Radiculopathies

Question 1

Define radiculopathies

Answer 1

Conduction block in the axons of a spinal nerve or its roots

Radiculopathy is a state of neurological loss and may or may not be associated with radicular pain
Radicular pain is pain deriving from damage or irritation of the spinal nerve tissue, particularly the dorsal root ganglion

Question 2

Aetiology of radiculopathies

Answer 2

Intervertebral disc prolapse
- Predominantly lumbar spine - rupture of the annulus fibrosus and sequestration of disc material (the nucleus pulposus)
Degenerative disease of the spine
- Spinal canal stenosis
- Cervical spine most common (due to normal ageing process)
Fracture
Malignancy
Infection

Question 3

Symptoms of radiculopathies

Answer 3

Sensory features: paraesthesia and numbness
Motor: weakness
Radicular pain: burning, deep, strap-like/narrow pain

Question 4

Investigations for radiculopathies

Answer 4

Can be clinical

Nerve conduction
EMG
X-ray
MRI

Question 5

Features of cervical spondylosis

Answer 5

Degenerative disease of the cervical spine

neck pain
Flaccid upper limb paresis
Myelopathy: variable sensory changes (sometimes including the Lhermitte phenomenon) and spastic paraparesis
Bladder and bowel disturbance

Question 6

Features of L5 radiculopathy

Answer 6

Due to lumbosacral disc herniation

Foot drop (dragging of foot)
Loss of inversion and sensory loss over the L5 dermatome

Question 7

Management for radiculopathies

Answer 7

Acute
Analgesia e.g. simple or neuropathic (Amitriptyline, Pregabalin)
Muscle relaxation: Benzodiazepines, baclofen
Physiotherapy

Chronic
Treat underlying cause E.g. disc prolapse
Cervical spondylosis → anterior cervical decompression (discectomy, corpectomy), posterior decompression (laminoplasty, laminectomy), and fusion techniques

Question 8

Aetiology of foot drop

Answer 8

Common peroneal nerve lesion
L5 radiculopathy
Distal motor neuropathy
Small cortical lesions
Intrinsic cord disease
Partial sciatic nerve disease
Myopathy

Question 9

Features of common peroneal nerve lesion

Answer 9

Compression where it loops over the fibula’s head on the knee joint’s lateral aspect

Weakness or paralysis of dorsiflexion and eversion of the foot
Difficulty in lifting the front part of the foot
A high-stepping gait or foot dragging

Question 10

Features of distal motor neuropathy

Answer 10

Foot drop + glove and stocking sensory disturbance and loss of all movements of the foot

Question 11

Features of small cortical lesions

Answer 11

Foot drop + other UMN features