Radiculopathies (MSK) Flashcards
Define radiculopathy.
AKA pinched nerve root - a set of conditions where one or more nerves are affected and do not work properly
How does radiculopathy differ from neuropathy?
Radiculopathies are issues with nerve roots, but neuropathies are issues with nerves
How does radiculopathy come about?
When surrounding bone or tissue like cartilage, muscles or tendons put pressure on nerve and disrupt its function
What are some causes of radiculopathy? (8)
- mechanical compression of nerve root
- herniated disc
- degenerative disc disease
- spinal stenosis
- osteoarthritis
- facet joint degeneration/hypertrophy
- cervical spondylosis
- spondylolisthesis (vertebra moves and rests on vertebra below)
What is the most common type of radiculopathy?
Sciatica - compression of lumbosacral nerve roots forming sciatic nerve (L5, S1)
What is sciatica (radiculopathy) most commonly caused by?
Herniated intravertebral disc
What are the clinical features of sciatica (radiculopathy)? (2)
- pain and tingling radiating from lower back to ipsilateral leg
- weakness in calf muscles
How do we diagnose sciatica (radiculopathy)?
Straight leg raise test (pain on passive flexion of leg –> Lasegue’s sign)
How do we manage sciatica (radiculopathy)? (3)
- physiotherapy
- analgesia (NSAIDs)
- if no improvement in Sx in 4-6 weeks –> refer to MRI
What are the general clinical features of radiculopathy? (3)
- pain starting in area where SC nerve roots are dysfunctional and radiates down to dermatome (shooting pain)
-
motor - LMN symptoms for muscles innervated by this spinal root e.g. hyporeflexia
- biceps: C5, C6
- triceps: C7, C8
- knee: L3, L4
- ankle: S1, S2
- (C5, C6 pick up sticks. C7, C8, lay them straight. L3, L4, kick the door. S1, S2, buckle my shoes.)
- sensory - dermatomal pattern of pain, numbness, tingling
What are the clinical features of cervical radiculopathy? (3)
- neck pain
- headache
- shoulder pain
Which radiculopathy is scapular winging seen in?
C3/4 radiculopathy (affects C2-C4 discs)
What are the clinical features of lumbosacral radiculopathy? (2)
Both worse on sitting:
- lower back pain
- leg pain
What are the features of L3 nerve root compression? (4)
- sensory loss over anterior thigh
- weak hip flexion, knee extension and hip adduction
- reduced knee reflex
- positive femoral stretch test
What are the features of L4 nerve root compression? (4)
- sensory loss anterior aspect of knee and medial malleolus
- weak knee extension and hip adduction
- reduced knee reflex
- positive femoral stretch test
What are the clinical features specific for L5 radiculopathy? (6)
- sensory loss dorsum of foot and big toe
- weakness in hip abduction, inversion of foot, big toe dorsiflexion
- foot drop - weakness/paralysis of dorsiflexion and eversion of foot
- lower back pain that shoots down the leg
- reflexes intact
- positive sciatic nerve stretch test
What is L5 radiculopathy commonly caused by? (2)
- lumbosacral disc herniation
- common peroneal nerve lesion (secondary to compression at neck of fibula)
What are the features of S1 nerve root compression? (4)
- sensory loss posterolateral aspect of leg + lateral aspect of foot
- weakness in plantar flexion of foot
- reduced ankle reflex
- positive sciatic nerve stretch test
What are some risk factors for radiculopathy? (5)
- age
- overweight
- poor posture
- improper lifting technique
- Fx degenerative bone conditions
What scan can we do for radiculopathy and when?
MRI spine if symptoms do not improve with conservative treatment (after 4-6 weeks)
What might CT/MRI show in radiculopathy? (5)
- nerve root compression by disc
- osteophyte
- tumour
- root avulsion
- enlarged epidural veins
How can we assess nerve function in radiculopathy?
EMG - denervation in myotomal distribution BUT normal conduction velocity
What examination can we do in clinic to test for sciatica (radiculopathy)?
Straight leg raise test (positive)
What are some differential diagnoses for radiculopathy? (6)
- diabetic amyotrophy
- peripheral neuropathies
- HIV
- Herpes zoster/simplex
- EBV, CMV, Lyme disease, leprosy
- sarcoidosis, Sjogren’s syndrome, rheumatoid arthritis
How do we manage radiculopathies?
Conservative treatment:
- physiotherapy
- lifestyle measures
- NSAIDs +/- PPIs
- steroid injections
What do we do if radiculopathy symptoms persist after 4-6 weeks?
Refer for MRI
When do we do surgery for radiculopathy?
Only if significant neurological deficits
