Radiculopathy

Question 1

General presentation of radiculopathy

Answer 1

-Muscle weakness and wasting
-Dermatomal sensory and reflex loss reflecting pattern of roots involved
-Pain in muscles innervated by affected roots.
-Sciatica, cervical, thoracic, lumbar

Question 2

Muscle weakness, reflex changes, and sensory changes in C5

Answer 2

-Shoulder abduction and flexion, elbow flexion
-Biceps
-Lateral arm

Question 3

Muscle weakness, reflex changes, and sensory changes in C6

Answer 3

-Elbow flexion and wrist extension
-Biceps and supinator
-Lateral forearm, thumb, index finger

Question 4

Muscle weakness, reflex changes, and sensory changes in C7

Answer 4

-Elbow extension, wrist flexion, finger extension
-Triceps
-Middle finger

Question 5

Muscle weakness, reflex changes, and sensory changes in C8

Answer 5

-Finger flexion
-None
-Medial side lower forearm, ring, and little fingers

Question 6

Muscle weakness, reflex changes, and sensory changes in T1

Answer 6

-Finger abduction and adduction
-None
-Medial side upper forearm, lower arm

Question 7

Investigations of radiculopathies

Answer 7

-Spurling test
-Arm squeeze test
-Axial traction
-Upper limb neurodynamic test
-MRI indicated with complex cervical radiculopathy (myelopathy, abscess, progressive, failure to improve)

Question 8

Management of radiculopathy

Answer 8

-NSAIDs, paracetamol, codeine, neuropathic pain
-Muscle relaxants
-Physiotherapy
-4-6 weeks or neurological signs: MRI diagnosis, injections, spinal surgery (unremitting radicular pain despite conservative treatment, progressive motor weakness, nerve root compression).

Question 9

Sciatica presentation

Answer 9

-Unilateral leg pain radiating below knee
-Low back pain
-Numbness/ tingling
-Weakness
-Reflex changes.

POSITIVE STRAIGHT LEG RAISE

Question 10

Management of sciatica

Answer 10

-NSAIDs
-Exercise
-Heat packs
-Physiotherapy
-Decompression surgery