many routine tasks, such as gripping or lifting objects, writing, typing, or getting dressed.

See What Causes Hand Pain and Numbness?

Neurological Deficits in Cervical Radiculopathy

Cervical radiculopathy involves one or more of the following neurological deficits that may be experienced in the neck, shoulder, arm, hand, and/or fingers:

Sensory. Feelings of numbness or reduced sensation in the skin. There may also be tingling, electrical sensations.
Motor. Weakness or reduced coordination in one or more muscles.
Reflex. Changes in the body’s involuntary (automatic) reflex responses. Some examples may include diminished ability to respond when the skin touches hot or cold, or possibly a reduced triceps or biceps reflex when the elbow is tapped by a rubber hammer during an exam.

See Could That Shoulder Pain Really Stem From the Neck?

Cervical nerve roots are comprised of both motor and sensory fibers. Whether cervical radiculopathy signs involve diminished motor movement or sensation (or both) depends on which fibers are damaged by the radiculopathy.

How Pain May Feel with Cervical Radiculopathy

Cervical radiculopathy is typically accompanied by some form of radicular pain, but not always. In cases where cervical radiculopathy involves pain, it can range anywhere from a dull, general discomfort or achiness to a sharp, shock-like or burning pain. Cervical radicular pain may be felt anywhere from neck all the way down the arm into the fingers.

See Radiculopathy, Radiculitis and Radicular Pain

While a radiculopathy is commonly accompanied by radicular pain, the two are not the same. A radiculopathy involves a neurological deficit, whereas radicular pain can occur without a neurological deficit. It is possible to have cervical radiculopathy with little to no pain in the neck and/or arm, but most cases do involve pain in addition to the neurological deficits.

Cervical radiculopathy signs and symptoms differ depending on which nerve root is affected. For example, C6 radiculopathy occurs when the nerve root that runs above the C6 vertebra is affected.

See Cervical Spinal Nerves

While any patient’s specific signs and symptoms can vary widely and do not always follow a predictable pattern,

¹
McAnany SJ, Rhee JM, Baird EO, et al. Observed patterns of cervical radiculopathy: how often do they differ from a standard, "Netter diagram" distribution? Spine J. 2018. pii: S1529-9430(18)31090-8.
the following are common descriptions for how cervical radiculopathy may differ by location:

The location of cervical radiculopathy symptoms will vary depending on which nerve root is affected.

C5 radiculopathy. Tingling, numbness, and/or pain may go from the neck into the shoulder and/or down the arm and into the thumb. Weakness may be experienced in the shoulder or upper arm.
C6 radiculopathy. Tingling, numbness, and/or pain may radiate through the arm and into the second digit (index finger). Weakness may occur in the front of the upper arm (biceps) or wrist.
See All About the C5-C6 Spinal Motion Segment
C7 radiculopathy. Tingling, numbness, and/or pain may be felt down the arm and into the middle finger. Weakness may be experienced in the back of the upper arm (triceps).
Watch Spinal Motion Segment: C6-C7 Animation
C8 radiculopathy. Tingling, numbness, and/or pain may radiate down the arm and into the little finger. Handgrip strength may be reduced.
See All About the C7-T1 Spinal Segment (Cervicothoracic Junction)

Less commonly, cervical radiculopathy can occur higher in the cervical spine, such as C4 radiculopathy or higher. While rare, it is also possible to have nerve compression or inflammation at multiple levels of the cervical spine at the same time, resulting in multiple radiculopathies.

Sometimes cervical radiculopathy signs and symptoms flare up with certain activities, such as bending the neck forward to peer at a mobile phone or laptop screen for long periods, and will resolve when the neck is supported and at rest. For others, signs and symptoms may become persistent and do not resolve when the neck is in a supported, resting position.

Dr.