Radiculopathy profoma

Question 1

What is radiculopathy?

Answer 1

Radiculopathy describes a range of symptoms produced by the pinching of a nerve root in the spinal column.

Question 2

Pathophysiology of radiculopathy?

Answer 2

Stenosis - abnormal narrowing of a passage in the body.

Osteophytes - boney projections along bone edges.

Disc herniation- nucleus pulposus bulges or ruptures annulus fibrosus, causing pressure on spinal nerves.

Trauma- lumbar disc herniation is caused by lifting heavy objects while the spine is flexed.
- Injury to the lumbar spine results loss of normal lumbar lordosis.
-Causes spasm of the paraspinal muscles.

Question 3

Clinical presentation of radiculopathy?

Answer 3

General presentation
- Paraesthesia
- Weakness
- Radiates below the knee
- Unilateral leg pain worse than low back pain.
- Nerve irritation signs e.g. reduced straight leg raise.
- Usually L5 or S1

Cervical radiculopathies
- Pain in neck- radiates in distribution of affected nerve root.
- Neck is held rigidly & neck movements exacerbate pain
- Parasethesia & sensory loss
- Lower motor neurone signs - weakness, wasting & reflex impairment

C5:
- bicep, deltoid, spinati weakness
- bicep reflex loss
- i.e. lateral aspect of arm

C6:
- Brachioradialis weakness
- supinator reflex loss
- i.e. Lateral aspect forearm

C7:
- triceps, finger & wrist extensor weakness
- tricep reflex loss
- medial aspect of arm

Lumbar radiculopathies:
- Onset may be sudden or gradual.
- Or repeated episodes of lower back pain may precede sciatica by months or years.
- Constant aching pain felt in the lumbar region.
- Pain is exaserbated by coughing or straining
- Relieved by lying flat.
- Pain may radiate to the buttock, thigh, calf and foot.

L5:
- weak dorsiflexion of big toe & feet
- weak dorsiflexion lateral 4 toes
- weak eversion
- sensory loss dorsum of foot
- positive sciatic nerve stretch test

L4:
- weak Knee extension
- weak Foot inversion/ dorsiflexion
- decreased knee jerk
- weak quadriceps
- sensory loss in anterior aspect of knee
- positive femoral stretch test

L3:
- weak Hip adduction
- weak knee extension
- reduced knee reflex
- sensory loss over anterior thigh
- postive femoral stretch test

L2:
- Weak hip flexion & adduction

S1:
- sensory loss lateral aspect of leg & foot
- absent ankle jerk
- weak gluteal contraction*
- weak knee flexion*
- weak toe planter flexion*
- positive sciatic nerve stretch test
* do not occur w/out absent ankle jerk

NOTE: always ask about red flags of quada equina

Question 4

Investigations for radiculopathy?

Answer 4

1. Where there is no trauma, imaging should not be carried out for isolated cervical pain.
2. MRI - invesigation of choice- especially for quada equina
3. X-ray- offer limited benefit except for finding destructive lesions.

Question 5

Management for radiculopathy?

Answer 5

1. Analgesics
2. Physiotherapy - early mobilisation asbbed rest does not help recovery. Back strengthening exercises & avoiding physical manoevures.
3. Injections of local anesthetic & glucocorticoids may help if symptoms are due to ligament injury or joint disfunction.
4. Surgery - disc decompression or discectomy.