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
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- 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 is the dermatomal map?
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 mechanism of central sensitisation of non-dermatomal spread of symptoms?
Where does the pain come from?
What is the purpose of neurodynamics?
Elbow extension + wrist extension = will move the nerve on its soft tissue interfaces
What is neural mechanisensitivity?
Neural mechanosensitivity can occur with or without nerve compression (radiculopathy)
What are the 3 clinical provocation tests for neural mechanosensitivity?
What are the 6 systematic components of Upper Limb Neurdynamic Tests I (ULNT- Median Nerve)?
What are the 6 components of neurodynamics?
What are the categorisation of responses for neurodynamics?
What is structural differentiation?
What action can be used as structural differentiation for neurodynamics?
Using lateral flexion away as structural differentiation
When is a test considered positive?
Unilateral is more common, not bilateral
What are the systematic components of Upper Limb Neurdynamic Tests Ib (ULNT- Median Nerve) if the patient has shoulder limitations?
What are the 5 systematic components of Upper Limb Neurdynamic Tests IIb (ULNT- Radial Nerve)?
What are the 5 systematic components of Upper Limb Neurdynamic Tests III (ULNT- Ulnar Nerve)?
