radiculopathy

Question 1

sx of radiculopathy

Answer 1

acute stabbing pain/electrical sensation at the level of the compression - dermatomal

radiates to legs (sciatica) or arms

parasthesia of dermatome

numbness, dull reflex, LMN weakness and wastage at level of root

pain increases with pressure

short walks and changing position reduces the pain

Question 2

what is radiculopathy

Answer 2

root compression

Question 3

which root is affected

Answer 3

the one below the herniation eg L4L5 herniation = L5 radiculopathy

Question 4

S1 root compression

Answer 4

calf pain

weak foot plantar flexion

reduced pinprick sensation over sole of foot and back of calf

reduced ankle jerk

Question 5

L5 root compression

Answer 5

hallux extension is weak

reduced sensation on outer dorsum of foot and lateral leg

Question 6

Ix for radiculopathy

Answer 6

MRI or CT

plain XR - exclude other dx

straight leg raise test (lasegue sign) - straight leg raised = increased pain on ipsilateral with radiation to motor and sensory of affected root

bragard sign - straight leg raised = increased pain in ipsilateral leg - leg lowered to just below this point + ankle dorsiflexed = reproduction of the pain

crossed straight leg raise test - opposite straight leg raised = pain in contralateral in root area

spurling manouvre (neck compression test) - cervical spine radiculopathy - forward flexion, tilting and rotation of neck to affected side and application of downward pressure to head = reproduction of pain or parasthesia with radiation

Question 7

aetiology of radiculopathy

Answer 7

degenerative disc changes

• disc protrusion - protrusion of the vertebral disc nucleus pulposus through annulus fibrosus
• disc herniation - (disc extrusion ot prolapse) - complete herniation of the nucleus pulposus through a tear in anulus fibrosis
• disc sequestration - extrusion of nucleus pulposes and separation of a fragment of the disc

trauma

OA

Question 8

epidemiology of radiculopathy

Answer 8

30-50yrs

female

cervical and thoracic herniations - rare

lumbosacral L5-S1 most common site

Question 9

MRI for radiculopathy

Answer 9

confirm dx

disc degeneration - sclerosed, dehydrated disc - hypointense on T2 weighted image

disc prolapse/herniation - herniation and oedema

Question 10

c3/4 radiculopathy

Answer 10

level of lesion - c2-4

sensory loss - shoulder and neck

scapular wing

Question 11

c5 radiculopathy

Answer 11

level of lesion - c4-c5

sensory - anterior shoulder

motor - biceps and detoid

biceps reflex reduced

Question 12

c6 radiculopathy

Answer 12

lesion - c5–c6

sensory - upper lateral elbow -> radial forearm -> thumb and radial side of index

motor - biceps and wrist extensor

reflex - biceps, brachioradial

Question 13

c7 radiculopathy

Answer 13

level - c6-c7

sensory

• palmar - ulnar side of finger 2, all 3, radial side of 4
• dorsal - medial forarm up to 2-4

motor - triceps and wrist flexors, finger extensors

reflex - triceps

Question 14

c8 radiculopathy

Answer 14

level c7-c8

sesnory - dorsal - forarm and up to dorsal and palmar area of fingers: ulner part of 4 and all 5, hypothenar eminence

motor - finger flexors

Question 15

l3 radiculopathy

Answer 15

lesion - l2-3

sensory - anterior lateral area of the thigh, stretching diagonally from the thigh to the upper area of the medial knee

motor - hip flexion

reflex - adductor, patella

Question 16

l4 radiculopathy

Answer 16

lesion - l3-4

sesnory - distal anterolateral thigh ober patella to inner side of lower leg

motor - knee extension

reflex - patella

Question 17

l5 radiculopathy

Answer 17

lesion - l4-5

sensory - lateral sides of the thigh and knee, anterolateral leg, dorsum of foot, big toe

motor

• tibialis anterior (foot dorsiflexion) = difficulty heel walking ie foot drop
• extensor hallucis longus - first toe dorsiflexion

reflex - posterior tibial reflex (medial hamstring)

Question 18

S1 radiculopathy

Answer 18

lesion - l5-S1

sesnory - dorsolateral thigh and lower leg, lateral foot

motor - peroneus longus and brevis muscle (foot eversion) and gastrocnemius muscle (foot plantarflexion) = difficulty walking

reflex - achilles, lateral hamstring

Question 19

s2 3 and 4 radiculopathy

Answer 19

lesion - s1-s4

sensory - posterior aspect of thigh and lower leg (s2), perineum (s3), perianal (s4)

reflex - bulbocavernosus, perineal

Question 20

mx of sciatica

Answer 20

STarT back screening tool - assess disability
1. self mx - continue normal activities - usually settle within months
2. analgesia (NOT opioids) - lowest NSAID dose for shortest time
3. gp exercise program
4. physio
5. psychological therapy - CBT

Question 21

self mx for sciatica

Answer 21

• return to work
• hot water bottle
• keep active
• pain doesnt = injury

Question 22

mx of cervical radiculopathy

Answer 22

• if less than 4-6 wks = conservative
• if >4-6wks or neuro signs - MRI, iterlaminar cervical epidural injections

Question 23

conservative mx for cervical radiculopathy

Answer 23

• reassure good px
• activity
• dont drive if range of neck motion reduced
• firm pillow
• oral analgesics
• consider amitriptyline, duloxetine, pregabalin, or gabapentin
• physio

Question 24

indications for surgery for cervical radiculopathy

Answer 24

unremitting pain despite 3 mo conservative rx
disabling sx
progressive motor weakness
mri shows root compression