C5–C6 Radiculopathy or Rotator Cuff? How to Tell from Home

The nerves that power and feel the shoulder leave the spinal cord in the lower neck. When one of these roots is pinched or irritated—most commonly C5 or C6—pain can be felt at the deltoid, outer arm, or down toward the thumb and index finger, easily mimicking a rotator cuff injury. Rotator cuff pain, by contrast, usually lives in the lateral shoulder and upper arm, worsens with overhead use, and does not cause hand symptoms or clear neurologic changes. Getting this distinction right matters: the exercises, medications, and timelines are different for each. ^[1]

• Pain map: neck and lateral shoulder pain that may radiate below the elbow; C6 patterns often reach the thumb and index finger.
• Neurologic hints: numbness/tingling, reduced reflexes (biceps for C5–C6), and true weakness—for example, trouble with shoulder abduction (C5/deltoid) or elbow flexion and wrist extension (C6/biceps/wrist extensors).
• Relief sign: resting the hand on top of the head (the shoulder-abduction relief sign) may decrease pain or tingling.
• Provocation sign: Spurling (turn head to the painful side, gently extend, apply axial load) increases arm pain/paresthesia. Use only if symptoms are familiar and not severe. ^{[2] [3]}

• Pain map: lateral shoulder/upper arm—often a “deltoid-region” ache—without hand symptoms.
• Use-linked pain: worse with reaching overhead, lifting, sleeping on that side, or repetitive shoulder elevation; sharp pain arcs between ~60–120° of abduction.
• Strength profile: pain-limited elevation or external rotation; true neurologic deficits are absent.
• Positional tests: cuff-provocation tests reproduce local shoulder pain, not radiating hand symptoms. Current guidelines emphasize that history and function beat any single special test. ^[4]

Quick memory hook: Neck problems add nerves (numbness, reflex changes, hand symptoms); rotator cuff problems add load (overhead use, night pain on that side).

1. Arm Squeeze Test (takes 5 seconds)

   Using your opposite hand, squeeze the middle third of the painful upper arm (over the brachial muscles), then squeeze the acromion area and the forearm with similar pressure. If the mid-arm squeeze is markedly more painful (≥3/10 points more) than the other sites, studies suggest a neck source is more likely than a primary shoulder disorder. This is especially helpful when the diagnosis is unclear. ^[1]

2. Shoulder-abduction relief sign

   Gently rest the hand of the painful side on top of your head. Less arm pain/tingling favors C5–C6 radicular pain. If it worsens the pain, stop. ^[2]

3. Spurling (do not force it)

   Sit tall, turn head toward the painful side, gently extend, and apply very light downward pressure with your own hand. Reproduction of familiar arm symptoms (not just neck pressure) supports radicular irritation. Because evidence shows high specificity and lower sensitivity, a positive result helps confirm, but a negative does not rule it out. If symptoms are severe/new, skip this and see a clinician. ^[3]

4. Painful arc and external-rotation check

   Slowly lift the arm to the side. A sharp painful window mid-range that eases past it, or pain/weakness with external rotation against gentle resistance, leans toward rotator cuff involvement. Follow up with a clinician for confirmation and a plan. ^[4]

• Progressive weakness of elbow flexion or wrist extension, hand clumsiness, or worsening numbness.
• Severe unremitting pain, fever, unexplained weight loss, or night pain that does not vary with position.
• Trauma with suspected fracture or dislocation.
• New severe headache, double vision, or neurologic deficits beyond the arm.

These are not typical of straightforward rotator cuff pain or uncomplicated radiculopathy and require urgent assessment. ^[1]

Causes. Age-related disc changes and uncovertebral or facet joint overgrowth can narrow the foramen where C5 or C6 roots exit, or an acute disc protrusion can inflame a root. The result is neck-to-arm pain, sensory change, and myotomal weakness. Most cases improve without surgery. First-line care: activity modification, short courses of anti-inflammatories if safe, and targeted physical therapy (cervical and scapular strengthening, nerve-glide exposure, and posture work). Select patients benefit from traction; imaging or injections are reserved for persistent deficits or red flags. ^[1]

What recovery looks like. Many people improve over weeks to a few months, as inflammation settles and capacity returns. Clear strength loss or progressive neurologic deficit warrants earlier imaging and specialist review. ^[1]

Causes. Repetitive elevation, deconditioning of the rotator cuff and scapular muscles, and workload spikes can irritate the tendon and subacromial space. Modern guidelines favor active rehabilitation (motor control + progressive resistance), education on load management, and short-term pain relief methods to support training. Injections may reduce pain short term, but lasting recovery comes from strength and capacity gains. Full-thickness traumatic tears or failure of months of rehabilitation may need surgical opinions. ^[4]

