Differential dx for Cervical radiculopathy by Yin Tang https://padlet.com/ytan0151/8g0mn69tsz269lmd en-us 2021-10-06 10:20:53 UTC 2024-05-17 06:34:51 UTC hello@padlet.com Cervical radiculopathy ytan0151 https://padlet.com/ytan0151/8g0mn69tsz269lmd/wish/1796002336
  • Irritation of one or more Cx nerve roots
  • C6 & C7 most commonly affected
  • Features:
    • pain in the neck, shoulder and/or arm
    • muscle weakness
    • altered sensation
    • decreased dtr 
    • ]]>     2021-10-06 10:23:26 UTC https://padlet.com/ytan0151/8g0mn69tsz269lmd/wish/1796002336     Compresive ytan0151 https://padlet.com/ytan0151/8g0mn69tsz269lmd/wish/1796008004 Cervical spondylosis and/or lateral disc herniation ]]> 2021-10-06 10:26:29 UTC https://padlet.com/ytan0151/8g0mn69tsz269lmd/wish/1796008004 Non-degenerative ytan0151 https://padlet.com/ytan0151/8g0mn69tsz269lmd/wish/1796010769
  • infectious processes 
    • herpes zoster/ shingles
    • Lyme disease 
  • malignancy, 
  • nerve root infarction 
  • nerve root demyelination 
    • ]]>     2021-10-06 10:27:58 UTC https://padlet.com/ytan0151/8g0mn69tsz269lmd/wish/1796010769     Physical exam ytan0151 https://padlet.com/ytan0151/8g0mn69tsz269lmd/wish/1796014707 2021-10-06 10:30:11 UTC https://padlet.com/ytan0151/8g0mn69tsz269lmd/wish/1796014707 Sensory impairment ytan0151 https://padlet.com/ytan0151/8g0mn69tsz269lmd/wish/1796015501
  • extensive overlap of dermatomes
  • well-demarcated sensory loss = peripheral nerve lesions, root lesions  
    • ]]>     2021-10-06 10:30:39 UTC https://padlet.com/ytan0151/8g0mn69tsz269lmd/wish/1796015501     Weakness ytan0151 https://padlet.com/ytan0151/8g0mn69tsz269lmd/wish/1796015769 Myotomal pattern?]]> 2021-10-06 10:30:49 UTC https://padlet.com/ytan0151/8g0mn69tsz269lmd/wish/1796015769 Spurling manoeuvre (neck compression test) ytan0151 https://padlet.com/ytan0151/8g0mn69tsz269lmd/wish/1796024313
  • ext & rotates neck to affected side, apply downward pressure on the head 
    • posterior disc bulging, lateral flexion and rotation constrict the neural foramina  
  • +ve: pain or paraesthesia
  • high specificity; low sensitivity 
    • ]]>     2021-10-06 10:35:05 UTC https://padlet.com/ytan0151/8g0mn69tsz269lmd/wish/1796024313     Shoulder abduction relief test ytan0151 https://padlet.com/ytan0151/8g0mn69tsz269lmd/wish/1796034473
  • rest palm of affected side on top of head 
  • +ve: relief of radicular pain 
  • low-moderate sensitivity; moderate-high specificity 
    • ]]>     2021-10-06 10:39:51 UTC https://padlet.com/ytan0151/8g0mn69tsz269lmd/wish/1796034473     Neuroimaging ytan0151 https://padlet.com/ytan0151/8g0mn69tsz269lmd/wish/1796039129
  • No gold standard; MRI preferred choice
  • Indication:
    • persistent symptoms after conservative mx (4-6wks); possible sx candidate
    • suspicion of other sinister causes 
    • ]]>     2021-10-06 10:42:06 UTC https://padlet.com/ytan0151/8g0mn69tsz269lmd/wish/1796039129     Differentials ytan0151 https://padlet.com/ytan0151/8g0mn69tsz269lmd/wish/1796041262 2021-10-06 10:43:17 UTC https://padlet.com/ytan0151/8g0mn69tsz269lmd/wish/1796041262 Carpal tunnel syndrome ytan0151 https://padlet.com/ytan0151/8g0mn69tsz269lmd/wish/1796048464
  • Median neuropathy at the wrist 
  • s/s:
    • pain radiating from wrist into hand, forearm  +/- shoulder 
    • paraesthesia in digits 1 to 4 ; Agg by flex/ext of wrist 
  • P/E
    • diminished sensation  palmar area of thumb, index & middle finger 
    • atrophy of thenar eminence 
    • weakness of APB
    • ]]>     2021-10-06 10:47:18 UTC https://padlet.com/ytan0151/8g0mn69tsz269lmd/wish/1796048464     Ulnar neuropathy at the elbow ytan0151 https://padlet.com/ytan0151/8g0mn69tsz269lmd/wish/1796080652 S/s
    • radiating pain from elbow into hand 
    • numbness and/or tingling in 4th & 5th digits and medial aspect of hand; Agg by prolonged elbow flexion 
    • difficulty w/ fine motor tasks 
    P/E
    • decreased sensation over ulnar side of hand
    • weakness in finger abductors and adductors (
    • ‘claw hand deformity’  

    ]]>     2021-10-06 11:05:08 UTC https://padlet.com/ytan0151/8g0mn69tsz269lmd/wish/1796080652     Brachial plexus injury ytan0151 https://padlet.com/ytan0151/8g0mn69tsz269lmd/wish/1796084072
  • mimic in a radicular manner if a trunk of the plexus is affected 
  • paraesthesia and flaccid paresis 
    • ]]>     2021-10-06 11:07:03 UTC https://padlet.com/ytan0151/8g0mn69tsz269lmd/wish/1796084072     Geoff ytan0151 https://padlet.com/ytan0151/8g0mn69tsz269lmd/wish/1796096848
  • 49yo M; ongoing (>three weeks) numbness, weakness, and pain in R) arm. 
  • Longstanding bouts of neck pain and stiffness, which has been ‘OK’ until his current presentation.
  • radicular pain that starts R) side of neck & shoulder extending to the side and back of forearm down into the middle two digits. 
  • Aggs: neck movements such as looking up. 
    • P/E
    • decreased triceps reflex (seen in C7 radiculopathies)
    • weakness (C6 &C7;↓ El ext, ↓Wr ext) 
    • altered sensation (↓ light touch).

