Clinical

Neurology – CLSC 6205

Cervical & Lumbar Radiculopathy; Plexopathy Lecture
Miguel Chiusano, DC, MBA, DACNB

Radiculopathy: Nerve root damage resulting in a single nerve root distribution of any combination of motor loss, pain
and sensory loss

Cervical Radiculopathies
Spinal
Root
exit Patient Presentation Examination findings Special Issues
Level
level
C5 C4-5 Pain medial scapula and Deltoid weakness – Unable to work with elevated Least frequent
into upper arm. arms Brachial plexitis
Rarely radiates below Sensory loss shoulder and radial side upper arm (Parsonage-Turner
elbow. Absent or diminished Biceps MSR syndrome) mimics C5
radiculopathy
C6 C5-6 Pain medial scapula, lateral Biceps weakness and arm abduction weakness at
side of forearm, hand and shoulder (proximal muscle weakness d/t overlap
thumb. with C5)
Difficulty flexing arm Wrist extensor weakness
Possible diminished biceps and brachioradialis
MSR
Sensory loss 1st and 2nd digits
C7 C6-7 Pain posterior arm. Weak triceps, wrist flexors and finger extensors. Most common
Unable to extend elbow. Possible diminished triceps MSR affected level
nd rd
Sensory loss C7 pattern including 2 & 3 digit
C8 C7-T1 Pain radiating from neck Weakness intrinsic muscles - Abduction and Medial brachial
into medial forearm and Adduction (both median and ulnar innervation) plexus neoplasm
into medial hand Finger flexion weakness (cancer or lymphoma)
th th
Sensory loss medial hand, 4 and 5 digit Absent mimics C8
or diminished finger flexion MSR radiculopathy
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 Clinical Neurology – CLSC 6205
Cervical & Lumbar Radiculopathy; Plexopathy Lecture
Miguel Chiusano, DC, MBA, DACNB

Causes of Cervical radiculopathies:
1. Cervical disc herniation (MC cause)
2. Cervical spondylosis
3. Vertebral infection
4. Primary (schwannomas MC 1° nerve tumor) or secondary neoplastic tumor
5. Metastatic extradural tumor (MC neoplasm) Source: Breast, lung, prostate & myeloma
6. Schwannoma & Meningioma (Intradural extramedullary tumors)
7. Inflammation of IVF structures



Thoracic Radiculopathies
Patient presentation:
Unilateral chest wall Pain - originating near the spine and radiating towards the front following a dermatome pattern
Rash – suggest Herpes Zoster (especially with vesicular findings)

Examination Findings:
a) Normal motor strength
b) Normal reflexes (unless myelopathic findings are present D/T nerve & spinal cord compression)
c) Normal labs
d) MRI may show structural issue, otherwise DM or Herpes Zoster is suspected




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 Clinical Neurology – CLSC 6205
Cervical & Lumbar Radiculopathy; Plexopathy Lecture
Miguel Chiusano, DC, MBA, DACNB

Lumbar Radiculopathies
Disc
Root
level Patient presentation Examination Findings
level
involved
L5 L4-5 Radiating pain over SI joint, hip, Sensory loss lateral lower leg and 1st through 3rd toes
and lateral leg Weakness in knee flexion, ankle dorsiflexion , extensor halluces
longus
Foot drop may be present Absent or diminished hamstrings MSR
Difficulty walking on heels
Minor to no atrophy

S1 L5-S1 Radiating pain over SI joint, hip, Sensory loss back of calf, lateral aspects of heel, foot and 5th toe
posterior lateral thigh and leg Weakness in hip extension, ankle plantar flexion and foot eversion
down to heel and lateral side of Difficulty walking on toes
foot Atrophy Gastrocnemius and Soleus
Absent or diminished Achilles MSR

Disc herniation @ cauda Imaging Examination Considerations:
equina area - MRI when supported by examination, unusual presentation, no improvement
or progressive Sx
Show Fig 44-2 X-rays useful for identifying spondylosis and some aspect of disc degeneration
X-rays flexion / extension study to identify instability


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 Clinical Neurology – CLSC 6205
Cervical & Lumbar Radiculopathy; Plexopathy Lecture
Miguel Chiusano, DC, MBA, DACNB

Plexus lesions: result in unilateral or asymmetric extremity MM weakness and sensory complaints that
do not conform to the distribution of a single root or nerve.
Cervical Plexopathy
Location of lesion Patient presentation
Upper Plexus lesion Sensory and/or Motor deficits in the C5 and C6 nerve root distribution
Weakness deltoid and biceps
Sensory deficit that extends below the elbow and into the hand
Lower Plexus lesion Sensory and/or Motor deficits in the C8 and T1 nerve root distribution
Median and ulnar innervated muscles are affected
Weakness of hand muscles
Sensory deficit in the palmer hand and ulnar aspect of dorsal hand

Causes for Brachial Plexopathy
1. Trauma (MC) - Tears D/T compression, traction, ischemia, laceration (or combination)
a) MVA, high speed cycling accidents, gunshot/knife wounds, falls
b) Iatrogenic – positioning during cardiothoracic surgery
c) Sporting accidents resulting in “burners” or “stingers”
2. Inflammation or immunization reaction
3. Constriction by scar (e.g. post-mastectomy radiation scarring)
4. Malignant tumor – Apical lung tumor
a) Numbness 4th and 5th digits
b) Weakness in the ulnar and median hand intrinsic MM
c) Horner’s syndrome (Pancoast tumor)

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 Clinical Neurology – CLSC 6205
Cervical & Lumbar Radiculopathy; Plexopathy Lecture
Miguel Chiusano, DC, MBA, DACNB

Lumbar & Sacral Plexopathy
Location of Patient presentation
lesion
Upper Lumbar Weakness of thigh flexion, adduction and leg extension
Plexus lesion
Complete Weakness and MM atrophy throughout the lower extremity with total areflexia and anesthesia
Lumbosacral
Plexopathy
Lower Sacral Weakness of thigh extension, knee flexion, foot dorsiflexion and plantar flexion with sensory changes
Plexus lesion

Diabetic Lumbosacral Radiculoplexus Neuropathy – MC cause of Lumbosacral Plexopathy
Signs and Sx:
a) Older patient with DM type 2
b) Abrupt or subacute onset of severe hip and thigh Pn
c) Weakness and MM atrophy within 1-2 weeks of onset (often when Pn begins to improve)
d) MSRs may be absent (especially Patella MSR)
e) Onset often unilateral presentation, frequently progressing to bilateral presentation
f) Associated with unexplained weight loss
g) Though to originate form peripheral nerve microvasculitis

UPDATED 2016-04-28