• Calm the flare, then move. Short course of a doctor-approved anti-inflammatory or topical gel, plus gentle neck mobility (pain-free range), scapular setting, and deep neck flexor activation (chin-tuck holds 5–7 seconds × 8–10).
• Decompress your day. Screen at eye level, elbows supported, frequent posture resets; avoid prolonged end-range neck positions.
• Graded nerve exposure. Under therapist guidance, median/open-chain nerve glides can desensitize the system without provoking symptoms.
• Traction as an option. Supervised mechanical traction can help some people; evidence supports it as part of a multi-modal program rather than a stand-alone fix.
• Running or gym? Keep cardio with upright posture; avoid heavy overhead pressing until arm pain/weakness calms. ^[6]

• Modify—but do not immobilize. Temporarily avoid painful overhead work and heavy out-to-the-side lifts; keep pain ≤3/10 during and after.
• Strengthen what matters.
  • External rotation (band at side), scaption raises to shoulder height, rowing for scapular control, and isometric external rotation for pain relief.
  • Progress to elevation with load only when pain is calm and motion quality is good.
• Night strategy. Sleep on the opposite side with a pillow supporting the painful arm, or supine with a small towel under the upper arm.
• Short-term help. Topical anti-inflammatory gels; a single subacromial corticosteroid injection may help stubborn pain—best used to enable rehabilitation, not replace it. ^[4]

Desk-bound posture and deconditioned scapular muscles can make neck and shoulder structures irritable together. In this case:

• Start with cervical-scapular control (chin-tucks, low-load rows) while keeping rotator cuff work pain-limited.
• Use the arm squeeze and symptom map daily to see which driver is louder; increase that program and hold the other at maintenance levels for a week.
• If hand symptoms or strength loss grow, prioritize the neck and seek a clinician’s exam sooner. ^[5]

• History + exam remain the core. For radiculopathy, clinicians look for dermatomal sensory changes, myotomal weakness, and reflex asymmetry; for rotator cuff, they assess painful elevation, external rotation strength, and scapular control. No single test rules in or out either condition—combinations and patterns matter. ^[1]
• Electrodiagnostics are useful only if the diagnosis is unclear (for example, to separate radiculopathy from peripheral nerve entrapments). ^[2]
• Imaging:
  • Cervical spine MRI is considered when neurologic deficits persist, pain is severe >6 weeks, or red flags exist.
  • Shoulder ultrasound or MRI is reserved for trauma, suspected full-thickness tear, or rehab-refractory pain after a solid trial. (Many painless “tears” exist on imaging; treat the person, not the picture.) ^[2]

Can a neck problem cause shoulder blade pain without arm tingling?

Yes. C5–C6 roots can refer to the periscapular and lateral shoulder region even before hand symptoms appear. Look for neck-position sensitivity and the arm squeeze or abduction-relief signs to tip the scale toward a neck source. ^[3]

Is Spurling safe to try at home?

If your symptoms are mild and familiar, a gentle self-applied version can add information. Because the test is specific but not sensitive, a negative does not rule out radiculopathy; if symptoms are new, severe, or worsening, skip it and see a clinician. ^[3]

How long until I feel better?

Uncomplicated radiculopathy often improves over weeks to a few months with non-surgical care; rotator cuff pain typically improves over 6–12 weeks of progressive strengthening and load management. Plateaus signal it is time to re-evaluate your plan (and your form). ^[6]

When should I see an orthopedist or spine specialist?

If you notice progressive weakness, worsening numbness, night pain not changing with position, or failure of a well-done 6–8 week program, specialist input is smart. Sudden traumatic weakness after a fall merits earlier imaging. ^[6]

Days 1–3 — Calm and clarify

• Use the arm squeeze and pain map to choose a starting lane (neck vs shoulder).
• Keep daily activities below a 3/10 pain during and the day after.
• For neck-dominant patterns: heat 10 min → chin-tuck holds 8–10 reps → gentle scapular sets 10 reps.
• For cuff-dominant patterns: isometric external rotation (elbow at side) 3×30–45 s, rows 3×12, scaption to shoulder height 2×10.

Days 4–10 — Build capacity without flares

• Neck lane: add mid-range rotations, nerve-glide exposure under guidance, and daily posture blocks (screen at eye level, elbows supported).
• Shoulder lane: progress to band external rotation 3×12–15, row progressions, and elevation with light load as pain allows. Keep sleep positions supported.

Days 11–14 — Re-load life

• Neck lane: resume light overhead tasks; keep overhead pressing off the menu until arm symptoms are quiet.
• Shoulder lane: extend range and add controlled overhead work if pain is ≤3/10 and settles by next day.
• If pain spikes >5/10, or if hand symptoms appear/worsen, pause and get assessed.

• C5–C6 radiculopathy typically brings neck-to-arm pain, numbness/tingling, possible reflex and strength changes, and may ease with the shoulder-abduction relief sign; Spurling helps confirm when positive. ^[3]
• Rotator cuff problems cause lateral shoulder pain with overhead use and night pain on that side; neurologic signs are absent, and active rehabilitation drives recovery. ^[4]
• When in doubt, the Arm Squeeze Test is a simple differentiator that favors a neck source when positive. ^[5]
• Most cases improve without surgery when you match the fix to the true source—and keep load smart and strength consistent. ^[6]

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