Radiculopathy – sifting through the symptoms

Radiculopathy is a common spinal condition that presents in clinical practice.

By definition, it is dysfunction of a spinal nerve root that may give rise to a mixture of pain, sensory and motor changes, in a pattern recognisable as being related to a single spinal segment, and is often unilateral.

Causes

The onset of radiculopathy can be abrupt or insidious, which suggests the underlying cause. Disc herniation will generally give rise to sudden onset symptoms, whereas degenerative stenosis will develop more slowly over weeks and months.

Other possible structural causes include spinal tumours, nerve root sheath tumours and epidural haematoma or abscess.

Webinar: RADICULOPATHY

In this breakfast briefing for GPs, I will cover causes, symptoms, diagnosis and management of this condition.

Wednesday 21 May 2025 at 8am

Register here

Symptoms

The common origin of pain due to cervical radiculopathy is the back of the shoulder, and for lumbar radiculopathy it is the buttock. From one of those origins, pain and sensory symptoms radiate in a dermatomal pattern to the affected limb. Associated weakness is noted as well.

• L4 – shin. Weakness of ankle dorsiflexion (possible drop foot) and knee extension
• L5 – lateral aspect of the calf; patients often say it grips their ankle. Weak great toe extension and occasionally a drop foot
• S1 – heel and lateral side of foot. Weak ankle plantar flexion, best observed by patient attempting to stand on their toes
• C6 – most commonly the thumb, sometimes index finger as well. Weak wrist extension
• C7 – index and middle fingers, and sometimes the pectoral region. Weak elbow and finger extension
• C8 – ring and little fingers. Weak finger flexion/grip.

The severity and mixture of pain, numbness and weakness are all surprisingly variable. Pain is usually dominant but sometimes is minimal despite significant loss of motor function.

Diagnosis

Radiculopathy shares common symptoms with other conditions.

• Hand numbness and tingling is most commonly due to carpal tunnel syndrome, which is frequently felt at night, and this is a good way to pick it up.
• Somewhat surprisingly, hip arthritis is often mistaken for lumbar radiculopathy. The best way to pick it up is when pain is triggered by internal rotation of the hip in the flexed (seated) position.
• Peripheral vascular diseases can also present with leg pain and can be ruled out if you feel the foot pulses.
• There are many but less common, non-structural causes of radicular symptoms. These include Guillain-Barre syndrome and diabetic mononeuritis.

If nerve root pain is your principal clinical concern then MRI is the investigation of choice, followed by CT scan.

Management

The most common cause of radiculopathy is disc herniation, and the majority of these will resolve spontaneously. The patient just needs reassurance and follow up.

Radiculopathy due to structural causes like stenosis are more likely to persist and usually need imaging with MRI and appropriate surgery.

In all cases of radiculopathy that are not improving by six weeks, imaging with MRI is recommended to determine the underlying pathology and thus appropriate treatment.

Early referral and/or imaging with MRI is indicated if:

• there is a significant loss of function, motor grade 3/5 or weaker
• the pain is very severe and debilitating
• the clinical background suggests a serious pathology such as tumour or infection. In each case, a history of prior tumour or infection at another site suggests that the spinal symptoms may be related to that pathology.

Webinar for GPs:

RADICULOPATHY

Wednesday 21 May 2025 at 8am

Register here >>

As always if you have any questions about your patient, please feel free to call me. I will return your call and discuss how I can help. You can also reach me via ralphstanford@powspine.com.au.

Posted 29 April 2025