Radiculopathies

Question 1

Definition

Answer 1

Condition where the nerve root in the spinal column becomes inflamed or compressed, causing, pain, numbness or weakness radiating due to herniated discs, spinal stenosis or degenerative disc disease.

Question 2

Classification

Answer 2

Cervical radiculopathy: affects the neck and upper limbs
Thoracic radiculopathy: affects the mid-back and torso
Lumbo-sacral radiculopathy: affects the lower back and lower limbs

Question 3

Epidemiology and risk factors

Answer 3

Age - 30-50
Sex: men
Occupational factors: jobs involving heavy lifting or repetitive movements
Osteoarthritis: cervical radiculopahy can arise from osteoarthritic changes in the c-spine

Question 4

Pathophysiology

Answer 4

Nerve roots arise from individual level of the spine cord, with most roots interconnecting at plexi (e.g brachial plexus, lumbosacral plexus) before forming district peripheral nerves.
A peripheral nerve may have multiple nerve root contributions.
Delineating between a radiculopathy and a peripheral neuropathy

Question 5

Signs

Answer 5

• Positive straight leg raise test: places tensile stress on the L2-4 + sciatic nerve
• Sensory deficits in a dermatomal distributiom
• Reduced muscle power

Question 6

Symptoms

Answer 6

• Radiating pain : may originate in neck or back, depending on site of pathology
• Paraesthesia or numbness
• Muscle weakness

Question 7

Dermatomes definition

Answer 7

Skin that receives sensory nervous supply from a single spinal nerve root (e.g. T1)

Question 8

Ddx

Answer 8

Peripheral neuropathy

Question 9

L5 radiculopathy clinical features

Answer 9

• Weakness of foot dorsiflexion
• Weakness of toe extension
• Weakness during foot inversion
• Lower limb tendon reflex changes present
• L5 dematomal distribution of sensory loss

Question 10

Common perioneal nerve injury clinical features

Answer 10

• Weakness of foot dorsiflexion
  -Weakness of toe extension
• Weakness during foot eversion
• No changes to lower limb reflexes
• Sensory loss over the anterior aspects of foot and leg

Question 11

Diagnosis

Answer 11

• MRI: to identify the level and cause of nerve root compression = for persistent or severe symptoms
• Nerve conduction studies: assess speed of nerve signal transmission.
• Electromyography (EMG): evaluate electrical activity in muscles and identify the affected nerve root.

Question 12

Treatment

Answer 12

FIRST LINE:
- NSAIDs: ibuprofen
- Physical therapy
Second-line:
- Epidural steroid injections: (severe) to reduce inflammation around the nerve root
- Surgery: laminectomy or discectomy may be considered for persistent, severe symptoms not responsive to conservative treatment

Question 13

Complications

Answer 13

Chronic pain
Motor weakness
Sensory loss