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34 Cards in this Set

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Define Radiculopathy
Irritation of a nerve root (radical) as it leaves the spinal canal.
What are the generalized symptoms of radiculopathy? x4
VARIABLE effects on:

Pain
Weakness
Diminished reflex
Loss of dermatome sensation
T/F - Radiculopathy affects the UMN and LMN.
False: Only the LMN
Describe the peaks of incidence in radiculopathy.
Decades 4-5 --> Disc herniation

Decades 8-9 --> Degenerative foraminal stenosis
Describe the prognosis of radiculopathies in younger cohorts.
80% - 90% chance of spontaneous improvement
Cervical radiculopathy:

- describe onset
- common complaint
Insidious onset

"shoulder pain"
which is actually neck pain until proven otherwise.
Cervical radiculopathy:

- Pain location/intensity
- Pain increases with what?
- Pain decreases with what?
Extremity > Axial
(80:20)

Neck extension or Spurling's (neck rotation towards painful extremity)

Placing hand on head.
What is Spurling's sign?
Increased pain (along with possible loss of dermatome sensation) when rotating neck toward painful extremity.
Irritation of nerve root C5 will affect the following how?

- Reflex
- Muscle
- Dermatome
Biceps reflex

Deltoid muscle

Lateral arm
Irritation of nerve root C6 will affect the following how?

- Reflex
- Muscle
- Dermatome
Brachioradialis reflex

Biceps muscle

Thumb and index
Irritation of nerve root C7 will affect the following how?

- Reflex
- Muscle
- Dermatome
Tricep reflex

Tricep muscle

Middle finger
Irritation of nerve root C8 will affect the following how?

- Reflex
- Muscle
- Dermatome
none

Fingers (FDP)

Ring finger and pinky
Irritation of nerve root T1 will affect the following how?

- Reflex
- Muscle
- Dermatome
none

Interossei

Medial arm
Irritation of nerve root C5 will affect the following how?

- Reflex
- Muscle
- Dermatome
Biceps reflex

Deltoid muscle

Lateral arm
Irritation of nerve root C6 will affect the following how?

- Reflex
- Muscle
- Dermatome
Brachioradialis reflex

Biceps muscle

Thumb and index
Irritation of nerve root C7 will affect the following how?

- Reflex
- Muscle
- Dermatome
Tricep reflex

Tricep muscle

Middle finger
Irritation of nerve root C8 will affect the following how?

- Reflex
- Muscle
- Dermatome
none

Fingers (FDP)

Ring finger and pinky
Irritation of nerve root T1 will affect the following how?

- Reflex
- Muscle
- Dermatome
none

Interossei

Medial arm
Lumbar radiculopathy:

- describe onset
- common complaint
Insidious onset

"Hip/butt pain" --> usually means back pain
Lumbar radiculopathy:

- Pain location/intensity
- Pain increases with what actions?
- Pain increases with what movement?
Extremity > Axial
(80:20)

Cough, sneeze, valsalva

Forward flexion of leg
The straight leg raise test is for which nerve roots?
L5 and S1
What is Bragard's sign?
Procedure used to determine whether source of lower back pain is nervous or muscular; leg is kept straight as if flexed forward at hip.

Confirms Straight Leg Raise Test.
In lumbar radiculopathy, an irritation of nerve root L4 does what to the following:

- Reflex
- Muscle
Patella reflex diminished

Quadricep weakness
In lumbar radiculopathy, an irritation of nerve root L5 does what to the following:

- Reflex
- Muscle
None

EHL/TA
In lumbar radiculopathy, an irritation of nerve root S1 does what to the following:

- Reflex
- Muscle
Ankle

Gastrocnemius
Are MRI's a screening tool for radiculopathy? Why or why not?
Not a screening tool, because of VERY HIGH FALSE POSITIVE RATE.
What is the best diagnosis tool for radiculopathy?
History and Exam
In treatment for radiculopathy, what would you want to do first?
Nothing, but be cautious.

Gain additional history
What is the best option with radiculopathies?
Time
What is the surgical alternative for cervical radiculopathy?
ACDF

(Anterior Cervical Dissection and Fusion)
What are the indications for ACDF? x5
"Failure" of epidural steroids

6 weeks of pain without improvement

Progressive weakness

Unbearable pain

Bowel/Bladder involvement
What is the surgical alternative for lumbar radiculopathy?
Lumbar Microdissectomy
What are the indications for Microdissectomy? x5
"Failure" of epidural steroids

6 weeks of pain without improvement

Progressive weakness

Unbearable pain

Bowel/Bladder involvement
What is Cauda Equina syndrome and what is it an indication for?
Dull pain in upper sacral region with anesthesia or analgesia

accompanied by bowel and bladder disturbance

Indicative of pressure on cauda equina

may require lumbar microdissectomy