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radiculopathy
Dysfunction of a nerve root often caused by compression of the root. Pain, sensory impairment, weakness or depression of deep tendon reflexes may be noticed in the distribution of nerves derived from the involved nerve root.
Etiology:
1) compressive lesions
a) osteophyte
b) ruptured disk
c) neoplasm
2) non-compressive lesions
a) post-infectious
b) inflammatory radiculopathy
c) metabolic - diabetes mellitus
Clinical manifestations:
1) sharp, lancinating pain in a dermatomal pattern
2) pain is increased by coughing or sneezing
3) pain often has a myotomal rather than dermatomal pattern
4) manifestations in the root distribution
a) weakness
b) sensory impairment
c) decreased muscle stretch reflexes
Radiology:
- magnetic resonance imaging [4]
a) indications:
- rule out malignancy or infection
- assessment of whether surgery is necessary
b) generally does not change initial management
Management:
1) avoid activities that induce pain
2) physical therapy
3) non-steroidal anti-inflammatory agents (NSAIDs)
4) epidural glucocorticoid injections may provide short-term benefit [3]
5) limited bedrest
6) surgery for refractory cases
Related
entrapment neuropathy; nerve entrapment syndrome; pinched nerve
nerve root
Specific
cervical radiculopathy
L1 radiculopathy
L4 radiculopathy
L5 radiculopathy
S1 radiculopathy
sciatica; lumbosacral radiculopathy; sciatic neuropathy
T1 radiculopathy
General
sign/symptom
spine disease; vertebral disorder
peripheral nerve disease; peripheral neuropathy
References
- nlmpubs.nlm.nih.gov/hstat/ahcpr/
- Mayo Internal Medicine Board Review, 1998-99, Prakash UBS (ed)
Lippincott-Raven, Philadelphia, 1998, pg 638
- Journal Watch 25(9):74-75, 2005
Wilson-MacDonald J, Burt G, Griffin D, Glynn C.
Epidural steroid injection for nerve root compression.
A randomised, controlled trial.
J Bone Joint Surg Br. 2005 Mar;87(3):352-5.
PMID: 15773645
- Modic MT, Obuchowski NA, Ross JS, Brant-Zawadzki MN, Grooff PN,
Mazanec DJ, Benzel EC.
Acute low back pain and radiculopathy: MR imaging findings and
their prognostic role and effect on outcome.
Radiology. 2005 Nov;237(2):597-604.
PMID: 16244269