T19

• UPMN is CNS
• LMN is PNS
• UPMN lesions need immediate referral to A+E
• If Babinski and Clonus are positive and reflexes are hyperreactive - immediate referral to A+E
• dermatome is region of skin supplied by spinal nerve
• Indications to do a neuro integrity exam:

  • Neural symptoms
  • referred/radiating pain beyond buttocks/gluteal fold
• myotome is muscle group supplied by the same spinal nerve
• • LMN lesions only need referral to GP if symptoms are severe e.g. no sensation at all
  • but if symptoms have come on rapidly, its an instant referral to A+E
• Types of referred pain - somatic referred pain vs radicular pain:

  • both are symptoms and both require a neuro integrity test to be done
  • radicular pain is neuropathic - sharp shooting pain, burning, usually part of a dermatome
  • somatic refereed pain - nociceptive pain - inflammatory mediators setting off nociceptors, the nerve in the area and surrounding nerves converge in a direction , so the brain interprets the whole area of being painful. Dull achey pain
• Radiculopathy:

  • is a diagnosis (not a symptoms like radicular pain and somatic referred pain)
  • interference in conduction of a nerve, so nerve isnt functioning as it should
  • is what were testing for in neuro integrity exams - altered sensations, hypoactivity
  • can happen with or without radicular pain
• If patient doesnt get better:

  • revaluate and reflect
  • is patient doing exercise, why not, are our exercises good enough, is our diagnosis right
  • in the end we refer the patient