Yr 3 neuro > radiculopathy > Flashcards

radiculopathy Flashcards

(24 cards)

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1
Q

sx of radiculopathy

A

acute stabbing pain/electrical sensation at the level of the compression - dermatomal

radiates to legs (sciatica) or arms

parasthesia of dermatome

numbness, dull reflex, LMN weakness and wastage at level of root

pain increases with pressure

short walks and changing position reduces the pain

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2
Q

what is radiculopathy

A

root compression

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3
Q

which root is affected

A

the one below the herniation eg L4L5 herniation = L5 radiculopathy

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4
Q

S1 root compression

A

calf pain

weak foot plantar flexion

reduced pinprick sensation over sole of foot and back of calf

reduced ankle jerk

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5
Q

L5 root compression

A

hallux extension is weak

reduced sensation on outer dorsum of foot and lateral leg

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6
Q

Ix for radiculopathy

A

MRI or CT

plain XR - exclude other dx

straight leg raise test (lasegue sign) - straight leg raised = increased pain on ipsilateral with radiation to motor and sensory of affected root

bragard sign - straight leg raised = increased pain in ipsilateral leg - leg lowered to just below this point + ankle dorsiflexed = reproduction of the pain

crossed straight leg raise test - opposite straight leg raised = pain in contralateral in root area

spurling manouvre (neck compression test) - cervical spine radiculopathy - forward flexion, tilting and rotation of neck to affected side and application of downward pressure to head = reproduction of pain or parasthesia with radiation

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7
Q

aetiology of radiculopathy

A

degenerative disc changes

  • disc protrusion - protrusion of the vertebral disc nucleus pulposus through annulus fibrosus
  • disc herniation - (disc extrusion ot prolapse) - complete herniation of the nucleus pulposus through a tear in anulus fibrosis
  • disc sequestration - extrusion of nucleus pulposes and separation of a fragment of the disc

trauma

OA

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8
Q

epidemiology of radiculopathy

A

30-50yrs

female

cervical and thoracic herniations - rare

lumbosacral L5-S1 most common site

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9
Q

MRI for radiculopathy

A

confirm dx

disc degeneration - sclerosed, dehydrated disc - hypointense on T2 weighted image

disc prolapse/herniation - herniation and oedema

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10
Q

c3/4 radiculopathy

A

level of lesion - c2-4

sensory loss - shoulder and neck

scapular wing

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11
Q

c5 radiculopathy

A

level of lesion - c4-c5

sensory - anterior shoulder

motor - biceps and detoid

biceps reflex reduced

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12
Q

c6 radiculopathy

A

lesion - c5–c6

sensory - upper lateral elbow -> radial forearm -> thumb and radial side of index

motor - biceps and wrist extensor

reflex - biceps, brachioradial

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13
Q

c7 radiculopathy

A

level - c6-c7

sensory

  • palmar - ulnar side of finger 2, all 3, radial side of 4
  • dorsal - medial forarm up to 2-4

motor - triceps and wrist flexors, finger extensors

reflex - triceps

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14
Q

c8 radiculopathy

A

level c7-c8

sesnory - dorsal - forarm and up to dorsal and palmar area of fingers: ulner part of 4 and all 5, hypothenar eminence

motor - finger flexors

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15
Q

l3 radiculopathy

A

lesion - l2-3

sensory - anterior lateral area of the thigh, stretching diagonally from the thigh to the upper area of the medial knee

motor - hip flexion

reflex - adductor, patella

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16
Q

l4 radiculopathy

Study These Flashcards
A

lesion - l3-4

sesnory - distal anterolateral thigh ober patella to inner side of lower leg

motor - knee extension

reflex - patella

17
Q

l5 radiculopathy

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A

lesion - l4-5

sensory - lateral sides of the thigh and knee, anterolateral leg, dorsum of foot, big toe

motor

  • tibialis anterior (foot dorsiflexion) = difficulty heel walking ie foot drop
  • extensor hallucis longus - first toe dorsiflexion

reflex - posterior tibial reflex (medial hamstring)

18
Q

S1 radiculopathy

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A

lesion - l5-S1

sesnory - dorsolateral thigh and lower leg, lateral foot

motor - peroneus longus and brevis muscle (foot eversion) and gastrocnemius muscle (foot plantarflexion) = difficulty walking

reflex - achilles, lateral hamstring

19
Q

s2 3 and 4 radiculopathy

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A

lesion - s1-s4

sensory - posterior aspect of thigh and lower leg (s2), perineum (s3), perianal (s4)

reflex - bulbocavernosus, perineal

20
Q

mx of sciatica

Study These Flashcards
A

STarT back screening tool - assess disability
1. self mx - continue normal activities - usually settle within months
2. analgesia (NOT opioids) - lowest NSAID dose for shortest time
3. gp exercise program
4. physio
5. psychological therapy - CBT

21
Q

self mx for sciatica

Study These Flashcards
A
  • return to work
  • hot water bottle
  • keep active
  • pain doesnt = injury
22
Q

mx of cervical radiculopathy

Study These Flashcards
A
  • if less than 4-6 wks = conservative
  • if >4-6wks or neuro signs - MRI, iterlaminar cervical epidural injections
23
Q

conservative mx for cervical radiculopathy

Study These Flashcards
A
  • reassure good px
  • activity
  • dont drive if range of neck motion reduced
  • firm pillow
  • oral analgesics
  • consider amitriptyline, duloxetine, pregabalin, or gabapentin
  • physio
24
Q

indications for surgery for cervical radiculopathy

Study These Flashcards
A

unremitting pain despite 3 mo conservative rx
disabling sx
progressive motor weakness
mri shows root compression

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