Lumbar Radiculopathy: Difference between revisions
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<div class="noeditbox">Welcome to [[Vrije Universiteit Brussel Evidence-based Practice Project|Vrije Universiteit Brussel's Evidence-based Practice project]]. This space was created by and for the students in the Rehabilitation Sciences and Physiotherapy program of the Vrije Universiteit Brussel, Brussels, Belgium. Please do not edit unless you are involved in this project, but please come back in the near future to check out new information!!</div> <div class="editorbox"> | <div class="noeditbox">Welcome to [[Vrije Universiteit Brussel Evidence-based Practice Project|Vrije Universiteit Brussel's Evidence-based Practice project]]. This space was created by and for the students in the Rehabilitation Sciences and Physiotherapy program of the Vrije Universiteit Brussel, Brussels, Belgium. Please do not edit unless you are involved in this project, but please come back in the near future to check out new information!!</div> | ||
'''Original Editors ''' | <div class="editorbox"> | ||
'''Original Editors '''- [[User:Adam James|Adam James]], [[User:Clay McCollum|Clay McCollum]], [[User:Liesbeth De Feyter|Liesbeth De Feyter]] | |||
'''Lead Editors''' - Your name will be added here if you are a lead editor on this page. [[Physiopedia:Editors|Read more.]] | '''Lead Editors''' - Your name will be added here if you are a lead editor on this page. [[Physiopedia:Editors|Read more.]] | ||
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== Search Strategy == | == Search Strategy == | ||
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== Clinically Relevant Anatomy == | == Clinically Relevant Anatomy == | ||
add text here | add text here relating to '''''clinically relevant''''' anatomy of the condition<br> | ||
== Epidemiology /Etiology == | == Epidemiology /Etiology == | ||
add text here <br> | add text here relating to the mechanism of injury and/or pathology of the condition<br> | ||
== Characteristics/Clinical Presentation == | == Characteristics/Clinical Presentation == | ||
The clinical presentation of lumbar radiculopathy will vary depending on the cause of the radiculopathy and which nerve roots are being affected. Patients will often present with pain in the lumbar region that radiates through one or both legs. This pain is often described as burning, stabbing, or shooting. For this pain to be considered radiculopathy, however, neurological signs must be present such as weakness, numbness, or reflexive changes.<ref name="Svetlana 2009">Svetlana Tomic et al. (2009). Lumbosacral Radiculopathy - Factors Effects on It's Severity. Coll. Antropol. (33)1: 175-178.</ref> The following chart may be useful in identifying radiculopathy clinically. | The clinical presentation of lumbar radiculopathy will vary depending on the cause of the radiculopathy and which nerve roots are being affected. Patients will often present with pain in the lumbar region that radiates through one or both legs. This pain is often described as burning, stabbing, or shooting. For this pain to be considered radiculopathy, however, neurological signs must be present such as weakness, numbness, or reflexive changes.<ref name="Svetlana 2009">Svetlana Tomic et al. (2009). Lumbosacral Radiculopathy - Factors Effects on It's Severity. Coll. Antropol. (33)1: 175-178.</ref> The following chart may be useful in identifying radiculopathy clinically. | ||
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== Differential Diagnosis == | |||
Differential diagnoses for upper lumbar radiculopathy include spondylolesthesis or an infection (diskitis, epidural abscess). | |||
== | == Diagnostic Procedures == | ||
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== Outcome Measures == | == Outcome Measures == | ||
add links to outcome measures here (see [[Outcome Measures|Outcome Measures Database]]) | add links to outcome measures here (also see [[Outcome Measures|Outcome Measures Database]]) | ||
== Examination == | |||
add text here related to physical examination and assessment<br> | |||
== Medical Management <br> == | |||
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== Physical Therapy Management <br> == | |||
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== Key | == Key Research == | ||
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== Resources <br> == | == Resources <br> == | ||
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== Clinical Bottom Line == | |||
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== Recent Related Research (from [http://www.ncbi.nlm.nih.gov/pubmed/ Pubmed]) == | |||
<div class="researchbox"> | <div class="researchbox"> | ||
<rss>http://eutils.ncbi.nlm.nih.gov/entrez/eutils/erss.cgi?rss_guid=1lClT3-kMn79CZUZKBcYtaY7EMS7_AuIEFI2WdIltBAUjtgkA|charset=UTF-8|short|max=10</rss> </div> | <rss>http://eutils.ncbi.nlm.nih.gov/entrez/eutils/erss.cgi?rss_guid=1lClT3-kMn79CZUZKBcYtaY7EMS7_AuIEFI2WdIltBAUjtgkA|charset=UTF-8|short|max=10</rss> </div> | ||
== References == | == References == | ||
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[[Category:MCG_Student_Project]] [[Category:Articles]] [[Category:Condition]] [[Category:Lumbar]] [[Category:Musculoskeletal/Orthopaedics]] [[Category:Videos]] | [[Category:Vrije_Universiteit_Brussel_Project|Template:VUB]] [[Category:MCG_Student_Project]] [[Category:Articles]] [[Category:Condition]] [[Category:Lumbar]] [[Category:Musculoskeletal/Orthopaedics]] [[Category:Videos]] |
Revision as of 13:17, 26 November 2010
Original Editors - Adam James, Clay McCollum, Liesbeth De Feyter
Lead Editors - Your name will be added here if you are a lead editor on this page. Read more.
