Radiculopathy Flashcards
1
Q
What is radiculopathy?
A
- conduction block in the axons of a spinal nerve or its roots
- results in weakness and paraesthesia
2
Q
What is radicular pain?
A
- pain deriving from damage or irritation of the spinal nerve tissue, particularly the dorsal root ganglion
- Radiculopathy may not be associated with pain
3
Q
What causes radiculopathy?
A
- Disc prolapse
- Degenerative disease of spine
- spine #
- Malignancy (mets)
- infection
- Pott’s disease in TB
- extradural abcess
- Herpes Zoster
4
Q
What are the clinical features of radiculopathy?
A
- paraesthesia
- motor weakness
- radicular pain
- some red flag symptoms
5
Q
What are the redflags for Cauda Equina?
A
- Progressive bilateral neurological deficit of legs
- Recent onset faecal incontinence
- Recent onset urinary retention and/or urinary incontinence
- saddle anasthesia
- Unexpected laxity of anal sphincter
6
Q
What are the red flags for infection?
A
- Immunosuppression
- Intravenous drug abuse
- Unexplained fever
- Diabetes
- TB
- recent UTI
7
Q
What are the red flags for spinal fracture?
A
- Sudden onset severe central spinal pain - relieved when lying down
- Chronic steroid use
- Significant trauma hx
- Structural deformity of spine
- Point tenderness over vertebral body
- Osteoporosis or metabolic bone disease
8
Q
What are the red flags for malignancy?
A
- 50 y/o or more
- Gradual onset sx
- Aching night pain that prevents/disturb sleep
- Localised spinal tenderness
- No symptomatic improvement after 4-6 weeks of pain therapy
- unexplained weight loss
- Hx of malignancy
9
Q
What will your diffferentials be for radiculopathy?
A
- Referred pain – myocardial ischaemia, hepatobiliary disease, UTI
- Myofascial pain – hip muscles can mimic pain from lumbar radiculopathy; shoulder girdle muscles can produce pain radiating into the upper extremity
- Thoracic outlet syndrome
- Greater trochanteric bursitis
- Iliotibial band syndrome
- Meralgia paraesthetica – compression of the lateral cutaneous nerve of the thigh as it passes under the inguinal ligament. It presents with clearly demarcated area of paraesthesia and/or numbness in the anterolateral aspect of the thigh
- Piriformis syndrome
10
Q
How would you Mx radiculopathy?
A
- Treat underlying cause
- Symptomatic reliever
- Amitriptylline (first line)
- Pregabalin, gabapentine
- Benzodiazepine
- Analgesia WHO step ladder
- Physiotherapy
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11
Q
What are the red flags for myelopathy?
A
- gait disturbance
- clumsy/weak hands
- loss of sexual, bowel, bladder dysfunction
- UMN signs (hyperreflexia, clonus, spasticity)
12
Q
What is myelopathy?
A
- injury to the spinal cord caused by severe compression
- caused by spinal stenosis, disc degeneration, disc herniation, autoimmune disorders or other trauma.
13
Q
What is cauda equina?
A
- severe compression of the nerve roots in the thecal sac of the lumbar spine
14
Q
What are the yellow flag signs of back pain?
A
- Negative attitude that back pain is harmful or potentially severely disabling – Explain that moving even though painful is helpful not harmful
- Fear, avoidance behaviour and reduced activity levels
- Expectation that passive, rather than active, treatment will be beneficial
- Tendency to depression, low morale, and social withdrawal
- Social or financial problems
15
Q
What is upper motor neuron lesion?
A
- Lesion in the neural pathway above the anterior horn cell of the spinal cord or motor nuclei of the cranial nerves
