RADICULOPATHY AND PLEXOPATHY

Question 1

What are the clinical features of any radiculopathy?

Answer 1

Pain - severe, sharp, shooting and/or burning pain radiating into the dermatome or myotome supplied by the root. Aggravated by movement, straining or coughing.

Lower motor neurone lesion signs

Sensory impairment in affected dermatome

Question 2

What is the most common radiculopathy in the cervical spine?

Answer 2

C7

Question 3

What are the muscles affected by a C7 radiculopathy?

Answer 3

Triceps

Wrist and finger extensors

Question 4

What are the reflexes affected by a C7 radiculopathy?

Answer 4

Triceps jerk

Question 5

What is the most common radiculopathy affecting the lumbar spine?

Answer 5

L5 and S1 due to lateral prolapse of L4/5 and L5/S1

Question 6

What are the symptoms of L5 or S1 radiculopathy?

Answer 6

Low back pain

Pain radiating down the buttock and lower limb

Question 7

What are the movements affected by a L5 radiculopathy?

Answer 7

Extension of the big toe

Question 8

What are the movements affected by a S1 radiculopathy?

Answer 8

Plantar flexion at the ankle

Question 9

What are the classic clinical features of cauda equina compression due to a central lumbar disc protrusion?

Answer 9

Low back pain
Radiation down the legs
Lower motor neurone weakness of the legs and feet
Sacral numbness
Urinary retention
Bowel dysfunction
Impotence

Question 10

How do you treat cauda equina compression?

Answer 10

Imaging and decompression

Question 11

What are the clinical features of neuralgic amyotrophy?

Answer 11

Severe shoulder muscle pain followed 2-7 days later by rapid wasting and weakness in the proximal muscles of the arms
Can be bilateral
Loss of tendon reflexes
Minor sensory impairment

Question 12

What are the features of thoracic outlet syndrome (cervical rib)?

Answer 12

Caused by a fibrous band or cervical rib stretching the lower part of the brachial plexus (C8, T1).

Pain along the ulnar border of the forearm and sensory loss initially in the distribution of T1, with wasting of the thenar muscles predominantly.
Can develop vascular syndrome with compression of subclavian artery or vein - unilateral Raynaud’s, loss of radial pulse on abduction and external rotation of shoulder (Adson’s sign)

Question 13

What is the treatment of cervical rib (thoracic outlet syndrome)?

Answer 13

Surgical decompression

Question 14

What are the features of diabetic amyotrophy?

Answer 14

Painful wasting usually strikingly asymmetrical. Normally of the quads and psoas.
Loss of knee jerk
Extreme tenderness over affected area