Radiculopathy Flashcards
What are the myotomes for the lower limb?
L2 - hip flexors L3 - quads L4 - tib ant L5 - extensor hallucis/peroneals S1 - gastrocs S2 - flexor dig longus
What are the relfexes for the LL?
Quads - L3/4
Achilles - S1/2
What are indications for neuro exam for lumbar spine complaint?
- Pain in dermatomal distribution
- Pain past the buttock
- Altered sensation in the LL
What are the myotomes for the UL?
C5 - deltoids C6 - biceps C7 - triceps C8 - extensor pollicis longus/flexor dig profundus T1 - palmar interrossei
Define neuropathic pain
- disturbance of function or pathological change in a nerve
- mononeuropathy, mononeuropathy multiplex, or polyneuropathy
- pain caused by a lesion of the somatosensory nervous system
Define radiculopathy
- disorder of the spinal nerve root
- d/t SOL in the IVF
- results in nerve root inflammation
- ischaemia
- inflammation
- compression
What are the different causes of lumbar vs cervical radiculopathy?
Lumbar - disc
Cervical - spondylosis (facet joints, uncovertebral joints, osteophytes)
What are the stages of DDD?
Mild - dehydration of nucleus pulposus
Moderate - disintegrated nature of annulus pulposus + dehydration
Severe - decreased IVD height
What is radicular pain?
- arise from a irritation of spinal nerve
- shooting
- band like
- localized
- distal > central
- pain below elbow
What is the diagnosis cluster for cervical radiculopathy
- ULTT
- Spurlings
- Distraction
- ROM - reduced rotation <60º
Specificity of 99%
Whats the difference between painful and non-painful radiculopathy?
- 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
How does management differ between painful vs non painful radiculopathy
Non painful - wait and see/physio/surgery
Painful - Physio/epidural/pain meds/surgery
What is peripheral neuropathy and what are the causes?
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)
What are the main nerves of the UE and where can they get entrapped?
Ulnar nerve - Canal of Guyon, cubital tunnel, in FCU
Medial nerve - carpal tunnel, pronator/flexor group
Radial nerve - spiral groove, supinator, extensors
Describe Guyon’s canal syndrome
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
What are the main causes of median nerve entrapment
- fractures/dislocations
- CTS
- ligament of Struthers
- pronator teres/FDS/Gantzer mm/biceps aponeurosis compression
The pinch sign is indicative of what affected nerve?
AIN
What are the main causes of radial nerve injury?
- humeral head fractures
- compression/trauma @ spiral groove
- mm entrapment - ECRB, supinator,
Describe tarsal tunnel syndrome
Entrapment of tib pos behind the flexor retinaculum
Paresthesia in plantar foot
D/t trauma/SOL/swelling/
What might causes problems with the various parts of the peroneal nerve?
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
What are the indications for use of NC testing?
- deteriorating neuro signs
- red flag signs
- conservative treatment not helping
- clinical exam unclear
What might education include for a pt with radiculopathy?
- 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
When is neural mobs used?
- when neural structures are a source of pain but there’s no neuropathy (condcution loss) since it might hinder repair/remyelination
What are manual therapy options for radiculopathy?
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
What are management considerations for radiculopathy?
- should see improvement in 4 weeks - usually recovers greatly in 12 weeks
- ## refer if neuro deteriorates
What are management considerations for PNE?
- Reduce compression
- Strengthen mm’s (simple to functional)
- Neural mobs if no neuropathy and there’s mechanosensitivity
- Injections/surgery
