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Radiculopathy Vs. Radiculitis

Key Concepts:

Terms in this set (11)

• Can sometimes be painless
• Almost always will involve both sensory and motor
o Can get loss of the normal reflex
• The EMG will quantify a true nerve radiculopathy
o EMG is when they insert the probe into the muscle and can read the insertional activity of that muscle
o NCS is when they put the needle in two different places and they zap you and they check the velocity of the nerve conduction
• We have pain in the neck which radiates into the shoulder, peri-scapular and down the arm and to the hand this is radiculitis, but if you have motor changes and decrease in sensation then you have radiculopathy
• If you have a patient that you suspect with a radiculopathy, you have to see if they have any weakness along the dermatomal distribution
o You can conduct the Spurling maneuver which is when you have a patient looking up and to the side while you push their head down and this can elicit pain
- This is specific but have poor sensitivity for cervical radiculopathy just like the shoulder abduction relief test
• In your differential make sure to include all of the potential orthopedic problems of the cervical spine and shoulders and any other nerve neuropathy
o Ex. If you're walking your dog and it runs after a squirrel and pulls your arm, this can cause a brachial plexus dysfunction
• Always ask patients about their history and what they were doing before the pain began since it can help diagnose spinal stenosis (can be worst when you sit down)
• Sometimes you need neural imaging such as CT or MR (need contrast especially if they just had surgery)
o The MRI seems to be the study of choice
• Ex. A patient present with an acute neck pain, with a positive Spurling maneuver but their neural exam is clean, but they have symptoms of nerve root irritation why
o Maybe have a bone spur in their neck spondylosis or they have a disc swollen and shooting off to the side and can't get an MRI in that patient for the first 4 weeks so he needs to treat them.
• If they had some neuro deficit and decrease brachial radialis and triceps reflex, and they had functional weakness in their hands, then he can get the MRI, however you order the X-ray first
• CT myelography is superior only to help differentiate between bone and soft tissue then the MR, but CT has lots of radiation, but MR doesn't have radiation
• The diagnosis is typically confirmed by the EMG which will reveal the myotomal patter of denervation and the nerve conduction studies will show some slowing of the nerve velocity.
o It takes anywhere from 18-21 days to have some of the neurologic deficit show up in a EMG hence why you need to wait sometime before giving a person an EMG