L11: Assessment of specific disorders involving the neural system Flashcards
What is the difference between somatic and radicular pain?
Radicular pain
- Quality of pain (not just nociceptive but nociceptive)
- Pins and needles
- Numbness
- Weakness
- Follows a dermatomal distribution
Somatic pain
- Referred pain (arm, shoulder, elbow pain)
- Not always in a dermatomal distribution
What is the difference between somatic and radicular pain in the physical examination?
Neurological
- Somatic: normal
- Radicular: weakness, loss of sensation and altered reflexes in distribution of nerve
Why is it important to know the difference between somatic and radicular pain?
Management is different
c
- generally well-localized pain that results from the activation of peripheral nociceptors without injury to the peripheral nerve or central nervous system.
- Pain emanating from muscles, skeleton, skin; pain in the parts of the body other than the viscera
- Often can be more vague, less well defined distribution but may be related to dermatomes (No sharp pain)
What is cervical radiculopathy?
- A neurological condition characterised by dysfunction of the cervical spinal nerves and/or the nerve roots
- It is characterised by pain in the neck and one arm with a combination of sensory loss, loss of motor function and/or reflex changes in the affected nerve root distribution
What are the 4 main distributions of radicular pain?
What is the diagnosis of cervical radiculopathy? What are 3 diagnostic criterion reference standards?
Lack of uniform diagnostic criteria for cervical radiculopathy
- No gold standard
- Nerve conduction studies
- MRI
- Poor correlation between these in diagnosis of suspected cervical radiculopathy
Cerical radiculopathy has a considerable impact on _______ .
overall health status
Significant functional _____ and ______ for cervical radiculopathy.
limitations; disability
Cervical radiculopathy have much _____ (greater/lesser) levels of disability than people with neck pain.
greater
________ may be helpful long term for taking pressure off the nerve root in cervical radiculopathy.
Neurodynamic techniques (eg. sliders, tensions)
What are the 4 epidemiology factors of cervical radiculopathy?
- Prevalence of 0.10 to 0.35% for entire population, with a peak 4th and 5th decade
- More common in men
- Risk factors include white race, smoking and prior lumbar radiculopathy
- Some occupational or sports factors, not trauma
What are 3 causes of cervical radiculopathy?
- Foraminal encorachment of the spinal nerve due to cervical spondylosis
- Decrese disc height
- Degenerative changes of the uncovertebral joints and/or zygapophyseal joints
- More common in older populations (degeneration)
- Intervertebral disc herniation
- Tumour of the spine, spinal infection, synovia cyst…(all infrequent- but obviously important (red flags))
What does cervical spondylosis and disc herniation look like?
What are some common compression sites for cervical radiculopathy?
What are 2 key characteristics of cervical radiculopathy?
- Cervical radiculopathy is characterised by pain, motor weakness and sensory loss in the distribution of the affected nerve roots (s)
- Neurological examination is mandatory (muscle strength, reflexes, sensory testing)
- Important contrast with somatic referred pain: no sensory, motor or reflex changes
- If you suspect nerve compression must do neurological examination
What are the indications of neurological examination?
- Indicated if pain extends beyond the tip of the acromion
- Any report of paraesthesia or altered sensation
- Any report of weakness or clumsiness
What are 3 main parts of the neurological examination? What are the 4 additional parts?
- Sensation
- Power
- Reflexes
Bilateral symptoms
- Babinski
- Clonus
- Important to exclude myelopathy
- Sperling’s test:
- Combined extension& LF + compression –> will cause pain (provocative)
- OR
- Traction/distraction –> alleviate pain
What is the dermatomal map?
_____ (Not always/always) dermatomal presentation with radicular pain/radiculopathy
Not always
What is the non-dermatomal spread of symptoms for cervical radiculopathy?
- Overlap between the cervical spine
- Symptoms can travel upwards
What is Cloward’s areas?
areas or referred pain from lower cervical discs
What are the 3 possible MSK causes of pain, when a patient presents with referred pain in the arm?
- Radicular pain
- Neurological test = +ve
- Somatic referral of pain
- Neurological test = normal
- Nerve tissue mechanosensitivity
- Neurological test = normal
- Neurodynamic test = replicates symptoms
- Often these sources of pain will co-exist
- But can have mechanosensitivity without neurological signs
- Might not have radiculopathy
What are the mechanism of central sensitisation of non-dermatomal spread of symptoms?
