Clinical Care- Radiculopathy/ Cauda Equina Flashcards
common cause of radiculopathy
lumbar disk herniation (herniation or extrusion of nucleus pulposus into the spinal cord area)
also occurs with degenerative disk disease
which disks are most often affected in 90% of cases of radiculopathy
L5-S1
clinical presentation of radiculopathy
pain with flexion or sitting
radicular pain into the leg
lower extremity numbness/weakness
pathophysiology of Cauda Equina
herniated disk
infection or inflammation
cancer
spinal stenosis
All pressing or irritating the cauda equina
significant disk herniation can cause numbness and weakness with what vertebrae with plantar flexion?
L5-S1
disk herniation causes numbness and weakness with which vertebrae with dorsiflexion of the toes?
L4/L5
what should be ruled out if the patient complains of perianal numbness or bowel or bladder incontinence?/
Cauda Equina
Clinical presentation of disk herniation with associated vertebrae
L1- pain in inguinal area
L2, L3, L4- pain that radiates around anterior aspect thigh to knee. weakness of hip flexion, knee extension, hip abduction
.
L5- most common. back pain radiating down later aspect of the leg into the foot. Decreased strength in foot dorsiflexion, toe extension, foot inversion, foot eversion
S1- pain down posterior aspect of leg into food. weakness in plantar flexion and gastrocnemius.
Physical examination of radiculopathy
Straight leg testing
1) Lay patient supine and raise patients extended leg on the symptomatic side with foot dorsiflexed
2) Lasegue’s sign – presence or worsening of radicular pain with straight leg maneuver
what type of imaging is helpful to assess spinal alignment (scoliosis, lordosis) disk space narrowing, and OA changes
plain radiographs
what is the best method of imaging to assess the level of morphology of herniation and is recommended if surgery is planned?
MRI
Treatment of radiculopathy
NSAIDS/analgesics, modified activities
Cyclobenzaprine 5mg PO Q8Hr and can increase dose to 7.5 –
10mg
4-6 week reevaluation
PT considered if pain is still present.
what is the medical term for a group of symptoms that happen when some of the nerve in the cauda equina get squeezed or damaged?
cauda equina syndrome
clinical presentation of cauda equina
(1) Pain, numbness, or tingling in the lower back and spreading down 1 or both legs
(2) Leg weakness or a problem called “foot drop,” which is when you cannot seem to hold your foot up (for example, while walking)
(3) Problems with bowel or bladder control
(4) Problems with sex
TX of cauda equina syndrome
Medical EMERGENCY
likely needs MRI
Treatment for cauda equina syndrome involves treating whatever is affecting the nerves and causing the symptoms.
1) Often, that means having surgery to remove bits of bone or discs, or tumors.
2) If the cause is an infection or inflammation, medications to treat those problems might be needed
