Cervical Radiculopathy vs. Muscle Spasm Pain: Complete Guide with Diagnosis & Assessment

Introduction

Neck pain can be tricky to diagnose because different conditions can mimic each other. Two of the most common causes are cervical radiculopathy and muscle spasm pain.
While both may cause discomfort and limit movement, their causes, symptoms, and treatments differ significantly.
This guide explains the differences, subjective and objective assessments, and differential diagnosis—helping healthcare providers and patients understand their condition better.

What is Cervical Radiculopathy?

Cervical radiculopathy occurs when a nerve root in the neck is compressed or irritated, most commonly at C6 or C7 levels.
Causes include herniated discs, cervical spondylosis, osteophyte formation, or foraminal narrowing.
Main Symptoms:

• Sharp, burning, or electric pain radiating into the arm

• Numbness or tingling following a dermatomal pattern

• Weakness in muscles supplied by the affected nerve root

• Pain worsens with neck extension, rotation, or Valsalva maneuver
  (AAFP, 2016, Orthobullets).

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What is Muscle Spasm Neck Pain?

Muscle spasm pain (non-specific cervicalgia or myofascial pain) results from tight, overworked, or injured neck muscles.
Common Triggers: poor posture, prolonged computer work, sudden awkward movements, stress, or repetitive strain.
Main Symptoms:

• Localized aching or stiffness in the neck and upper shoulders

• Tenderness on palpation of trapezius or paraspinal muscles

• Pain that does not radiate below the shoulder

• Symptoms improve with stretching, heat therapy, and posture correction
  (Medilex Inc).

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Key Differences: Cervical Radiculopathy vs Muscle Spasm Pain

Feature	Cervical Radiculopathy	Muscle Spasm Pain
Cause	Nerve root compression	Local muscle overuse or injury
Pain Pattern	Radiates down arm in dermatomal pattern	Localized to neck & shoulders
Neurological Signs	Sensory loss, reflex changes, weakness	None
Aggravated By	Neck extension, rotation, Valsalva	Prolonged posture, stress
Special Tests	Spurling’s, Shoulder Abduction Relief Test, ULTT	Negative nerve tests

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Subjective Assessment (History Taking)

Cervical Radiculopathy

• Radiating pain down the arm

• Numbness/tingling in specific dermatome

• Weakness in hand or arm muscles

• Pain worsens with specific neck positions

Muscle Spasm Pain

• Aching or stiffness localized to the neck

• Triggered by poor posture or overuse

• No neurological symptoms

• Pain relieved by stretching or massage

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Objective Assessment (Physical Examination)

For Cervical Radiculopathy

• Spurling’s Test: Pain reproduction confirms nerve compression

• Shoulder Abduction Test: Symptom relief suggests nerve root irritation

• Neurological Exam: Reflex changes, dermatomal sensory loss, muscle weakness

• ROM: Restricted due to nerve pain

For Muscle Spasm Pain

• Palpation: Local tenderness & tightness

• ROM: Reduced due to muscle tension, no nerve symptoms

• Neurological Exam: Normal

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Differential Diagnosis Checklist

For Cervical Radiculopathy:

• Cervical myelopathy

• Thoracic outlet syndrome

• Brachial plexopathy

• Rotator cuff tear

• Carpal tunnel syndrome

For Muscle Spasm Pain:

• Acute torticollis

• Cervical facet syndrome

• Myofascial pain syndrome

• Early cervical spondylosis without radiculopathy

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Diagnostic Tools

• MRI: Best for nerve root compression

• X-ray: Shows degenerative changes

• EMG/Nerve Conduction Study: For unclear or mixed presentations

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Conclusion

Understanding the differences between cervical radiculopathy and muscle spasm pain is essential for accurate diagnosis and effective treatment.
Radiculopathy involves nerve compression with neurological signs, while muscle spasm pain is localized and mechanical.
Accurate assessment—combining subjective history, objective testing, and imaging—ensures correct management.