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Questions and Answers

How many pairs of spinal nerves are present in the human body?

  • 26 pairs
  • 28 pairs
  • 31 pairs (correct)
  • 34 pairs
  • Where does the C8 nerve root exit in relation to the cervical vertebrae?

  • Below C7 and above T1 (correct)
  • Below T1 vertebral level
  • At the level of C7
  • Above C8 vertebral level
  • Which spinal region does the cauda equina consist of?

  • Coccygeal only
  • Thoracic only
  • Cervical only
  • Lumbar and sacral (correct)
  • At what vertebral levels does the spinal cord typically end in adults?

    <p>Between L1 and L2</p> Signup and view all the answers

    Which of the following statements about the exit of spinal nerve roots is true?

    <p>Lumbar nerve roots exit below their corresponding vertebral segments.</p> Signup and view all the answers

    What describes radicular pain experienced by patients?

    <p>An electrical shock sensation radiating from the buttock to the foot</p> Signup and view all the answers

    Which examination test is most commonly used to diagnose cervical radiculopathy?

    <p>Spurling test</p> Signup and view all the answers

    What is the typical presentation of L5 radiculopathy?

    <p>Pain radiating down the lateral aspect of the leg into the foot</p> Signup and view all the answers

    Which nerve root reflex is tested at the C6 level?

    <p>Brachioradialis reflex</p> Signup and view all the answers

    What occurs in the shoulder abduction test that indicates a positive result?

    <p>Relief of symptoms when the hand rests on the head</p> Signup and view all the answers

    For which nerve do the symptoms of S1 radiculopathy commonly present?

    <p>Pain radiating down the posterior leg</p> Signup and view all the answers

    What is a common risk factor for developing radiculopathy?

    <p>Age over 60 years</p> Signup and view all the answers

    Which treatment is often part of managing radiculopathy?

    <p>Pain control and muscle relaxants as needed</p> Signup and view all the answers

    What does a 0 rating mean in the reflex scoring system?

    <p>Absent reflex with no evidence of contraction</p> Signup and view all the answers

    Which imaging method is NOT typically used in evaluating radiculopathy?

    <p>Ultrasound</p> Signup and view all the answers

    Which factor differentiates non-degenerative radiculopathies from compressive etiologies?

    <p>They may affect the dorsal root ganglion</p> Signup and view all the answers

    What is the significance of the Bowstring sign in examination findings?

    <p>Shows relief of radicular pain with knee flexion</p> Signup and view all the answers

    What does the term 'myotome' refer to?

    <p>A collection of muscles innervated by a single nerve root</p> Signup and view all the answers

    Which statement about spondylosis is true?

    <p>It refers to nonspecific degenerative changes of the spine.</p> Signup and view all the answers

    What is typically the predominant mechanism causing radiculopathy?

    <p>Nerve root compression</p> Signup and view all the answers

    In which part of the cervical spine is the spinal canal widest?

    <p>In the upper part of the cervical spine</p> Signup and view all the answers

    Which of the following statements about disc herniation is correct?

    <p>Prolapse can lead to radicular symptoms if it affects a nerve root.</p> Signup and view all the answers

    Which nerve roots are most commonly involved in radiculopathy due to disc protrusion?

    <p>L5 and S1</p> Signup and view all the answers

    What is the primary reason for the prevalence of radiculopathies at the L4-L5 and L5-S1 levels?

    <p>High degree of flexibility and mobility.</p> Signup and view all the answers

    Which symptom is most commonly associated with radiculopathy?

    <p>Paresthesia in a root distribution</p> Signup and view all the answers

    What is a significant risk factor for developing radiculopathy?

    <p>Chronic smoking</p> Signup and view all the answers

    The reflex exam is valuable in diagnosing radiculopathy because it assesses what?

    <p>Nerve root function objectively</p> Signup and view all the answers

    Why do symptoms develop more acutely when caused by a herniated disc?

    <p>Because it often involves immediate nerve root compression</p> Signup and view all the answers

    Which cervical nerve root is most frequently affected by compression?

    <p>C7</p> Signup and view all the answers

    How does the presence of pain affect motor examination in radiculopathy?

    <p>It complicates the ability to perform an accurate motor examination.</p> Signup and view all the answers

    What role does history play in diagnosing radiculopathy?

    <p>It is the most important factor in diagnosis.</p> Signup and view all the answers

    Study Notes

    Spinal Cord Anatomy

    • 31 pairs of spinal nerves, each with a specific path and function
    • Cervical nerves exit above their corresponding vertebrae, expect for C8 nerve which exits below C7
    • Thoracic, lumbar, and sacral nerves exit below their corresponding vertebrae
    • The spinal cord ends between L1 and L2 in adults
    • Lumbar and sacral roots descend caudally forming the cauda equina

    Terminology

    • Dermatome: the specific area of skin innervated by a single spinal nerve root
    • Myotome: a group of muscles primarily innervated by a single nerve root
    • Paresthesia: Subjective tingling sensation caused by nerve or nerve pathway pathology
    • Radiculopathy: Pathology affecting a nerve root, often caused by compression

    Causes of Radiculopathy

    • Spondylosis: Degenerative spinal changes, often leading to stenosis but not always interchangeable
    • Disc Herniation: Protrusion of the nucleus pulposus through the annulus, often caused by degeneration and pressure

