The Bonati Institute Glossary: Radiculopathy

The mission of The Bonati Institute is to provide hope to people suffering with chronic pain from a back or neck condition. We believe that a well-informed patient is vital to restoring hope and finding answers to pain. We developed this web site primarily to help educate pain sufferers and their families. We’ve found that the more individuals in pain learn about their anatomy, their condition and the options available to them the more likely they will be to choose the advanced arthroscopic procedures offered by The Bonati Institute.

Radiculopathy

Referred pain into the upper or lower extremities often accompanies back or neck pain. Referred pain can be the initial symptom of a compressed nerve root by a ruptured disc or neural foraminal stenosis from osteophytes. Radicular pain is usually described as sharp or even shock-like, and may be associated with certain activities or positions. The distribution of the pain may not always be classic, and often doesn’t respect dermatomal distributions.

Sensory changes are also often seen, with complaints of tingling and numbness being very common. On examination decreased sensation to pinprick and light touch are found in a dermatomal distribution in many patients. It is interesting that areas of referred pain and sensory loss often are different. Making determinations of level of nerve root compression solely from pain or sensory distribution is often difficult.

Motor weakness is also seen in nerve root compression syndromes. Muscle innervation is more constant and has less overlap than sensory innervation and is better at predicting level of pathology. Motor deficits that are of a more long-standing nature can have significant wasting. Hyporeflexia in the appropriate distribution is also seen.

Cervical

Cervical radiculopathy can present acutely, as with a traumatic ruptured disc, or can be of a more chronic and intermittent nature, as is seen in foraminal narrowing from osteophytes. Typically, the inferior nerve root is affected (e.g. C5-6 disc abnormalities affect the C6 nerve root). C5-6 and C6-7 are the most commonly affected segments.

A C5 radiculopathy typically presents with pain in the shoulder and the upper part of the lateral arm. Paresthesias are often seen in the more distal part of the affected dermatome. Deltoid weakness is seen commonly with a C5 radiculopathy. Biceps or brachioradialis weakness can be seen with a C6 radiculopathy along with the appropriate hyporeflexia. Paresthesias and frank sensory loss are more distal, and can extend into the hand. Root compression at C7 produces triceps weakness and a decreased triceps reflex. Pain extending into the distal forearm or hand is common. Sensory loss is commonly seen in the hand.

Lumbar

Sciatica is a classic syndrome of lower lumbar nerve root compression. Low back pain, that may or may not have been associated with some sort of trauma, is commonly antecedent to the onset of leg pain by days to a few weeks. Pain tends to be more proximal, and in a slightly different distribution than sensory changes. Motor weakness is also seen, but can be missed if dynamic testing is not done. All patients should be asked to stand on their toes and heels, as confrontational testing will miss subtle motor deficits in the lower extremities. As in the cervical spine, the pathologic level usually affects the caudal nerve root (e.g. L5-Sl disc produces an S1 radiculopathy). L5-S1 and L4-5 are overwhelmingly the most common levels affected. The upper lumbar spine is affected less frequently.

The classic S1 radiculopathy results in pain down the back of the leg and into the heel or foot. Sensory loss is usually over the lateral aspect of the foot. Plantar-flexion weakness is seen, but can be subtle. A loss of the Achilles reflex is also fairly specific to S1. The L5 radiculopathy produces similar pain, but the sensory symptoms tend to be over the dorsum of the foot. Weakness in dorsiflexion of the foot (or more specifically extensor hallicus longus) is the motor finding associated with L5. There is not a reliably reproducible reflex associated with L5.