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A - MSRA MSK [11] > [13] Radiculopathy > Flashcards

[13] Radiculopathy Flashcards

1
Q

What is a radiculopathy?

A

A conduction block in the axons of a spinal nerve or its roots

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2
Q

What does the impact of radiculopathy on motor axons cause?

A

Weakness

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3
Q

What does the impact of radiculopathy on sensory neurones cause?

A

Paresthesia and/or anaesthesia

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4
Q

What is radicular pain?

A

Pain deriving from damage or irritation of the spinal nerve tissue, particularly the dorsal root ganglion

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5
Q

Is radiculopathy associated with radicular pain?

A

It may or may not be

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6
Q

Where do the anterior and posterior roots of the spinal nerves unite?

A

Within the intervertebral foramina

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7
Q

Where do the anterior and posterior roots of the spinal nerve originate from?

A

Both roots originate from the cord

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8
Q

What happens to the anterior and posterior roots of the spinal nerves once they have originated from the cord?

A

They pass to their appropriate intervertebral foramine, where each evaginates the dura mater separetely before uniting to form the mixed spinal nerve

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9
Q

What is radiuclopathy most commonly a result of?

A

Nerve compression

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10
Q

What can cause nerve compression?

A
  • Intervertebral disc prolapse
  • Degenerative diseases of spine
  • Fracture
  • Malignancy
  • Infection
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11
Q

What causes intervertebral disc prolapse?

A

Repeated minor stresses that predispose to rupture of the annulus fibrosis and sequesteration of the disc material (the nucleus pulposus)

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12
Q

Which region of the spine is predominantly affected by intervertebral disc prolapse?

A

The lumbar spine

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13
Q

How can degenerative diseases of the spine cause nerve compression?

A

It can lead to neuroforaminal or spinal canal stenosis

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14
Q

Which section of the spine is most likely to have degenerative changes?

A

Cervical spine - degenerative changes are a normal part of the ageing process

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15
Q

Why is the cervical spine the most susceptible to degenerative change?

A

Because it is the most mobile segment

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16
Q

What % of the population over 55 years old have degenerative change between C5/6 and C6/7?

A

80%

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17
Q

What kind of malignancy is most commonly found in the spine?

A

Most commonly metastatic

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18
Q

What infections can cause nerve compression?

A
  • Extradural abscesses
  • Osteomyelitis (most commonly TB)
  • Herpes Zoster
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19
Q

What are the clinical features of radiculopathy?

A
  • Sensory features, including paresthesia and numbness
  • Motor features, including weakness
  • Radicular pain
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20
Q

What is radicular pain typically described as?

A

Lancinating, burning, deep, strap-like, or narrow pain

It is not uncommon for radicular pain to be intermittent

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21
Q

Why should ‘red flag’ symptoms be asked for in patients presenting with suspected radiculopathy?

A

It may indicate emergency or sinister pathology

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22
Q

What is it important to identify on examination in radiculopathy?

A

Dermatomal and myotomy involvement

23
Q

What should be excluded on examination of radiculopathy?

A

Cauda equina syndrome

24
Q

How is cauda equina syndome assessed for on examination?

A
  • Pinprick sensation in the perianal dermatomes
  • Anocutaneous reflex
  • Anal tone
  • Rectal pressure sensation
25
Q

What will be found on assessment of the perianal dermatones in cauda equina syndrome?

A

Reduced

26
Q

What will be found on assessment of the anocutaneous reflex in cauda equina syndrome?

A

Diminished or absent

27
Q

What will be found on assessment of the anal tone in cauda equina syndrome?

A

Reduced

28
Q

What will be found on assessment of rectal pressure sensation in cauda equina syndrome?

A

Reduced

29
Q

What red flag symptoms are associated with cauda equina syndrome?

A
  • Faecal incontinence
  • Urinary retention (painless with secondary overflow incontinence)
  • Saddle anaesthesia
30
Q

What red flags are associated with infection in radiculopathy?

A
  • Immunosuppression
  • Intravenous drug abuse
  • Unexplained fever
31
Q

What red flag is associated with fracture or infection in radiculopathy?

A

Chronic steroid use

32
Q

What red flags are associated with fracture in radiculopathy?

A
  • Significant trauma
  • Osteoporosis or metabolic bone disease
33
Q

What red flag is associated with malignancy in radiculopathy?

A

New onset after 50 years old

34
Q

What red flag is associated with metastatic disease in radiculopathy?

A

History of malignancy

35
Q

What should the differential diagnosis for radicular pain include?

A

Pseudoradicular pain syndromes

36
Q

What are pseudoradicular pain syndromes?

A

Conditions that do not directly arise from nerve root dysfunction, but do cause radiating limb pain in an approximate radicular pattern

37
Q

What conditions do pseudoradicular pain syndromes include?

A
  • Referred pain
  • Myofascial pain
  • Thoracic outlet syndrome
  • Greater trochanteric bursitis
  • Iliotibial band syndrome
  • Meralgia paresthetica
  • Piriformis syndrome
38
Q

Give three examples of referred pain?

A
  • Into the arm from myocardial ischaemia
  • Into the right shoulder from hepatobiliary disdase
  • Into the flank, groin, or thigh from urinary tract and perinephric symptoms
39
Q

Give two examples of how myofascial pain can mimic radiculopathy

A
  • Hip muscles can mimic pain from lumbar radiculopathy
  • Shoulder girdle muscles can produce pain radiating into the upper extremity
40
Q

How can myofascial pain be differentiated from radicular pain?

A

Examine for tenderness at specific muscle sites which when palpated produce radiating pain

41
Q

What is thoracic outlet syndrome?

A

Compression or irritation of the stuctures between the base of the neck and axilla due to anatomical variations

42
Q

How can greater trochanteric bursitis be differentiated from radiculopathy?

A

Usually palpation will reveal the area of imflammation, typically over the superolateral aspect of the trochanter

43
Q

What causes illiotibial band syndrome?

A

Excessive friction between the iliotibila band and underlying bursa, often in long distance runners or cyclists

44
Q

What is iliotibial band syndrome often associated with?

A

Tightness of the iliotibial tract

45
Q

Where is the pain felt in iliotibial band syndrome?

A

2-3cm proximal to the knee joint

46
Q

What is meralgia paresthetica?

A

Compression of the lateral cutaneous nerve of the thigh as it passes under the inguinal ligament

47
Q

How does meralgia paresthetica present?

A

With a clearly demarcated area of paresthesia and/or numbness in the anterolateral aspect of the thigh

48
Q

What happens in piriformis syndrome?

A

Anatomic variations in either the muscle or the sciatic nerve can cause pain in the region of the sacroiliac joint or the sciatic notch

49
Q

What determines the definitive long-term management of radiculopathy?

A

The underlying cause

50
Q

Which of the conditions causing radiculopathy require emergency surgical treatment?

A

Cauda equina syndrome

51
Q

Can most IV disc prolapses be managed non-operatively?

A

Yes

52
Q

What are the indications for surgical treatment of IV disc prolapse?

A
  • Unremitting pain despite comprehensive non-surgical management
  • Progressive weakness
  • New or progressive myelopathy
53
Q

What analgesia is used in radiculopathy?

A

The WHO analgesic ladder can be utilised, however neuropathic pain medications are frequently utilised. Amitriptyline is usually first line, which may then be added to GABA antagonists such as pregabalin or gabapentil.

54
Q

How can muscle spasms that may be experienced by radiculopathy patients be managed?

A

With benzodiazepines and/or baclofen

A - MSRA MSK [11] (38 decks)

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