Transcript Cervico-Thoracic

Radiculopathy
and
Plexopathy
Dr Massud Wasel
M.D D.O. N.D
Registered osteopath
P.G.C.A.P
Fellow of Higher Education Academy
Radiculopathy
(spinal root lesion)
 When a spinal nerve root is damaged
 Causes:
 Csp and Lsp spondylosis (degenerative
changes including disc prolapse, osteophytes)
 Trauma
 Tumours-neurofibroma, metastases
 Herpes zoster virus (shingles)
 Meningeal inflammation
 Arachnoiditis
Clinic features:
 Pain: sharp, shooting, and or burning pain
radiating into the cutaneous distribution
(dermatome) or muscle group (myotome)
supplied by the root, can be aggravated by
movement, straining or coughing
 Neurological signs: LMN signs- wasting,
flaccid in the affected myotome and sensory
impairment in the affected dermatome
Specific radiculopathies
 Lateral cervical disc protrusion
 Lateral lumbar disc protrusion
 Central lumbar disc protrusion
Peripheral nerve lesions
 Common:
 Radial nerve
 Ulnar nerve
 Median nerve
Peripheral nerve lesions
 Uncommon:
 Long thoracic nerve
 Axillary or circumflex nerve
 Musculocutaneous nerve
 Posterior interosseous nerve
 Deep palmar branch of ulnar nerve
Peripheral nerve lesions
 Common:
 Sciatic nerve
 Lateral cutaneous nerve of thigh
(MERALGIA PARESTHETICA)
 Common peroneal nerve
Peripheral nerve lesions
 Uncommon:
 Obturator nerve
 Femoral nerve
 Posterior tibial nerve
Plexopathy
 When a plexus is damaged
 Spinal nerves from C5-T1 contribute to the
brachial plexus, which runs from the lower
Csp to the axilla
 Spinal nerves from L2-S2 from the
lumbosacral plexus which runs in the region
of the iliopsoas muscle
Plexopathies
 Disease of brachial and lumbosacral plexuses
is relatively uncommon
 Several specific conditions affect the plexuses
 In both pain is a common symptom, together
with sensory, motor and DTR loss in the
affected limb
Lesions of the brachial plexus
 Malignancy: apical lung CA, metastasis,
 As a consequence of radiotherapy for breast
cancer
 Cervical rib, may be associated vascular
insufficiency (common in women, symptoms
aggravated by carrying heavy)
 Brachial neuritis
Brachial plexopathies
 Causes:
 Trauma
 Neuralgic amyotrophy
 Malignant infiltration
 Radiotherapy
 Compression-thoracic outlet syndrome
(cervical rib or fibrous band)
Trauma
 Most common cause
 Upper plexus lesion (C5,C6): injury is usually caused
by falling on the shoulder or traction on the neck and
shoulder at birth’ Erb’s palsy’. It is associated with
the characteristic posture of a ‘ waiter’s tip’ with the
arm internally rotated, extended and slightly
adducted with loss of shoulder abduction and elbow
flexion
 Sensory loss occurs in the outer aspect of the
shoulder, arm, forearm and thumb in the C5,C6
dermatomes
 Lower plexus lesion (C8,T1): usually caused
by forced abduction of the arm, which may
occur at birth’ Klumpke’s palsy’ and following
trauma in later life, e.g. motorcycle accidents.
There is characteristically a’ clawed hand’
with loss of function of the intrinsic muscles
of the hand and long flexors and extensors of
the fingers as well as loss of sensation in C8
and T1 dermatomes
Lumbosacral plexus
 Lesion may be unilateral or bilateral
 Diabetic amyotrophy and malignant
infiltration in the pelvis are the most common
causes
 Upper plexus lesions: weakness of hip flexion
and adduction, with anterior leg sensory loss
 Lower plexus lesion: weakness of the
posterior thigh and foot muscles, with
posterior sensory loss
Other causes of L.S. plexopathy:
 Infiltration by neoplasia, prostate, ovarian,
and cervical, can infiltrate or metastasize to
the lumbosacral plexus
 Trauma following abdominal or pelvic
surgery-e.g. hysterectomy
 Compression from an abdominal aortic
aneurism
Diabetic amyotrophy
 Usually seen in older men with mild to
moderate DM (with poor glycaemic control
 The site of pathology may be in the plexus or
in the roots and may have an inflammatory
aetiology
 Patients present with painful wasting-usually
strikingly asymmetrical-of the quadriceps and
psoas muscles
 Loss of the knee jerks and extreme
tenderness in the affected area
 There is usually minimal sensory loss
 It resolves with careful control of blood
glucose over many months