Clinical Syndromes of Neural Origin - UQ PDF
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Universidad de San Pablo CEU
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Summary
This document provides an overview of clinical syndromes of neural origin, focusing on the upper quadrant (UQ). It details various conditions like Cervical Radiculopathy, Thoracic Outlet Syndrome (TOS), and nerve compressions affecting the upper body. The document includes diagnostic procedures, potential causes and associated symptoms, offering a comprehensive guide for medical professionals.
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CLINICAL SYNDROMES OF NEURAL ORIGIN: UPPER QUADRANT MSKP II Universidad San Pablo-CEU INDEX COMPRESSIVE NERVE SYNDROMES IN THE UPPER QUADRANT: Cervical radiculopathy TOS Median nerve Uln...
CLINICAL SYNDROMES OF NEURAL ORIGIN: UPPER QUADRANT MSKP II Universidad San Pablo-CEU INDEX COMPRESSIVE NERVE SYNDROMES IN THE UPPER QUADRANT: Cervical radiculopathy TOS Median nerve Ulnar nerve Radial nerve 2 COMPRESSIVE NERVE SYNDROMES IN THE UQ: CERVICAL RADICULOPATHY 3 CERVICAL RADICULOPATHY: ETIOLOGY Mechanisms: 83 cases per 100000 inhabitants Intervertebral foramen stenosis: o Disc herniation – Younger pats o Foraminal narrowing o Degenerative changes – Older pats (e.g. Spondylosis => Stenosis / bony spurs) Compression, irritation, traction and/or nerve root injury: Associated inflammation is main cause Other: C7 => 46.3 – 69% C6 => 19 – 17.6% Cytokines released from damaged intervertebral discs C8 => 10 – 6.2% C5 => 2 – 6.6% 4 CERVICAL RADICULOPATHY: SUBJECTIVE EXAMINATION (C/O) BODY CHART Variable presentation Neuropathic dermatomal pain pattern (unilateral) => Irradiating arm pain Associated symptoms: Neck and scapular pain, parasthesia, possible muscle weakness (myotomal pattern), reflex alteration 5 CERVICAL RADICULOPATHY: SUBJECTIVE EXAMINATION (C/O) 24 HOURS BEHAVIOUR Unilateral pain Depends on the affected level HISTORY Any age. Peak prominence 40-50 y.o. 2:1 Possible Double-compression syndrome 6 CERVICAL RADICULOPATHY: OBJECTIVE EXAMINATION (P/E) NEUROLOGICAL EXAMINATION CLINICAL PREDICTION RULES (Wainner et al. 2003): Spurling Test ULNTT1 90% probability Distraction test Cerv Rot < 60º Wainner RS, Fritz JM, Irrgang JJ, et al. Reliability and diagnostic accuracy of the clinical examination and patient self- report measures for cervical radiculopathy. Spine. 2003;28(1):52-62. 7 CERVICAL RADICULOPATHY: OBJECTIVE EXAMINATION (P/E) 8 CERVICAL RADICULOPATHY: OBJECTIVE EXAMINATION (P/E) SPECIAL STUDIOS XR, MRI, EM DIFFERENTIAL DX ✓ VBI or CAD ✓ Carpal Tunnel Sdre ✓ Cubital Tunnel Sdre ✓ Thoracic Outlet Sdre ✓ Cervical Myleopathy ✓ Brachial Plexus injury ✓ Systemic Neuropathies ✓ Shoulder issues 9 CERVICAL RADICULOPATHY PROGNOSIS (Cleland et al. 2005): The following short-term clinical features were found to be most predictive of a positive short-term outcome: Age
