Radiculo e plexopatias Flashcards
Quais os sintomas e sinais de radiculopatias cervicais?
Si/sx: Numbness & paresthesias in the fi ngers in a dermatomal distribution, lancinating pain radiating down the arm, weakness depending on the cervical roots involved.
Exam: Weakness and/or sensory loss in upper extremities depending on which nerves are affected. Spurling maneuver (passive cervical extension w/ lateral fl exion toward the affected side which reproduces symptoms), vertical traction. Be careful in performing maneuvers w/ spinal instability, traumatic cause, RA. Most common cervical radiculopathy C6–7. Pain in dorsal forearm, paresthesias/ numbness in third & fourth digits. Weakness w/ arm extension, fi nger & wrist fl exors & extensors. Diminished triceps refl ex.
Quais os sintomas e sinais de radiculopatias lombossacrais?
Si/sx: Brief, lancinating pain, often worse w/ standing, weakness, numbness.
Exam L3–L4: Back pain. Numbness & pain in the medial thigh/ calf in the L3–4 dermatomal distributions. Weakness of knee extension & hip fl exion. Decreased patellar refl ex. L5: Pain radiating to the posterior thigh, calf, foot, hallux. Numbness in L5 dermatomal distribution. Foot drop, hallux extension weakness. Typically refl exes intact. S1: Pain in the buttock, posterior thigh, calf, heel. S1 dermatome numbness. Straight leg raise: Good sensitivity for herniated disc but poor specifi city; rectal exam to evaluate sphincter tone, particularly if concerned for cauda equina syndrome.
Quais exames podem ser feitos para avaliação de radiculopatias?
- RM de coluna com gadolíneo (cervical ou lombar)
- Eletroneuromiografia (diferencia de neuropatia)
Causes: often secondary to arthritis, herniated disc, osteophyte formation, cervical spondylosis, space- occupying lesions such as tumors, abscesses, cysts.
Qual o tratamento para as radiculopatias?
#Rx Cervical: Urgent surgical evaluation for patients w/ evidence of cervical spine instability or myelopathy. Otherwise, conservative Rx initially for 3–6 wk. Ice or heating pad, muscle relaxants, NSAIDs, gentle massage, stretching, PT. May consider cervical epidural steroRx: Urgent surgical evaluation if rapidly progressive motor defi cits or if evidence of cauda equina syndrome w/ loss of bowel/bladder function. Otherwise, conservative Rx initially. Ice or heating pad, muscle relaxants, NSAIDs, gentle massage, stretching, PT, TENS (transcutaneous electrical nerve stimulation). May consider epidural steroid injections. Surgery if conservative Rx fails. Common Radiculopatid injections. Surgery if conservative Rx fails.
Rx Lombar: Urgent surgical evaluation if rapidly progressive motor defi cits or if evidence of cauda equina syndrome w/ loss of bowel/bladder function. Otherwise, conservative Rx initially. Ice or heating pad, muscle relaxants, NSAIDs, gentle massage, stretching, PT, TENS (transcutaneous electrical nerve stimulation). May consider epidural steroid injections. Surgery if conservative Rx fails
Quais os principais niveis das radiculopatias em relação a sensibilidade, força e reflexos?
# C5 Shoulder, lateral proximal arm Shoulder abduction, external rotators of arm, elbow fl exion Biceps, brachoradialis C4–5 # C6 First & second digits, lateral forearm, & arm Elbow fl exion, arm pronation, fi nger & wrist extension Biceps, brachoradialis C5–6 # C7 Third & fourth digits Elbow extension, fi nger/ wrist fl exors & extensors Triceps C6–7 # C8 Medial forearm & hand, fi fth digit Intrinsic hand muscles Finger fl exor C7–T1 # L4 Knee, medial leg Hip fl exion, knee extension, dorsifl exion, foot inversion Patellar L3–4 # L5 Lateral leg, dorsum of foot, large toe Foot dorsifl exion, eversion, & inversion None L4–5 # S1 Lateral foot, sole of foot, small toe Foot plantar fl exion Achilles L5–S1
Como é a anatomia do plexo braquial?
