A Cross-Check Framework for Radicular Versus Peripheral Nerve Pain

The framework compares sensory, motor, reflex and provocation findings to find features that only fit a root or only fit a peripheral nerve. The median and ulnar nerves supply no skin above the wrist, so forearm symptoms point toward a root. The radial nerve does not supply the palm. Using innervation charts such as Sonoo's, Andy tests muscles supplied by the suspected root but not the nerve: pronator teres and flexor carpi radialis for C7 versus radial, brachioradialis and extensor carpi radialis for radial versus C7. The LOAF muscles, the lateral two lumbricals, opponens pollicis, abductor pollicis brevis and flexor pollicis brevis, are supplied by C8 and T1 through the median nerve and help separate median, ulnar and C8-T1 problems. The biceps and brachioradialis reflexes share roots but not nerves. Neurodynamic tests confirm a neural source, and interface tests locate it: Tinel, Phalen and Durkan tests, the rule of nine, the elbow internal rotation test, Wainner's cluster, Spurling's and the arm squeeze test. In irritable patients, symptom-easing tests such as cervical distraction are preferred.