Ch 5 - EDX: Radiculopathy Flashcards

1
Q

What is a Radiculopathy?

A

Pathologic process affecting the nerves at the root level

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2
Q

What is the presentation of Radiculopathy?

A

Pure sensory > sensorimotor complaints> pure motor complaints

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3
Q

Why are sensory complaints MC in Radiculopathy?

A

Larger size of sensory fibers rendering more prone to injury

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4
Q

Describe NCS of Radiculopathy.

A

Typically normal due to sparing of DRG

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5
Q

What is the MCC of radiculopathy <50 yo?

A

Herniated nucleus pulposus (HNP)

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6
Q

What is the MCC of radiculopathy >50 yo?

A

Spinal stenosis

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7
Q

What are uncommon causes of radiculopathy?

A

“Hi Madam”
H—Herpes zoster
I—Inflammatory: TB, Lyme disease, HIV, syphilis, cryptococcus, and sarcoidosis
M—Metastasis
A—Arachnoiditis: Myelogram, surgery, steroids, and anesthesia
D—Diabetes mellitus
A—Abscess
M—Mass: Meningioma, neurofibroma, leukemia, lipoma, cysts, and hematoma

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8
Q

What is the clinic presentation of a C5 radiculopathy?

A

Reduced reflex: Biceps
Weakness: Elbow flexion
Numbness: lateral arm

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9
Q

What is the clinic presentation of a C6 radiculopathy?

A

Reduced reflex: Brachioradialis
Weakness: Elbow flexion
Numbness: lateral arm

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10
Q

What is the clinic presentation of a C7 radiculopathy?

A

Reduced reflex: Triceps
Weakness: Elbow extension
Numbness: middle finger

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11
Q

What is the clinic presentation of a C8 radiculopathy?

A

Reduced reflex: None
Weakness: Finger flexion
Numbness: medial forearm

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12
Q

What is the clinic presentation of a T1 radiculopathy?

A

Reduced reflex: None
Weakness: Finger abduction
Numbness: medial elbow

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13
Q

What is the clinic presentation of a L4 radiculopathy?

A

Reduced reflex: Patellar tendon
Weakness: Knee extension
Numbness: Anterolateral thigh/medial ankle

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14
Q

What is the clinic presentation of a L5 radiculopathy?

A

Reduced reflex: Lateral hamstring
Weakness: Hallux extension
Numbness: Posterolateral thigh/calf and dorsal foot

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15
Q

What is the clinic presentation of a S1 radiculopathy?

A

Reduced reflex: Achilles tendon
Weakness: Plantar flexion
Numbness: Posterior high/calf and lateral ankle

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16
Q

Describe the SNAP in Radiculopathy.

A

Normal if the lesion is located proximal to the DRG

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17
Q

Describe the CMAP in Radiculopathy.

A

Normal or reduced amplitude as lesion is distal to the motor neuron cell body.

Normal if the injury is purely demyelinating, incomplete, or reinnervation has occurred

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18
Q

Describe H-reflex in Radiculopathy.

A

Possibly abnormal in an S1 radiculopathy but not pathognomonic

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19
Q

Describe F-waves in Radiculopathy.

A

Not sensitive or specific for a radiculopathy. Muscles have more than one root innervation, which can result in a normal latency.

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20
Q

What are the optimal # of muscles to needle for EMG when screening for radiculopathy?

A

6 including paraspinals

If 1 is ABN, then more muscles should be evaluated

21
Q

What is found on EMG in Radiculopathy?

A

FIBs or PSWs should be found in two different muscles innervated by two different peripheral nerves originating from the same root

22
Q

When would radiculopathy not be found on EMG?

A

Lesion is demylinating, purely sensory, postreinnervation, or missed by random sampling

23
Q

What is the clinical finding of C3/C4 radiculopathy?

A

HA
Innervate posterior and lateral scalp
C2 and C3 nerves become greater and lesser occipital nerves

24
Q

Which muscles are involved in a C5 radiculopathy?

A
Rhomboids
Deltoid
Biceps
Supraspinatus
Infraspinatus
Brachialis
BR
Supinator
Paraspinals
25
Which muscles are involved in a C6 radiculopathy?
``` Deltoid Biceps BR Supraspinatus Infraspinatus Supinator PT FCR EDC Paraspinals ```
26
Which muscles are involved in a C7 radiculopathy?
``` PT FCR EDC Triceps Paraspinals ```
27
Which muscles are involved in a C8 radiculopathy?
``` Triceps FCU FDP Abductor digiti minimi First dorsal interossei PQ Abductor pollicus brevis Paraspinals ```
28
Which muscles are involved in a L2/3/4 radiculopathy?
``` Iliopsoas Iliacus Gracilis Adductor longus Vastus medialis TA Paraspinals Difficult to distinguish between radiculopathy and alternate lesions due to only two peripheral nerves ```
29
Which muscles are involved in a L5 radiculopathy?
``` Gluteus maximus Gluteus medius TFL TA MG Medial hamstring TP Peroneus longus Paraspinals ```
30
Which muscles are involved in a S1 radiculopathy?
``` Gluteus maximus Gluteus medius TFL MG Medial hamstring PL TP Paraspinals ```
31
What is the etiology of a S2/3/4 radiculopathy?
Iatrogenic Cauda equina Spinal stenosis
32
Which muscles are involved in a S2/3/4 radiculopathy?
``` Abductor hallucis Abductor digiti quinti Needle exam of the external anal sphincter ``` ``` Monitor: Bulbocavernosus reflex, anal wink, external sphincter tone, and bowel and bladder function ```
33
Which nerves innervate the Pectoralis major?
Medial and lateral pectoral nerves
34
Which nerves innervate the Brachialis?
Musculocutaneous and Radial nerve
35
Which nerves innervate Flexor digitorum profundus?
Median (AIN) and Ulnar nerves
36
Which nerves innervate the Lumbricals?
Median and Ulnar nerves
37
Which nerves innervate Flexor pollicis brevis?
Median and Ulnar nerves
38
Which nerves innervate Pectineus?
Femoral and obturator nerves
39
Which nerves innervate Adductor magnus?
Sciatic (tibial portion) and Obturator nerves
40
Which nerves innervate Biceps femoris?
Sciatic (tibial portion) and Sciatic (peroneal portion) nerve
41
Describe EDX findings in Radiculopathy at time of injury.
Decreased recruitment Decreased recruitment interval Prolonged F-wave Abnormal H-reflex (S1 radiculopathy)
42
Describe EDX findings in Radiculopathy 4 days after injury.
~50% Dec CMAP compared to opposite side in severe cases
43
Describe EDX findings in Radiculopathy 1 week after injury.
ABN spontenous activity in paraspinals 1st Normal if reinnervated or posterior rami spared
44
Describe EDX findings in Radiculopathy 2 weeks after injury.
ABN spontaneous activity beginning in the limbs
45
Describe EDX findings in Radiculopathy 3 weeks after injury.
ABN activity present in the paraspinals and limbs
46
Describe EDX findings in Radiculopathy 5-6 weeks after injury.
Reinnervation begins
47
Describe EDX findings in Radiculopathy 6 mo to 1 yr after injury.
Inc amplitude from reinnervated motor unit Reinnervation complete
48
Describe EDX findings in Radiculopathy if repeated every 3-4 mo.
Serial EMG could be performed in intervals to monitor for reinnervation
49
Describe EMG of Radiculopathy
Pure sensory injury: negative EMG