Acute And Chronic Nerve Roots

Question 1

What are some signs and symptoms of nerve root pain?

Answer 1

Unilateral leg pain (below knee to ankle)

Leg pain worse than back pain

Numbness in same Dermatome

Nerve axon loss (motor, sensory, or reflex changes)

Question 2

Radiculopathy

Answer 2

Pain down the leg associated with at least one of the following 3 symptoms

1. Strength loss in myotomal pattern
2. Sensation loss in a dermatomal pattern
3. Decrease or absence of associated DTR

Question 3

What results in a positive straight leg raise test?

Answer 3

If < 40° you get pain

Pain worsened with ankle dorsiflexion

Question 4

What is a positive crossed straight leg raise test?

Answer 4

SLR on uninvolved side provokes pain down involved side

Question 5

What is a positive femoral nerve stretch?

Answer 5

Burning or vague painful sensation down anterior thigh

Include hip extension

Question 6

What is the adverse neural tension test?

Answer 6

Slumping of spine

Question 7

When would you refer a patient to traction?

Answer 7

It is for people who could not get pain to centralize through repeated movements

Positive cross straight leg test

Peripheralizing with extension

Question 8

What are some other causes for those with leg symptoms who do not fit into Radiculopathy?

Answer 8

Denervation

Central sensization

Peripheral nerve sensation

Adverse neural dynamics

Myofascial trigger points

Question 9

How could you manage a patient with leg pain that doesn’t resolve with directional preference?

Answer 9

Bed rest

Injections

Surgery

(5% of patients with Radiculopathy)

Question 10

Why is bed rest not the best approach for sciatica?

Answer 10

Bed rest can make the symptoms worse (instead give them crutches so they can still move but have less pressure on leg)

Question 11

Is surgery effective for those with sciatica?

Answer 11

It has a benefit in the short term but no benefit in long term