Radiculopathy Flashcards
What is a radiculopathy?
conduction block in the axons of a spinal nerve or its roots causing weakness and paraesthesia/ anaesthesia
Radiculopathies are typically caused by nerve compression - give 5 causes of nerve compression:
1) intervertebral disc prolapse
2) degenerative disease of the spine
3) fracture
4) malignancy
5) infection
Why does compression of the nerve usually occur in the cervical spine?
Due to degenerative changes that narrow the space where nerve roots exit the spine
Why does compression of the nerve usually occur in the lumbar spine?
Herniated disc
Describe how an intervertebral disc prolapse can compress a nerve:
the annulus fibrosus is ruptured due to stress, allowing the nucleus pulposus jelly to herniate out and compress the nerve
In which region of the spine is disc prolapse most common?
Lumbar
In which region of the spine is degenerative change most common?
cervical
Give 2 examples of infections that can compress nerves:
1) extradural abscesses
2) osteomyelitis
Give 3 clinical features of radiculopathies:
1) paraesthesia and numbness
2) weakness
3) radicular pain
What are 4 possible sensory symptoms of radiculopathies?
- Pain
- Paresthesia (tingling/pins and needles)
- Numbness
- Hypersensitivity
What are 3 possible motor symptoms of radiculopathies?
- Muscle weakness
- Muscle atrophy (in chronic cases)
- Fasciculations/Twitching
Describe the sensation of radicular pain:
burning, deep, strap-like pain
Give 3 red flags for cauda equina syndrome:
1) faecal incontinence
2) urinary retention
3) saddle anaesthesia
True or false: radiculopathies are mostly clinical diagnoses
True
Whar are 3 imagining investigations used for radiculopathies?
- Magnetic Resonance Imaging (MRI): This is often the first-line imaging modality for suspected radiculopathy.
- Computed Tomography (CT): CT scans are utilised when MRI is contraindicated or unavailable - less sensitive in detecting soft tissue abnormalities.
- X-ray: While not as detailed as MRI or CT, X-rays can reveal bony abnormalities such as osteophytes or fractures that may be causing nerve compression.
Give two investigations that can be used to find out more about a radiculopathy:
1) electromyography
2) nerve conduction studies
What is the first line analgesia for radiculopathies?
amitriptyline
Other than amitriptyline, give two other analgesics used for radiculopathies:
1) pregabalin (Gabapentinoid Anticonvulsant GABA analogue)
2) gabapentin
What drug may a patient with muscle spasm radiculopathies be given?
benzodiazepines (diazepam)
What non-pharmaceutical management plan may be offered to patients with radiculopathies?
physiotherapy
What are the 4 most common causes of radiculopathies?
- Disc herniation
- Spinal stenosis
- Spondylolisthesis (forward slipping of one vertebra over another)
- Trauma or injury
What are the 3 systemic causes of radiculopathies?
- Diabetes mellitus - Chronic hyperglycaemia can lead to diabetic neuropathy
- Infections - infections such as herpes zoster can affect nerve roots
- Malignancies
What are 3 risk factors for radiculopathies?
- Obesity
- Tobacco use
- Aging
Name 3 general differential diagnoses?
- Peripheral neuropathies
- Myelopathies
- Muscular skeletal conditions
