Ch 5 - EDX: Radiculopathy Flashcards by Chris Garrison

What is a Radiculopathy?

Pathologic process affecting the nerves at the root level

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What is the presentation of Radiculopathy?

Pure sensory > sensorimotor complaints> pure motor complaints

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Why are sensory complaints MC in Radiculopathy?

Larger size of sensory fibers rendering more prone to injury

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Describe NCS of Radiculopathy.

Typically normal due to sparing of DRG

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What is the MCC of radiculopathy <50 yo?

Herniated nucleus pulposus (HNP)

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What is the MCC of radiculopathy >50 yo?

Spinal stenosis

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What are uncommon causes of radiculopathy?

“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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What is the clinic presentation of a C5 radiculopathy?

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

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What is the clinic presentation of a C6 radiculopathy?

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

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What is the clinic presentation of a C7 radiculopathy?

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

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What is the clinic presentation of a C8 radiculopathy?

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

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What is the clinic presentation of a T1 radiculopathy?

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

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What is the clinic presentation of a L4 radiculopathy?

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

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What is the clinic presentation of a L5 radiculopathy?

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

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What is the clinic presentation of a S1 radiculopathy?

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

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Describe the SNAP in Radiculopathy.

Normal if the lesion is located proximal to the DRG

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Describe the CMAP in Radiculopathy.

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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Describe H-reflex in Radiculopathy.

Possibly abnormal in an S1 radiculopathy but not pathognomonic

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Describe F-waves in Radiculopathy.

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

6 including paraspinals

If 1 is ABN, then more muscles should be evaluated

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What is found on EMG in Radiculopathy?

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

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When would radiculopathy not be found on EMG?

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

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What is the etiology of a C3/C4 radiculopathy?

C2-C3 + C3-C4 HNP

What is the clinical finding of C3/C4 radiculopathy?

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

What is the etiology of a C5 radiculopathy?

C4-C5 HNP

Which muscles are involved in a C5 radiculopathy?

``` Rhomboids Deltoid Biceps Supraspinatus Infraspinatus Brachialis BR Supinator Paraspinals ```

What is the etiology of a C6 radiculopathy?

C5 – C6 HNP

Which muscles are involved in a C6 radiculopathy?

``` Deltoid Biceps BR Supraspinatus Infraspinatus Supinator PT FCR EDC Paraspinals ```

What is the etiology of a C7 radiculopathy?

C6 – C7 HNP

Which muscles are involved in a C7 radiculopathy?

``` PT FCR EDC Triceps Paraspinals ```

What is the etiology of a C8 radiculopathy?

C7 – T1 HNP

Which muscles are involved in a C8 radiculopathy?

``` Triceps FCU FDP Abductor digiti minimi First dorsal interossei PQ Abductor pollicus brevis Paraspinals ```

What is the etiology of a L2/3/4 radiculopathy?

L1–L2/L2–L3/L3–L4 HNP

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 ```

What is the etiology of a L5 radiculopathy?

Posterolateral | L4–L5 HNP

Which muscles are involved in a L5 radiculopathy?

``` Gluteus maximus Gluteus medius TFL TA MG Medial hamstring TP Palmaris longus Paraspinals ```

What is the etiology of a S1 radiculopathy?

Posterolateral | L5–S1 HNP

Which muscles are involved in a S1 radiculopathy?

``` Gluteus maximus Gluteus medius TFL MG Medial hamstring PL TP Paraspinals ```

What is the etiology of a S2/3/4 radiculopathy?

Iatrogenic Cauda equina Spinal stenosis

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 ```

Which nerves innervate the Pectoralis major?

Medial and lateral pectoral nerves

Which nerves innervate the Brachialis?

Musculocutaneous and Radial nerve

Which nerves innervate Flexor digitorum profundus?

Median (AIN) and Ulnar nerves

Which nerves innervate the Lumbricals?

Median and Ulnar nerves

Which nerves innervate Flexor pollicis brevis?

Median and Ulnar nerves

Which nerves innervate Pectineus?

Femoral and obturator nerves

Which nerves innervate Adductor magnus?

Sciatic (tibial portion) and Obturator nerves

Which nerves innervate Biceps femoris?

Sciatic (tibial portion) and Sciatic (peroneal portion) nerve

Describe EDX findings in Radiculopathy at time of injury.

Decreased recruitment Decreased recruitment interval Prolonged F-wave Abnormal H-reflex (S1 radiculopathy)

Describe EDX findings in Radiculopathy 4 days after injury.

~50% Dec CMAP compared to opposite side in severe cases

Describe EDX findings in Radiculopathy 1 week after injury.

ABN spontenous activity in paraspinals 1st Normal if reinnervated or posterior rami spared

Describe EDX findings in Radiculopathy 2 weeks after injury.

ABN spontaneous activity beginning in the limbs

Describe EDX findings in Radiculopathy 3 weeks after injury.

ABN activity present in the paraspinals and limbs

Describe EDX findings in Radiculopathy 5-6 weeks after injury.

Reinnervation begins

Describe EDX findings in Radiculopathy 6 mo to 1 yr after injury.

Inc amplitude from reinnervated motor unit Reinnervation complete

Describe EDX findings in Radiculopathy if repeated every 3-4 mo.

Serial EMG could be performed in intervals to monitor for reinnervation

Describe EMG of Radiculopathy

Pure sensory injury: negative EMG