    Risk factors for developing radiculopathy:

    • Manual labor involving heavy lifting, driving, or operating vibrating equipment
    • History of chronic smoking

    Cervical Spine

    • The spinal canal is widest in the upper cervical spine (C1-C3)
    • Canal narrows significantly with neck extension
    • Spondylotic disease most commonly occurs in the lower cervical spine

    Lumbar Spine

    • Most susceptible to disc herniations due to flexion, extension, and torsion movements
    • L4-L5 and L5-S1 are most vulnerable to injury, accounting for 90-95% of compressive radiculopathies

    Nerve Root Compression Symptoms

    • Acute onset with herniated disc
    • Slower onset with spondylosis
    • Pain typically radiates in a dermatomal pattern
    • Sensory loss may be mild or absent due to overlapping dermatomes

    Common Symptoms:

    • Paresthesia or numbness in a root distribution (80% of cases)
    • Subjective weakness is less common
    • Symptoms exacerbated by Valsalva maneuvers (cough, sneeze, strain)

    Cervical Radiculopathy Statistics:

    • C7 is the most frequently affected nerve root (approx. 70% of cases)
    • C6 root involvement occurs in approximately 20% cases

    Physical Exam:

    • Spurling test: compression of the affected nerve root
    • Shoulder abduction test: tests C5-C7 nerve root compression, relief of symptoms is a postive test
    • Valsalva maneuver
    • Neck distraction test: traction on the neck

    Reflexes:

    • C5 - biceps and brachioradialis
    • C6 - brachioradialis
    • C7 - triceps
    • L4 - quadriceps
    • S1 - Achilles

    Lower Extremity Examination:

    • Straight leg test: assesses lower lumbar nerve root involvement (L4 to S1)
    • Reverse straight leg: assesses L2 to L4 nerve roots
    • Slump test: can reproduce radicular symptoms

    Bowstring sign:

    • Relief of radicular pain when the knee is flexed during a positive straight leg raise

    Key Points to Remember:

    • Cervical radiculopathy is usually unilateral
    • Comparing reflexes side to side is vital
    • Reduced strength of muscles innervated by the affected nerve is a significant finding

    L1 Radiculopathy:

    • Uncommon
    • Symptoms: pain, paresthesia, sensory loss in the inguinal region
    • Rare: minor hip flexion weakness

    L2/L3/L4 Radiculopathy

    • Difficult to differentiate due to overlapping innervation
    • Commonly involved in older patients with spinal stenosis symptoms

    L5 Radiculopathy:

    • Most common lumbosacral radiculopathy
    • Symptoms: back pain radiating down the lateral leg into the foot
    • Weakness: foot dorsiflexion, toe extension, foot inversion/eversion, and sometimes leg abduction

    S1 Radiculopathy

    • Pain radiates down the posterior leg into the foot
    • Weakness: plantar flexion (gastrocnemius muscle), leg extension, and knee flexion

    S2/S3/S4 Radiculopathy:

    • Less common
    • Symptoms: sacral or buttock pain radiating down the posterior leg or into the perineum
    • Minimal weakness but urinary and fecal incontinence and sexual dysfunction may be present

    Diagnostic Evaluation:

    • Plain x-rays
    • CT scan
    • MRI
    • EMG/NCS
    • Myelogram

    Treatment:

    • Pain control
    • Muscle relaxants
    • Physical therapy
    • Epidural steroid injections
    • Surgical intervention

    Non-Degenerative Radiculopathies

    • Often affect the ventral and dorsal roots more diffusely
    • May also affect the dorsal root ganglion
    • Deficits may span multiple myotomes and dermatomes

    Non-Degenerative Causes of Radiculopathy:

    • Diabetes mellitus
    • Nerve root trauma
    • Nerve root infarction
    • Nerve root avulsion
    • Infectious or granulomatous conditions:
      • Herpes zoster
      • Lyme disease
      • Tuberculosis
      • HIV
      • Syphilis
      • Brucellosis
      • Cytomegalovirus
      • Histiocytosis X
    • Sarcoid
    • Infiltrative conditions:
      • Lymphoma
      • Carcinomatous meningitis
    • Inflammatory conditions:
      • Guillain-Barré syndrome
      • Chronic inflammatory demyelinating polyneuropathy
      • Vasculitis with nerve root infarction

    Herpes Zoster

    • Caused by varicella zoster virus
    • Symptoms:
      • Erythematous vesicular maculopapular rash
      • Sensory changes: burning or tingling pain
    • Most commonly affects thoracic dermatomes and face

    Herpes Zoster Risk Factors:

    • Age > 60 years
    • Underlying malignancy
    • Immunosuppression
    • Diabetes
    • Surgical trauma
    • UV light

    Herpes Zoster Disease Course:

    • 80-90% resolve spontaneously within 6 months
    • Chronic pain (Post-Herpetic Neuralgia):
      • Pain lasting greater than 2-3 months after rash
      • Occurs in about 5% of cases
      • Severity correlates with the severity of the rash and acute pain

    Herpes Zoster Treatment:

    • Prevention with the Shingrix vaccine
    • Antiviral medication started

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