Physical medicine and rehabilitation clinics of North America
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Phys Med Rehabil Clin N Am · Aug 2002
ReviewLumbar spinal stenosis, cauda equina syndrome, and multiple lumbosacral radiculopathies.
Narrowing of the vertebral canal, the lateral recess, or the neural foramina causes lumbar spinal stenosis. Stenosis results from degenerative changes that usually are superimposed on a congenitally narrowed spinal canal and can result in significant pain and disability, especially in the elderly. Signs and symptoms are related to the compression of neural and vascular elements from the limited canal space. The article reviews the anatomy and pathophysiology, clinical syndrome, diagnostic workup, and natural history of lumbar spinal stenosis to aid in proper diagnosis and treatment.
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Advances in imaging have greatly improved the ability to display spine anatomy and pathology. This article describes the imaging findings in degenerative, traumatic, infectious, and neoplastic disease. Anatomic information, however, must be tempered by an understanding of asymptomatic disease and interpreted in the context of the clinical syndrome.
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Phys Med Rehabil Clin N Am · Aug 2002
ReviewElectrodiagnostic approach to patients with suspected radiculopathy.
This article reviews the electrodiagnostic testing for persons suspected of having radiculopathies and the expected sensitivities that different testing modalities provide. One cannot minimize the importance of the clinical evaluation and differential diagnosis formulation by the electrodiagnostician to guide testing. ⋯ Electromyographic screening examinations using six muscles are possible that optimize identification yet minimize patient discomfort. Electrodiagnostic findings must be interpreted relative to the patient's clinical presentation, and the consultant should tailor the electrodiagnostic study to the clinical situation.
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Phys Med Rehabil Clin N Am · Aug 2002
ReviewTherapeutic spinal corticosteroid injections for the management of radiculopathies.
Current literature and a recent meta-analysis suggest a favorable role for corticosteroid injections in the nonoperative treatment of radiculopathy [70]. The superior results reported in recent literature may be attributable to precise fluoroscopically guided transforaminal placement of injectate close to the disc-nerve root interface and near the dorsal root ganglia, maximizing the therapeutic effect. The favorable results of corticosteroid injections in the treatment of radiculopathy caused by a focal disc herniation are consistent with the biochemical construct of radicular pain. ⋯ Such an emphasis is just beginning and inevitably will occur. Until then, decisions have to be predicated on the limited and flawed work conducted to date [71]. Nevertheless, the information gleaned from these published reports provides valuable insight not available just a decade ago.
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Phys Med Rehabil Clin N Am · Aug 2002
ReviewPhysical examination signs, clinical symptoms, and their relationship to electrodiagnostic findings and the presence of radiculopathy.
The validity of the history and physical examination varies with study method and the gold standard used. In general, symptoms are more sensitive than specific, and most patients with radiculopathy do present with some characteristic complaints. ⋯ Having a normal physical examination, however, does not rule out the possibility of having a radiculopathy that is revealed either electrodiagnostically or surgically. Although the history and physical examination may not be perfect tools for the diagnosis of radiculopathy or predicting electrodiagnostic outcome, they are an essential part of the clinical evaluation to assist in formulating a differential diagnosis and guiding the electrodiagnostic study.