The arm hurts. The neck decides: Cervical root pain as a mechanical decision problem

Arm pain of cervical origin is usually taught through four dermatomal maps. This educational analysis argues that the map is only the starting hypothesis. In a study of 66 patients with cervical radicular pain, 69.7% had pain that did not stay within the dermatome of the involved root (Murphy et al., 2009). Three further bodies of evidence turn the examination into a mechanical decision: foraminal area changes measurably with neck position; a four-test cluster shifts the probability of radiculopathy, with an independent validation published in 2026; and common exercises can each be read as a force vector with a dose and a stop rule. The analysis closes with a five-step sequence for clinicians (screen, localise, test, choose the vector, dose and re-test), set against population base rates for recovery, recurrence and surgery.

Published in Zenodo (CERN European Organization for Nuclear Research). The abstract is shown as published and remains the work of its authors; read the full article at the source.

doi.org/10.5281/zenodo.23060475