Radiculopathy

• Radiculopathy:

  • Compression of the spinal nerve root
  • Pain and sensory changes within the dermatome and or myotome
  • Lower motor neurone symptoms = hyporeflexia, hypotonia
  • Can happen anywhere in the spine but lumbosacral is most common
• Skeletal causes - compression due to lateral or foraminal spinal stenosis e.g.

  • Spondylosis - bony spurs at the facet joint can compress nerve roots
  • Spondylosis
  • Intervertebral disc herniation
• Non skeletal causes:

  • Diabetes
  • Infections e.g. lyme disease
  • Inflammatory conditions e.g. variant of GBS involving spinal nerves
  • Vascular e.g. vasculitis
  • Cancer e.g. metastatic disease, myeloma
• Cervical radiculopathies:

  • Neck, shoulder, arm pain with sensory changes and weakness in distribution of the affected spinal nerve
  • Lower cervical nerve roots most commonly affected e.g. C6 and C7
  • Often due to compressive causes - especially spondylosis and disc herniation
• Thoracic radiculopathy:

  • Less movement in this part of spine to less prone to degenerative change
  • Thoracic pain and radiculopathy is a red flag - cancer and infection
  • Pain in the back and/or sensory changes that radiate around chest in a linear pattern - dermatomal distribution
  • Muscle weakness is less noticeable
• L5 lumbar radiculopathy:

  • Most common lumbar radiculopathy
  • Back pain that radiates down the lateral aspect of the leg to the foot
  • May have sensory changes over lateral aspect of lower leg and dorsum of the foot
  • Weakness seen on foot dorsiflexion, big toe extension and foot inversion/eversion
• S1 lumbar radiculopathy:

  • Back pain that radiated down the posterior aspect of leg and into foot
  • Sensory changes may be present over posterior leg and lateral foot
  • Weakness may be present in hip extension and knee flexion
  • May be loss of ankle reflex
• Straight leg raise test for L5/S1 radiculopathy:

  • Patient lies on back
  • Hold ankle and raise leg (keep straight) - then add extra force by dorsiflexing foot
  • If there is L5/S1 radiculopathy this will cause worsening pain
• Reverse straight leg raise for L2-4 radiculopathy:

  • Patient lies on front
  • Flex knee to 90 degree and extend hip joint
  • If there is L2-4 radiculopathy this will cause worsening radicular pain
• The sciatic nerve:

  • Largest nerve in the body
  • Formed from a combination of nerve roots L4, L5, S1, S2 and S3
• Sciatica:

  • Lumbosacral radiculopathy that involves the L4-S3 nerve roots
  • Irritation of these nerve roots (alone or in combination) can cause a variety of sciatica like symptoms
  • Unilateral sharp or burning pain radiating from the buttock along the course of the sciatic nerve down the posterior/lateral leg and usually to the foot
  • Low back pain that is less severe than the leg pain
  • Numbness, tingling in dermatomal distribution
  • Weakness or reflex changes in myotomal distribution
  • Positive straight leg raise test
• Sciatica causes:

  • Same for any radiculopathy
  • 90% are due to disc herniation which most commonly occurs at L5/S1 level
• Femoral nerve:

  • L2-4 nerve roots make the femoral nerve
  • Compression of these roots causes femoral nerve radiculopathy which causes different symptoms to sciatic nerve compression
  • Pain in the back radiating down the front of the thigh and into the medial leg and foot
  • Positive reverse straight leg test
  • Femoral nerve radiculopathy much less common than L5/S1 radiculopathy