C5-6 radiculopathy occurs when the cervical (neck) nerve roots at the C5 and C6 levels are irritated or compressed as they exit between the C5–C6 vertebrae. These nerve roots connect to nerves and muscles of the shoulder, arm, and upper thoracic areas. Patterns of nerve innervation called dermatome and myotome charts describe the route a nerve from the neck takes to provide sensation and muscle function to a specific area of the body. In classic dermatome/myotome charts, C5 irritation tends to refer pain to the inner border of the scapula and outer upper arm, while C6 commonly produces radicular pain into the outer forearm and thumb region. Although classic dermatomal descriptions and images focus on patterns in the arm and shoulder areas, studies show that cervical radiculopathy can also produce pain in the periscapular and medial scapular border regions. This is especially true with C5 and C6 nerve involvement, and notably scapular pain often precedes arm pain in these conditions.
Conservative management including physical therapy is recommended for most cases of C5-6 radiculopathy without significant neurological deficits. This typically includes a structured course of physical therapy focused on cervical stabilization, postural stretching and exercise, and gentle hands-on mobilization to reduce nerve root irritation and improve spinal mechanics. Additional conservative measures may include short-term activity modification, anti-inflammatory modalities, and home exercises emphasizing neck and scapular posture. This is because forward head and rounded shoulder posture increases mechanical stress on the lower cervical spine and can perpetuate nerve irritation if left unaddressed. Improving postural awareness, strengthening deep cervical flexor muscles, and balancing periscapular musculature support can reduce radicular symptoms and improve functional outcomes as well.
Rubinstein SM, Pool JJM, van Tulder MW, Riphagen II, de Vet HCW. A systematic review of pain referral patterns in cervical radiculopathy: Scapular and arm distribution. North American Spine Society Journal. 2024;18:100279.
Boyles RE, Toy P, Mellon J, Hayes M, Hammer B. Effectiveness of manual physical therapy in the treatment of cervical radiculopathy: A systematic review. Journal of Manual & Manipulative Therapy. 2011;19(3):135–142.