Search Strategy[edit | edit source]
add text here related to databases searched, keywords, and search timeline
Definition/Description[edit | edit source]
add text here
Clinically Relevant Anatomy[edit | edit source]
add text here relating to clinically relevant anatomy of the condition
Epidemiology /Etiology[edit | edit source]
add text here relating to the mechanism of injury and/or pathology of the condition
Characteristics/Clinical Presentation[edit | edit source]
The clinical presentation of lumbar radiculopathy will vary depending on the cause of the radiculopathy and which nerve roots are being affected. Patients will often present with pain in the lumbar region that radiates through one or both legs. This pain is often described as burning, stabbing, or shooting. For this pain to be considered radiculopathy, however, neurological signs must be present such as weakness, numbness, or reflexive changes.[1] The following chart may be useful in identifying radiculopathy clinically.
Question | +LR (yes) | -LR(no) |
Weakness? | 1.2 | .73 |
Numbness? | 1.0 | .94 [2] |
See test diagnostics page for explanation of statistics.
Special Tests:
Patient lies supine and raises the leg on the involved side with the knee extended. If pain is produced at 40 degrees or less of hip flexion, the test is positive. Symptoms can be sharpened by adding ankle dorsiflexion to the straight-leg raise. Even if the test is negative, useful information can be gained if symptoms are produced past 40 degrees of hip flexion, assuming that hamstring length is equal.
Crossed Straight Leg Raise Test:
Patient lies supine and raises the leg on the uninvolved side with the knee extended. If pain is provoked down the involved leg, the test is positive for radiculopathy, and indicates that there is likely a large space-occupying lesion (herniated nucleus pulposus). This test is useful for ruling in radiculopathy, as it is highly specific for it.
Clinical presentation for radiculopathy from each lumbar nerve root:
Nerve Root | Dermatomal area | Myotomal area | Reflexive changes |
L1 | Inguinal region | Hip flexors | |
L2 | Anterior mid-thigh | Hip flexors | |
L3 | Distal anterior thigh | Hip flexors and knee extensors | Diminished or absent patellar reflex |
L4 | Medial lower leg/foot | Knee extensors and ankle dorsiflexors | Diminished or absent patellar reflex |
L5 | Lateral leg/foot | Hallux extension and ankle plantar flexors | Diminished or absent achilles reflex |
S1 | Lateral side of foot | Ankle plantar flexors and evertors | Diminished or absent achilles reflex [2] |
- Dermatomes and myotomes aren't intended as an all-inclusive list, but rather a clinically relevant system to assist in neurological screening. See dermatomal map to the left for further clarification.
Although relatively rare, cauda equina syndrome is a serious condition resulting from a central prolapse of a nucleus pulposus in the lumbar region. Cauda equina syndrome will present as bowel and bladder impairments, saddle area paresthesia (S4), and possible gross limitation of all lumbar movement. This condition constitutes an immediate referral to a physician.[3]
Differential Diagnosis[edit | edit source]
Differential diagnoses for upper lumbar radiculopathy include spondylolesthesis or an infection (diskitis, epidural abscess).
Diagnostic Procedures[edit | edit source]
add text here related to medical diagnostic procedures
Outcome Measures[edit | edit source]
add links to outcome measures here (also see Outcome Measures Database)
Examination[edit | edit source]
add text here related to physical examination and assessment
Medical Management
[edit | edit source]
add text here
Physical Therapy Management
[edit | edit source]
add text here
Key Research[edit | edit source]
add links and reviews of high quality evidence here (case studies should be added on new pages using the case study template)
Resources
[edit | edit source]
add appropriate resources here
Clinical Bottom Line[edit | edit source]
add text here
Recent Related Research (from Pubmed)[edit | edit source]
References[edit | edit source]
References will automatically be added here, see adding references tutorial.
- ↑ Svetlana Tomic et al. (2009). Lumbosacral Radiculopathy - Factors Effects on It's Severity. Coll. Antropol. (33)1: 175-178.
- ↑ 2.0 2.1 Flynn, T., Cleland, J., Whitman, J. (2008). User's Guide to Musculoskeletal Examination. Buckner, Kentucky. Evidence in Motion.
- ↑ Dutton, M. (2008). Orthopaedic Examination, Evaluation, and Intervention, 2nd edition. McGraw Medical, New York.