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BR 3rd Ed > Ch 5 - EDX: Radiculopathy > Flashcards

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

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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

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22
Q

When would radiculopathy not be found on EMG?

A

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

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23
Q

What is the etiology of a C3/C4 radiculopathy?

A

C2-C3 + C3-C4 HNP

24
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

25
Q

What is the etiology of a C5 radiculopathy?

A

C4-C5 HNP

26
Q

Which muscles are involved in a C5 radiculopathy?

A 
Rhomboids
Deltoid
Biceps
Supraspinatus
Infraspinatus
Brachialis
BR
Supinator
Paraspinals
27
Q

What is the etiology of a C6 radiculopathy?

A

C5 – C6 HNP

28
Q

Which muscles are involved in a C6 radiculopathy?

A 
Deltoid
Biceps
BR
Supraspinatus
Infraspinatus
Supinator
PT
FCR
EDC
Paraspinals
29
Q

What is the etiology of a C7 radiculopathy?

A

C6 – C7 HNP

30
Q

Which muscles are involved in a C7 radiculopathy?

A 
PT
FCR
EDC
Triceps
Paraspinals
31
Q

What is the etiology of a C8 radiculopathy?

A

C7 – T1 HNP

32
Q

Which muscles are involved in a C8 radiculopathy?

A 
Triceps
FCU
FDP
Abductor
digiti minimi
First dorsal
interossei
PQ
Abductor
pollicus
brevis
Paraspinals
33
Q

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

A

L1–L2/L2–L3/L3–L4 HNP

34
Q

Which muscles are involved in a L2/3/4 radiculopathy?

A 
Iliopsoas
Iliacus
Gracilis
Adductor longus
Vastus medialis
TA
Paraspinals
Difficult to distinguish
between radiculopathy
and alternate lesions
due to only two
peripheral nerves
35
Q

What is the etiology of a L5 radiculopathy?

A

Posterolateral

L4–L5 HNP

36
Q

Which muscles are involved in a L5 radiculopathy?

A 
Gluteus maximus
Gluteus medius
TFL
TA
MG
Medial hamstring
TP
Palmaris longus
Paraspinals
37
Q

What is the etiology of a S1 radiculopathy?

A

Posterolateral

L5–S1 HNP

38
Q

Which muscles are involved in a S1 radiculopathy?

A 
Gluteus maximus
Gluteus medius
TFL
MG
Medial
hamstring
PL
TP
Paraspinals
39
Q

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

A

Iatrogenic
Cauda equina
Spinal stenosis

40
Q

Which muscles are involved in a S2/3/4 radiculopathy?

A 
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
41
Q

Which nerves innervate the Pectoralis major?

A

Medial and lateral pectoral nerves

42
Q

Which nerves innervate the Brachialis?

A

Musculocutaneous and Radial nerve

43
Q

Which nerves innervate Flexor digitorum profundus?

A

Median (AIN) and Ulnar nerves

44
Q

Which nerves innervate the Lumbricals?

A

Median and Ulnar nerves

45
Q

Which nerves innervate Flexor pollicis brevis?

A

Median and Ulnar nerves

46
Q

Which nerves innervate Pectineus?

A

Femoral and obturator nerves

47
Q

Which nerves innervate Adductor magnus?

A

Sciatic (tibial portion) and Obturator nerves

48
Q

Which nerves innervate Biceps femoris?

A

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

49
Q

Describe EDX findings in Radiculopathy at time of injury.

A

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

50
Q

Describe EDX findings in Radiculopathy 4 days after injury.

A

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

51
Q

Describe EDX findings in Radiculopathy 1 week after injury.

A

ABN spontenous activity in paraspinals 1st

Normal if reinnervated or posterior rami spared

52
Q

Describe EDX findings in Radiculopathy 2 weeks after injury.

A

ABN spontaneous activity beginning in the limbs

53
Q

Describe EDX findings in Radiculopathy 3 weeks after injury.

A

ABN activity present in the paraspinals and limbs

54
Q

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

A

Reinnervation begins

55
Q

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

A

Inc amplitude from reinnervated motor unit

Reinnervation complete

56
Q

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

A

Serial EMG could be performed in intervals to monitor for reinnervation

57
Q

Describe EMG of Radiculopathy

A

Pure sensory injury: negative EMG

BR 3rd Ed (92 decks)

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