Lumbar Radiculopathy: Difference between revisions
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Be the first to edit this page and have your name permanently included as the original editor, see the [[Editing pages|editing pages tutorial]] for help. | Be the first to edit this page and have your name permanently included as the original editor, see the [[Editing pages|editing pages tutorial]] for help. | ||
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== Clinically Relevant Anatomy<br> == | == Clinically Relevant Anatomy<br> == | ||
add text here relating to '''''clinically relevant''''' anatomy of the condition<br> | add text here relating to '''''clinically relevant''''' anatomy of the condition<br> | ||
== Mechanism of Injury / Pathological Process<br> == | == Mechanism of Injury / Pathological Process<br> == | ||
add text here relating to the mechanism of injury and/or pathology of the condition<br> | add text here relating to the mechanism of injury and/or pathology of the condition<br> | ||
== Clinical Presentation == | == Clinical Presentation == | ||
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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. 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. The following chart may be useful in identifying radiculopathy clinically. | ||
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See test [[Test Diagnostics|diagnostics page]] for explanation of statistics. | See test [[Test Diagnostics|diagnostics page]] for explanation of statistics. | ||
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'''Special Tests:''' | '''Special Tests:''' | ||
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<u>''Straight Leg Raise Test:''</u> ([http://www.youtube.com/watch?v=u3wkt2KU6lU http://www.youtube.com/watch?v=u3wkt2KU6lU])<br>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. | <u>''Straight Leg Raise Test:''</u> ([http://www.youtube.com/watch?v=u3wkt2KU6lU http://www.youtube.com/watch?v=u3wkt2KU6lU])<br>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. | ||
<br> | <br> | ||
<u>''Crossed Straight Leg Raise Test:''</u> | <u>''Crossed Straight Leg Raise Test:''</u> | ||
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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. | 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. | ||
<br> | <br> | ||
'''Clinical presentation for radiculopathy from each lumbar nerve root:''' <br> | '''Clinical presentation for radiculopathy from each lumbar nerve root:''' <br> | ||
[[Image:Dermatomes.jpg|thumb|right]] | [[Image:Dermatomes.jpg|thumb|right]] | ||
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| Nerve Root | | Nerve Root | ||
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*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. | *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. | ||
<br> | |||
'''Cauda Equina Syndrome:''' | |||
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.<ref name="Dutton">Dutton, M. (2008). Orthopaedic Examination, Evaluation, and Intervention, 2nd edition. McGraw Medical, New York.</ref> | |||
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.<ref name="Dutton">Dutton, M. (2008). Orthopaedic Examination, Evaluation, and Intervention, 2nd edition. McGraw Medical, New York.</ref> | |||
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== Diagnostic Procedures == | == Diagnostic Procedures == | ||
add text here relating to diagnostic tests for the condition<br> | add text here relating to diagnostic tests for the condition<br> | ||
== Outcome Measures == | == Outcome Measures == | ||
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add links to outcome measures here (see [[Outcome Measures|Outcome Measures Database]]) | add links to outcome measures here (see [[Outcome Measures|Outcome Measures Database]]) | ||
== Management / Interventions<br> == | == Management / Interventions<br> == | ||
add text here relating to management approaches to the condition<br> | add text here relating to management approaches to the condition<br> | ||
== Differential Diagnosis<br> == | == Differential Diagnosis<br> == | ||
add text here relating to the differential diagnosis of this condition<br> | add text here relating to the differential diagnosis of this condition<br> | ||
Differential diagnoses for upper lumbar radiculopathy include spondylolesthesis or an infection (diskitis, epidural abscess). | Differential diagnoses for upper lumbar radiculopathy include spondylolesthesis or an infection (diskitis, epidural abscess). | ||
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== Key Evidence == | == Key Evidence == | ||
add text here relating to key evidence with regards to any of the above headings<br> | add text here relating to key evidence with regards to any of the above headings<br> | ||
== Resources <br> == | == Resources <br> == | ||
add appropriate resources here | add appropriate resources here | ||
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== Case Studies == | == Case Studies == | ||
add links to case studies here (case studies should be added on new pages using the [[Template:Case Study|case study template]])<br> | add links to case studies here (case studies should be added on new pages using the [[Template:Case Study|case study template]])<br> | ||
== References == | == References == | ||
Revision as of 12:06, 1 June 2009
This page is currently under construction as part of a project at the Medical College of Georgia. Please do not edit, but please come back in the near future to check out new information!!
Be the first to edit this page and have your name permanently included as the original editor, see the editing pages tutorial for help.
|
Original Editor - Your name will be added here if you created the original content for this page. Lead Editors - Your name will be added here if you are a lead editor on this page. Read more. |
Clinically Relevant Anatomy
[edit | edit source]
add text here relating to clinically relevant anatomy of the condition
Mechanism of Injury / Pathological Process
[edit | edit source]
add text here relating to the mechanism of injury and/or pathology of the condition
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. The following chart may be useful in identifying radiculopathy clinically.
| Question | +LR (yes) | -LR(no) |
| Weakness? | 1.2 | .73 |
| Numbness? | 1.0 | .94 [1] |
See test diagnostics page for explanation of statistics.
Special Tests:
Straight Leg Raise Test: (http://www.youtube.com/watch?v=u3wkt2KU6lU)
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 | Diminished or absent cremasteric reflex |
| 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 [1] |
- 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.
Cauda Equina Syndrome:
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.[2]
Diagnostic Procedures[edit | edit source]
add text here relating to diagnostic tests for the condition
Outcome Measures[edit | edit source]
add links to outcome measures here (see Outcome Measures Database)
Management / Interventions
[edit | edit source]
add text here relating to management approaches to the condition
Differential Diagnosis
[edit | edit source]
add text here relating to the differential diagnosis of this condition
Differential diagnoses for upper lumbar radiculopathy include spondylolesthesis or an infection (diskitis, epidural abscess).
Key Evidence[edit | edit source]
add text here relating to key evidence with regards to any of the above headings
Resources
[edit | edit source]
add appropriate resources here
Case Studies[edit | edit source]
add links to case studies here (case studies should be added on new pages using the case study template)
References[edit | edit source]
References will automatically be added here, see adding references tutorial.
