Makindo Medical Notes

Radicular syndromes (radiculopathies) occur when a spinal nerve root is compressed, irritated, or inflamed 🦴💥. This leads to pain, numbness, weakness, or motor dysfunction along the path of the affected nerve. Symptoms follow dermatomal patterns and help localize the lesion.

📖 Definition

A radiculopathy = pain + neurological deficit (sensory, motor, or reflex) due to nerve root involvement. It can affect the cervical, thoracic, or lumbar spine. Classic example = sciatica 🦵.

🩺 Common Causes

• 💥 Disc Herniation: Most common; nucleus pulposus compresses adjacent root.
• ⏳ Degenerative Disc Disease: Ageing ➝ foraminal narrowing.
• 📉 Spinal Stenosis: Central or foraminal narrowing compresses multiple roots.
• 🦴 Osteophytes: Bony spurs from osteoarthritis.
• 🤕 Trauma: Vertebral fracture or subluxation.
• 🦠 Infections / Tumours: Rare; e.g. spinal TB (Pott’s disease) or metastases.

🔎 Types of Radiculopathy

• 🧠 Cervical Radiculopathy: Radiating pain/numbness in arms & hands (C5–C8).
• 🦴 Thoracic Radiculopathy: Band-like pain around chest/abdomen ➝ can mimic angina or gallstones.
• 🦵 Lumbar Radiculopathy (Sciatica): Pain down buttock, thigh, calf ➝ most common (L4, L5, S1 roots).

📌 Symptoms

• ⚡ Pain: Sharp, shooting, burning along dermatome.
• 🧊 Numbness/Tingling: “Pins & needles” in root distribution.
• 💪 Weakness: Specific to muscles supplied by the root.
• 🔨 Reflex Loss: Biceps, triceps, patellar, or Achilles reflex may be reduced.
• 🚶 Gait/Balance Problems: Especially in lumbar radiculopathy.
• Red Flags 🚩: Saddle anaesthesia, bilateral leg weakness, urinary retention → consider cauda equina syndrome (surgical emergency).

🧪 Diagnosis

• History: Pain distribution, onset, aggravating/relieving factors.
• Examination: Sensory testing, myotomes, reflexes ➝ helps localize root.
• Special Tests: Spurling’s test (cervical), Straight-leg raise (lumbar).
• Imaging:
  • MRI 🥇: Gold standard for discs/stenosis.
  • CT: Bony causes (osteophytes, trauma).
  • X-ray: Alignment, spondylolisthesis.
• Nerve Studies: EMG/NCS confirm site/severity, distinguish from peripheral neuropathy.

💊 Treatment

• Conservative:
  • 🏃 Physiotherapy: Core strengthening, posture correction.
  • 💊 Medications: NSAIDs, neuropathic agents (gabapentin, pregabalin).
  • 💉 Epidural Steroids: Reduce inflammation.
• Surgical (for severe/progressive cases):
  • 🩻 Discectomy
  • 🔩 Laminectomy
  • 🛠️ Foraminotomy

📊 Prognosis

Most patients improve with conservative therapy within 6–12 weeks. Surgery reserved for intractable pain or neurological deficit. Chronic cases risk persistent neuropathic pain.

🛡️ Prevention

• 🪑 Good posture and ergonomic workspace.
• 🏋️ Core and back strengthening exercises.
• 📦 Proper lifting techniques; avoid heavy strain.

🧩 Cervical Nerve Root Syndromes

Nerve Root	Pain	Sensory Loss	Weakness	Reflex
C5	Neck → shoulder	Lateral upper arm	Deltoid, supraspinatus	↓ Biceps
C6	Neck → thumb	Lateral forearm, thumb	Biceps, wrist extensors	↓ Biceps & brachioradialis
C7	Neck → middle finger	Posterior forearm, middle finger	Triceps, wrist flexors	↓ Triceps
C8	Neck → little finger	Medial forearm, ring/little finger	Finger flexors, hand intrinsics	—

🦵 Lumbar Radiculopathy (Sciatica)

Nerve Root	Pain	Sensory Loss	Weakness	Reflex
L3	Back → anterior thigh	Anterior thigh	Hip flexion, knee extension	↓ Patellar
L4	Back → medial shin	Medial thigh/shin	Knee extension, dorsiflexion	↓ Patellar
L5	Back → top of foot	Lateral calf, dorsum of foot	Dorsiflexion, big toe extension	—
S1	Back → sole of foot	Lateral foot/sole	Plantarflexion	↓ Achilles