Approach to Radiculopathy - Penn State University方法对神经根型颈椎病-宾夕法尼亚州立大学.pptVIP

* * * * * * * * * * * * * * * * * * * * * Radiculopathy: Etiology Non-structural, or infiltrative Tumor (carcinomatous or lymphomatous meningitis) Granulomatous tissue (e.g., sarcoid) Infection (e.g., Lyme disease, herpes zoster, cytomegalovirus, herpes simplex). Acute inflammatory demyelinating neuropathy Infarction Vasculitic neuropathy Diabetic polyradiculopathy Severe radicular pain in All extermities, lime disease White over everything Differential diagnosis of radiculopathy: I do not expect you to know these next two slides in detail, however, please be familiar with the concepts Radiculopathy always must be distinguished from other peripheral nerve or plexus problems Root lesion (radiculopathy) vs plexus lesion C5/6 vs Upper trunk C8 vs Lower trunk L3/4 vs Lumbar plexus L5/S1 vs Sacral plexus Differential diagnosis of radiculopathy: Root lesion (radiculopathy) vs entrapment neuropathy C6/7 vs carpal tunnel syndrome (med. n. at wrist) C8 vs ulnar neuropathy at the elbow L3/4 vs femoral neuropathy L5 vs peroneal n. at the fibular neck Bilateral L5-S1 radiculopathy vs early peripheral polyneuropathy Could be appropriate by EMG/NSV Imaging: Indications Somatic back and neck pain: Often not helpful and not indicated unless the patient has risk factors for a serious underlying cause of back pain Incidence of spine abnormalities such as disk bulges/minor herniations is about 25-50% in asymptomatic people! Current techniques are not helpful in identifying the source of the somatic pain Imaging: Indications Imaging is appropriate in the following patients: Trauma Risk factors for serious underlying etiology Symptoms present for 4 weeks Neurologic deficit Imaging: Modalities X-rays: most useful in trauma to exclude fracture, not sensitive for nerve root or spinal cord pathology CT: most useful study for bony anatomy MRI: most useful study for imaging disk, nerve root and spinal cord pathology Contrast is used if patient has had prior spine surgery in the aff