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PHTY5206 > Radiculopathy > Flashcards

Radiculopathy Flashcards

1
Q

What are the myotomes for the lower limb?

A 
L2 - hip flexors
L3 - quads
L4 - tib ant
L5 - extensor hallucis/peroneals
S1 - gastrocs
S2 - flexor dig longus
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2
Q

What are the relfexes for the LL?

A

Quads - L3/4

Achilles - S1/2

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3
Q

What are indications for neuro exam for lumbar spine complaint?

A
  1. Pain in dermatomal distribution
  2. Pain past the buttock
  3. Altered sensation in the LL
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4
Q

What are the myotomes for the UL?

A 
C5 - deltoids
C6 - biceps
C7 - triceps
C8 - extensor pollicis longus/flexor dig profundus
T1 - palmar interrossei
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5
Q

Define neuropathic pain

A
  • disturbance of function or pathological change in a nerve
  • mononeuropathy, mononeuropathy multiplex, or polyneuropathy
  • pain caused by a lesion of the somatosensory nervous system
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6
Q

Define radiculopathy

A
  • disorder of the spinal nerve root
  • d/t SOL in the IVF
  • results in nerve root inflammation
  • ischaemia
  • inflammation
  • compression
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7
Q

What are the different causes of lumbar vs cervical radiculopathy?

A

Lumbar - disc

Cervical - spondylosis (facet joints, uncovertebral joints, osteophytes)

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8
Q

What are the stages of DDD?

A

Mild - dehydration of nucleus pulposus
Moderate - disintegrated nature of annulus pulposus + dehydration
Severe - decreased IVD height

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9
Q

What is radicular pain?

A
  • arise from a irritation of spinal nerve
  • shooting
  • band like
  • localized
  • distal > central
  • pain below elbow
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10
Q

What is the diagnosis cluster for cervical radiculopathy

A
  1. ULTT
  2. Spurlings
  3. Distraction
  4. ROM - reduced rotation <60º

Specificity of 99%

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11
Q

Whats the difference between painful and non-painful radiculopathy?

A
  • both have paresthesia, weakness, reflex changes - but painful will obvs have the addition of pain
  • both will have nerve conduction loss
  • painful rad might have clinical evidence of mechanosensitivity
  • both might have radiological evidence of nerve compression + nerve conduction loss
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12
Q

How does management differ between painful vs non painful radiculopathy

A

Non painful - wait and see/physio/surgery

Painful - Physio/epidural/pain meds/surgery

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13
Q

What is peripheral neuropathy and what are the causes?

A

PN = any condition that results in loss/reduced nerve function

Causes:

  • acute injury (traction like Burners- Stinger, laceration like glass cutting into nerve)
  • compression (external structures like cast, belt; internal structures like muscle, bone, cyst, tumor)
  • disease (diabetes, kidney disease, kidney disease)
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14
Q

What are the main nerves of the UE and where can they get entrapped?

A

Ulnar nerve - Canal of Guyon, cubital tunnel, in FCU
Medial nerve - carpal tunnel, pronator/flexor group
Radial nerve - spiral groove, supinator, extensors

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15
Q

Describe Guyon’s canal syndrome

A

What - ulnar nerve affected as it passes through Guyon’s canal in wrist - d/t cyst, pressure, trauma

  • symptoms can vary - depending on location of compression
  • ulbar nerve splits into superficial sensory and deep motor so symptoms can be: MIXED MOTOR/SENSORY; SENSORY only; MOTOR only
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16
Q

What are the main causes of median nerve entrapment

A
  • fractures/dislocations
  • CTS
  • ligament of Struthers
  • pronator teres/FDS/Gantzer mm/biceps aponeurosis compression
17
Q

The pinch sign is indicative of what affected nerve?

A

AIN

18
Q

What are the main causes of radial nerve injury?

A
  • humeral head fractures
  • compression/trauma @ spiral groove
  • mm entrapment - ECRB, supinator,
19
Q

Describe tarsal tunnel syndrome

A

Entrapment of tib pos behind the flexor retinaculum
Paresthesia in plantar foot
D/t trauma/SOL/swelling/

20
Q

What might causes problems with the various parts of the peroneal nerve?

A

Common peroneal - at fibular head - direct pressure/trauma/fracture

Superficial - trauma to shank of leg; inversion sprain that pulls on nerve; lateral compartment syndrome

Deep - tight shoe laces, anterior compartment syndrome

21
Q

What are the indications for use of NC testing?

A
  • deteriorating neuro signs
  • red flag signs
  • conservative treatment not helping
  • clinical exam unclear
22
Q

What might education include for a pt with radiculopathy?

A
  • the pathophysiology of the problem
  • the prognosis (many get better in 12 weeks; many recover without needing surgery)
  • self management - ie. the importance of positioning
  • investigation - what and when
23
Q

When is neural mobs used?

A
  • when neural structures are a source of pain but there’s no neuropathy (condcution loss) since it might hinder repair/remyelination
24
Q

What are manual therapy options for radiculopathy?

A

Manual therapy - IVF opening moves - PPIVM/lateral glides
Traction no more effective than placebo
Surgery - no diff to conservative tx long term
Injection - good alternative to surgery
Collar - semi rigid OR physio better than wait and see

25
Q

What are management considerations for radiculopathy?

A
  • should see improvement in 4 weeks - usually recovers greatly in 12 weeks
  • ## refer if neuro deteriorates
26
Q

What are management considerations for PNE?

A
  1. Reduce compression
  2. Strengthen mm’s (simple to functional)
  3. Neural mobs if no neuropathy and there’s mechanosensitivity
  4. Injections/surgery

PHTY5206 (11 decks)

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