Raizes => Troncos => Divisões => Ramos => Nervos
São os seguintes nervos:
n. Axillary n. Radial n. Musculocutaneous n. Median n. Ulnar n. Medial pectoral n. Medial brachial cutaneous n. Medial antebrachial cutaneous n. Upper subscapular n.
Lower subscapular n. Thoracodorsal n. Lateral pectoral n. Suprascapular n. N. to the subclavius Dorsal scapular n. Long thoracic (ver imagem do Netter).
Como faço o diagnóstico de plexopatia? Quais as causas mais comuns?
Dx: MRI C-spine & brachial plexus. Plain fi lms if h/o trauma to r/o bony fracture or dislocation. EMG/NCS.
Definition: Injury/irritation of the brachial plexus most often secondary to trauma, such as stretch injuries, lacerations, birth trauma, fracture-dislocations, orthopedic surgery. May also be caused by radiation, infections, & malignancy
Explique as principais sindromes de plexopatias - Parsonage-Turner syndrome; Erb-Duchenne palsy; Dejerine-Klumpke; Thoracic outlet syndrome; Bruns-Garland Syndrome.
Neuralgic amyotrophy or Parsonage-Turner syndrome Si/sx: Acute, severe shoulder pain radiating to the arm, neck, & back; weakness & atrophy of the shoulder girdle/ scapular muscles. Phrenic nerve weakness may occur. Arm held in fl exion at the elbow & adduction at the shoulderCause: Idiopathic but may be secondary to autoimmune process, virus, trauma, strenuous exercise, immunization, & childbirth. Rx: Conservative management, PT. Can consider trial of steroids or IVIg.
Erb-Duchenne palsy or upper trunk plexopathy Si/sx: Weakness, atrophy of the deltoid, biceps, brachoradialis, & brachialis muscles. Arm is internally rotated & adducted (“waiter’s tip” position). Sensory typically intact but there may be sensory loss over the outer surface of the upper arm. Diminished biceps or brachoradialis muscles. Cause: Lesions of the fi fth & sixth cervical roots or the upper trunk of the plexus. Often caused by trauma separating the head & shoulders or pressure on the shoulders, birth injury. Rx: Conservative management, PT.
Dejerine-Klumpke palsy or lower trunk plexopathy Si/sx: Claw hand, weakness wrist & fi nger fl exion, & intrinsic hand muscles. Sensation may be intact or lost on the medial forearm & ulnar aspect of hand, diminished fi nger fl exors. Ipsilateral Horner syndrome may be present. Cause: Lesions of the eighth cervical & fi rst thoracic roots. Usually secondary to trauma, such as arm traction, & associated w/ lung tumors (Pancoast tumor) or other mass lesions. Rx: Conservative management, PT. Thoracic outlet syndrome Si/sx: Recurrent coldness, cyanosis, pallor of hand. Bruit in the supra or infraclavicular areas. Lower trunk or medial cord is involved. Pain in the ulnar border of the hand & medial forearm. Paresthesias/numbness may occur in the same distribution. Motor & refl ex exam may be similar to a lower plexus lesion, although T1 may be spared. Cause: Compression of the brachial plexus of the subclavian vessels in the space between the fi rst rib & clavicle. May be due to cervical rib, enlarged transverse process, & hypertrophied scalene muscle. Rx: Conservative management or surgery in refractory cases.
LUMBOSACRAL PLEXOPATHY (BRUNS-GARLAND SYNDROME) Si/sx: Hip pain, weakness of iliopsoas, quadriceps, & thigh adductor muscles. Occurs in patients w/ diabetes, idiopathic, & in connective tissue diseases. Exam: Weakness, sensory loss, & loss of knee refl ex. Dx: EMG/ NCS.
