39 - Radiculopathy Flashcards
How many pairs of spinal nerves are there?
31 (8 cervical, 12 thoracic, 5 lumbar/sacral, 1 cocygeal)
What level does the spinal cord end?
ends at L1/L2 so do LP at L3/L4
What is the flow of structures after a neuron leaves the spinal cord?
rootlets > roots > MSN > anterior/posterior rami
Where are the roots and trunks of the brachial plexus with respect to teh clavicle?
supraclavitcular
Where are divisions of brachial plexus with respect to the clavicle?
divisions are retroclavicular
Where are cords and branches of the brachial plexus wrt clavicle?
infraclavicular
What are two most common etiologies of radiculopathies?
disk herniations and degenerations
Cervical: = herniated nucleus pulposus (C7>C6) OR spondylosis of C5+C6.
Lumbosacral = HNP at L5/S1
Patient hurts back and has radiculopathy affecting leg. Mother tells him to stay in bed and rest. You say?
momma don’t know shit. quit being a bitch. Avoid bed rest and be as routine as possible.
What is Spurling’s Maneuver?
??
What pattern of motor or sensory loss will you have with radiculopathies?
motor loss along myotomes
sensory loss along dermatomes
What will happen to muscle stretch reflexes in LMN disease?
decreased
What nerve levels are responsible for the anal wink? ;)
S2-S4
What is EDX testing? What is it good for?
asseses sensory nerves + muscle mfibers + myelination status + location + severity.
confirms clinical diagnosis from history and physical.
Not much good by itself though
What is a plexopathy?
LMN lesion in plexus of LMN and peripheral nerves
Ex: median N, ulnar N, radial n entrapment syndromes.
Patient complains of numbness and weakness of thumb, pointer finger, and half of the ring finger. What nerve?
Median nerve loss. Carpal tunnel
Patient has wrist drop. Where is lesion?
radial n. (axillary entrapment)
patient has foot drop. Where is lesion
fibular head (peroneal nerve)
Student has been studying at a desk for 22 hours nonstop with his elbows supporting weight. Where is he at risk for developing weakness/numbness?
medial elbow entrapment can compress the ulnar N., causing medial 1.5 digits and hypothenar/interosseous atrophy.
What is Charcot Marie Tooth Disease?
AD demyelinating disease AKA hereditary motor and sensory neuropathy type 1.
What is CMT disease type 1a?
deletion of myelin protein PMP on ch. 17
What is CMT disease type 1?
defect of protein 0 ch.1
What is PMP 22? What will a deficeincy of it cause?
a peripheral myelin protein involved in compaction of myelin on peripheral nerves.
Defects or deficiencies of it cause peripheral demyelinating neuropathies.
What is classic presentation of CMTD?
distal muscle weakness, atrophy of leg BELOW KNEES, orthopedic foot problems (HAMMER TOE/ARCH FEET)
What is diabetic nephropathy?
neuropathy secondary to hypoglycemia associated with DM. Can present as a mononeuroapthy, complex, polyneuropathy, truncal or diabetic amyotrophy.
What is LS plexus ischemia?
a diabetic amyotrophy
What is pathogenesis of DN?
Excess glucose converted to sorbitol via ALDOSE REDUCTASE.
cells like Schwann cells, retina, lens and kidney LACK sorbitol dehydrogenase and can not convert it to fructose so they get OSMOTIC DAMAGE.
What is guillain barre syndrome (GBS)?
acute autoimmune ascenidng paralysis and areflexia. May have normal sensation.
ALBUMINOCYTOLOGIC DISSOCIATION IN CSF.
usually 2 weeks after infection with campylobacter, EBC, CMV or mycoplasma
What are clinical findings of GBS?
progressive, symetrical, ASCENDING paralysis
acute and inflammatory radiculoneuropathy
INTACT sensory systems with mild paresthesia
Areflexia
What is treatment of GBS?
IV gamma glob to get rid of auto-antibodies
Steroids DO NOT work.
What is chronic inflammatory neuropathy?
autoimmune inflammatory neuropathy affecting myelin sheath
Segmental demyelination with signs of de/re-myelination
What is treatment for CIPD?
steroids, immunosuppressants, IV gamma globulin
What is clinical presentation of CIPD?
symmetrical distal paralysis with proximal features
NO CNS signs.
Severe Sensory loss of epicritic
INTACT pain/temperature
EMG shows denervation and conduction block
Areflexia
What spinal roots do not have sensory components?
C1 and Co1 have no sensory
What is clinical hallmark of radiculopathy?
pain that is radiating, stabbing or hot and aggravated by movement
What is most specific test for L5-S1 radiculopathy?
crossed-straight leg test
MRI or CT for spinal conditions?
MRI all day every day for radiculopathies