    ]]>     2021-10-06 11:14:08 UTC https://padlet.com/ytan0151/8g0mn69tsz269lmd/wish/1796096848     ytan0151 https://padlet.com/ytan0151/8g0mn69tsz269lmd/wish/1796101346 2021-10-06 11:16:36 UTC https://padlet.com/ytan0151/8g0mn69tsz269lmd/wish/1796101346 Geoff tbot0006 https://padlet.com/ytan0151/8g0mn69tsz269lmd/wish/1798120175 2021-10-07 00:35:01 UTC https://padlet.com/ytan0151/8g0mn69tsz269lmd/wish/1798120175 Surgical management tbot0006 https://padlet.com/ytan0151/8g0mn69tsz269lmd/wish/1798126909 2021-10-07 00:37:48 UTC https://padlet.com/ytan0151/8g0mn69tsz269lmd/wish/1798126909 Open discectomy/microdiscectomy tbot0006 https://padlet.com/ytan0151/8g0mn69tsz269lmd/wish/1798130139 Larger incision is made and then the damaged part of the spinal disc is removed]]> 2021-10-07 00:39:07 UTC https://padlet.com/ytan0151/8g0mn69tsz269lmd/wish/1798130139 Endoscopic surgery tbot0006 https://padlet.com/ytan0151/8g0mn69tsz269lmd/wish/1798132727 Minimally invasive or keyhole surgery 
    Harder surgery 
    Can only be done when there is enough space to move muscles and structures 
    Long thin tube known as an endoscope to reach the damaged disc ]]>     2021-10-07 00:40:08 UTC https://padlet.com/ytan0151/8g0mn69tsz269lmd/wish/1798132727     Surgery on the nucleus of the spinal disc/cervical corpectomy/percutaneous discectomy tbot0006 https://padlet.com/ytan0151/8g0mn69tsz269lmd/wish/1798134671 Indirect procedure to the nucleus of the affected spinal disc 
    Nucleus can be either suctioned out using a device known as a percutaneous nucleotomy or vaporized using a laser beam known as a laser discectomy 
    This type of surgery can only be completed if the outer layer of the disc is still completely intact ]]>     2021-10-07 00:40:51 UTC https://padlet.com/ytan0151/8g0mn69tsz269lmd/wish/1798134671     Spinal fusion surgery tbot0006 https://padlet.com/ytan0151/8g0mn69tsz269lmd/wish/1798136962 Vertebra above and below the damaged segment are fixed together so the joint becomes immobile 
    Spinal disc is also removed and replaced with bone or an artificial implant
    Not ideal- last resort ]]>     2021-10-07 00:41:47 UTC https://padlet.com/ytan0151/8g0mn69tsz269lmd/wish/1798136962     Corticosteroids myou0014 https://padlet.com/ytan0151/8g0mn69tsz269lmd/wish/1798178167 This type of medication is typically recommended for individuals who don’t respond to physiotherapy treatment within four to six weeks.

    The evidence supporting this treatment is of high quality.

    ]]>     2021-10-07 00:57:45 UTC https://padlet.com/ytan0151/8g0mn69tsz269lmd/wish/1798178167     NSAIDS myou0014 https://padlet.com/ytan0151/8g0mn69tsz269lmd/wish/1798209538
    It was mentioned that the evidence regarding this is of low quality explaining that NSAIDs has an overall improvement in the severity of the pain the patient presents with.
    ]]>     2021-10-07 01:10:00 UTC https://padlet.com/ytan0151/8g0mn69tsz269lmd/wish/1798209538     Steroid injections myou0014 https://padlet.com/ytan0151/8g0mn69tsz269lmd/wish/1798212082 Steroid injections
    Is performed on the patient under x-ray fluoroscopy. That is where the steroidal injection and the numbing agent are inserted into the epidural space of the spine.

    The decrease in the pain present is sometimes temporary for a short period of time and as a result, multiple injections would need to be administered to achieve the desired outcome of reducing the pain levels
    ]]>     2021-10-07 01:11:03 UTC https://padlet.com/ytan0151/8g0mn69tsz269lmd/wish/1798212082     tbot0006 https://padlet.com/ytan0151/8g0mn69tsz269lmd/wish/1798255872 2021-10-07 01:28:17 UTC https://padlet.com/ytan0151/8g0mn69tsz269lmd/wish/1798255872 Connection to Geoff myou0014 https://padlet.com/ytan0151/8g0mn69tsz269lmd/wish/1798266372 It would be suggested that he utilizes some of the over-the-counter pain medication to begin treatment. 
    If all those fail, then he should consult the GP to have a corticosteroid regime in place to bring down the radicular pain that he experiences. 

    He could also use NSAIDS under the guidance of the GP treating him and return for a check-up visit after those medications have been used for around two weeks, to see if the dosage provided is enough to reduce the pain in the long run.
    ]]>     2021-10-07 01:32:37 UTC https://padlet.com/ytan0151/8g0mn69tsz269lmd/wish/1798266372