Radiculopathy

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Radiculopathy , also commonly referred to as pinched nerve , refers to a set of conditions in which one or more nerves are affected and does not work properly (neuropathy). It can cause pain (radicular pain), weakness, numbness, or difficulty controlling certain muscles.

In radiculopathy, the problem occurs on or near the nerve root, shortly after getting out of the spinal cord. However, other pain or symptoms often radiate to the part of the body that the nerves are servicing. For example, the nerve root sting in the neck can produce pain and weakness in the forearm. Similarly, collisions in the lower spine or lumbar-sacral spine can be manifested by the symptoms in the leg.

The radicular pain resulting from radiculopathy should not be confused with the referred pain, which differs in both the mechanism and the clinical picture.

Polyradiculopathy refers to conditions in which more than one spinal cord root is affected.

Video Radiculopathy

Cause

Radiculopathy is a mechanical compression of the nerve roots usually in the foramen exit or lateral recess. It may be secondary to degenerative disc disease, osteoarthritis, facet/hypertrophic facial degeneration, ligament hypertrophy, spondylolistesis, or a combination of these factors. Less common causes of radiculopathy may include radiation, diabetes mellitus, neoplastic disease, or meningeal-based disease processes. Lyme meningitis The second stage resembles aseptic meningitis and is often associated with radiculopathies.

Maps Radiculopathy

Injury Mechanism

Most often the radiculopathy found in patients located in the cervical spine, most commonly affecting the C6-C8 spinal cord.

Certain injuries can also cause radiculopathy. These injuries include heavy lifting of undue objects or minor trauma such as car accidents. Less common causes of radiculopathy include tumor-induced injury (which can suppress locally-rooted nerve roots) and diabetes (which can effectively lead to ischemia or lack of blood flow to the nerves).

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Diagnosis

Radiculopathy is a diagnosis commonly made by doctors in primary care specialties, chiropractic, orthopedic, physiological, and neurological. Diagnosis may be suggested by symptoms of pain, numbness, and weakness in patterns that are consistent with the distribution of certain nerve roots. Neck pain or back pain can also occur. Physical examination may reveal motor and sensory deficits in the distribution of nerve roots. In the case of cervical radiculopathy, the Spurling test may induce or reproduce the symptoms that radiate to the arm. In the case of lumbosacral radiculopathy, maneuvering of straight legs can aggravate the symptoms of radiculopathy. Deep tendon reflexes (also known as stretch reflexes) may be reduced or absent in areas that are innervated by certain nerve roots.

For further examination, the American College of Radiology recommends that projection radiography is the most appropriate early study in all patients with chronic neck pain. Two additional diagnostic tests that may be useful are magnetic resonance imaging and electrodiagnostic testing. Magnetic resonance imaging (MRI) of the spine in which radiculopathy is thought to reveal evidence of degenerative changes, arthritis disease, or other explanatory lesions responsible for patient symptoms. Electrodiagnostic testing, consisting of NCS (neural conduction study) and EMG (electromyography), is also a powerful diagnostic tool that may indicate a nerve root injury in a suspected area. In neural conduction studies, the pattern of compound muscle action potential is reduced and the normal sensory nerve action potential can be seen given that the lesion is proximal to the posterior root ganglion. EMG needles are a more sensitive part of the test, and may reveal active denervation in the distribution of involved nerve roots, and voluntary neurogenic motor units that appear neurogenically in more chronic radiculopathy. Given the key role of electrodiagnostic testing in the diagnosis of acute and chronic radiculopathy, the American Association of Neuromuscular & amp; Electrodiagnostic drugs have issued evidence-based practice guidelines, for the diagnosis of cervical and lumbosacral radiculopathy. American Neuromuscular & amp; Electrodiagnostic drugs have also participated in the Wise Choosing Campaign and some of their recommendations relate to what tests are not needed for neck and back pain.

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Treatment

Ideally, effective treatment aims to resolve the underlying cause and restore the nerve roots to normal function. Common conservative treatment approaches include physical therapy and chiropractic. A systematic review found evidence of moderate quality that spinal manipulation is effective for the treatment of acute lumbar radiculopathy and cervical radiculopathy. Only low-level evidence was found to support spinal manipulation for the treatment of chronic lumbar radiculopathy, and no evidence was found to exist for the treatment of choroid radiculopathy.

Rehabilitation

Therapy exercises are often used in combination with many of the modalities mentioned earlier and with good results. Various exercise regimes are available in patient care. Sports regimens should be modified according to the patient's capabilities and weaknesses. Stabilization of the cervicothoracic area is helpful in limiting pain and preventing back injury. Cervical support and lumbar braces are usually not indicated for radiculopathy, and may cause weakness of the support muscles. The first part of the stabilization procedure is to reach the full range of free pain that can be achieved through stretching exercises. Furthermore, strengthening exercises should be designed to restore the cervical muscles, shoulders, and upper deconditional muscles. Because dependence on the neck support is reduced, the isometric exercise regimen should be introduced. This is the preferred method of exercise during the sub-acute phase because it is resisting atrophy and is at least likely to aggravate the condition. Single-plane resistance exercises against cervical flexion, extension, bending, and rotation are used.

Surgery

While the conservative approach to rehabilitation is ideal, some patients will not improve and surgery is still an option. Patients with large cervical disk bulges may be recommended for surgery, but the most conservative management will help the herniation to decline naturally. Procedures such as foraminotomy, laminotomy, or discectomy may be considered by neurosurgeons and orthopedic surgeons.

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Epidemiology

Cervical radiculopathy is less common in the United States than lumbar radiculopathy with an incidence rate of 83 cases per 100,000. According to AHRQ 2010 National Statistics for cervical radiculopathy the age group most affected was between 45 and 64 years old with 51.03% of the incidents. Women are more frequently affected than men and account for 53.69% of cases. Private insurance is a payer in 41.69% of incidents followed by Medicare with 38.81%. In 71.61% of cases, patient income is considered not low for their zip code. In addition, more than 50% of patients live in large metropolitan (inner city or suburb). South Korea is the most affected area in the US with 39.27% ​​of cases. According to a study conducted in Minnesota, the most common manifestation of this series of conditions is C7 monoradiculopathy, followed by C6.

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See also

• Peripheral neuropathy

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References

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External links

• Radiculopathy at the US National Library of Medicine's Medical Subject Headings (MeSH)
• Symptoms
• More about Radiculopathy
• Youtube Videos: Spine & amp; Nerve Health with Dr. Aaron Filler (comparing Sciatica and Piriformis Syndrome)
• Neck and Arm Pain Infection, Cervical Radiculopathy from Mount Sinai Hospital, New York
• The nerve is caught in the neck
• Medical Term for Neuropathy: Radiculopathy or Neuritis?
• Chou, Roger; Hashimoto, Robin; Honestly, Janna; Fu, Rongwei; Bougatsos, Christina; Dana, Tracy; Sullivan, Sean D.; Jarvik, Jeffrey (2015). "Epidural corticosteroid injection for Radiculopathy and Spinal Stenosis". Annals of Internal Medicine . 163 (5): 373-81. doi: 10.7326/M15-0934. PMID 26302454. Summary of layman - The New York Times (August 24, 2015).

Source of the article : Wikipedia