Lumbar Radiculopathy

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Clinically Relevant Anatomy

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Mechanism of Injury / Pathological Process

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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. The following chart may be useful in identifying radiculopathy clinically.

Question	+LR (yes)	-LR(no)
Weakness?	1.2	.73
Numbness?	1.0	.94

See test diagnostics page for explanation of statistics. 

Special Tests:

Straight Leg Raise Test: 

Link to Video of Test

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: 

File:Dermatomes.jpg

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

• 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.

 Diagnostic Procedures

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Outcome Measures

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Management / Interventions

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Differential Diagnosis

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Differential diagnoses for upper lumbar radiculopathy include spondylolesthesis or an infection (diskitis, epidural abscess).

Key Evidence

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Resources

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Case Studies

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References

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