Accurate clinical differentiation between true cervical radiculopathy and subscapularis-driven myogenic pseudo-radiculopathy is critical for preventing unnecessary surgical consultations, spinal injections, and procedural complications. In this sixth installment of his clinical series, Dr. Ken Kaufman examines the practical diagnostic criteria required to distinguish primary pain drivers from secondary structural incidental findings. True cervical radiculopathy involves genuine nerve-root compression, producing reproducible dermatomal sensory loss, true myotomal weakness, reflex abnormalities, and pain provoked by cervical loading. Conversely, subscapularis syndrome mimics nerve pain through diffuse, poorly localized upper-extremity discomfort, vague paresthesia, and muscle fatigue without objective neurological deficits. Symptoms typically fluctuate with shoulder mechanics, scapular dyskinesis, and repetitive loading rather than cervical movement. Clinicians must avoid relying strictly on spinal imaging, as asymptomatic disc bulges and degenerative foraminal changes are ubiquitous. Identifying subscapularis syndrome enables clinicians to implement targeted conservative interventions, including trigger-point therapy, active myofascial release, dry needling, joint manipulation, and progressive scapular stabilization exercises. By identifying the true neuromuscular generator rather than defaulting to spinal assumptions, practitioners protect patients from premature invasive interventions while establishing effective, individualized treatment pathways that optimize long-term clinical outcomes.