Radiculopathies
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This document discusses electrodiagnostic techniques for evaluating radiculopathy. It covers nerve conduction studies including SNAPs, CMaps, H-reflexes and F-waves. It also discusses needle EMG findings including fibrillations, positive sharp waves and complex repetitive discharges. The advantages and disadvantages of each technique are provided for assessing different nerve roots involved in radiculopathy.
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This document discusses electrodiagnostic tests used to evaluate neuromuscular disorders, including nerve conduction studies and electromyography (EMG). It provides details on reaction of regeneration testing, strength-duration curves, chronaxie and rheobase measurements, galvanic twitch-tetanus ratios, nerve excitability testing, EMG motor unit action potentials, common mode rejection ratios, waveform types, EMG circuitry, electrode types, normal and abnormal EMG findings, indications for EMG testing, and findings that can be observed on EMG that provide information about muscle and nerve diseases.
Lumbar disc prolapse
This document provides a summary of the history, anatomy, and components of lumbar disc prolapse. It discusses key figures who contributed to understanding of the condition over time. The summary describes the anatomy of the lumbar spine, intervertebral disc structure including the annulus fibrosus and nucleus pulposus, and facet joints. Nutrition to the disc and functions of its components are also summarized.
Peripheral Nervous System
The document provides an overview of the peripheral nervous system, including details about cranial nerves, the spinal cord, spinal nerves, and peripheral nerve plexuses. It discusses the names, functions, and pathways of 12 pairs of cranial nerves. It describes the gross anatomy and histology of the spinal cord, as well as the organization and branches of spinal nerves. Finally, it reviews the cervical, brachial, lumbar, and sacral plexuses and their contributions to innervation of the head, neck, upper limbs, lower limbs, and pelvis.
Sciatica
Sciatica is a common radiating pain syndrome caused by irritation of the sciatic nerve root, usually from a herniated disc at L4-L5 or L5-S1. It presents as low back pain radiating down the back of the leg and can affect the foot. Sciatica is a symptom rather than a diagnosis. Examination may reveal a positive straight leg raise test. Differential diagnoses include spondyloarthropathies. Imaging like MRI can identify disc herniations while conservative treatments include rest, analgesics, and epidural injections. Surgery is considered if conservative options fail or neurological deficits are present.
EMG
Electromyography (EMG) measures the electrical activity produced by muscle contractions. Surface EMG (sEMG) uses electrodes on the skin to detect muscle activation, while fine wire EMG inserts electrodes directly into muscles. EMG can indicate which muscles are active during motions like gait, but does not determine strength, movement type, or whether activity is compensatory. Proper electrode positioning, skin preparation, and signal processing are needed to obtain accurate, repeatable EMG data for analysis of muscle function.
Tuberculosis of spine
1) Tuberculosis of the spine is the most common form of skeletal tuberculosis, frequently affecting the dorsal spine.
2) It is caused by hematogenous spread of Mycobacterium tuberculosis from a primary focus. This can lead to destruction of vertebral bodies and discs, collapse, deformity, and neurological deficits in advanced cases.
3) Treatment has evolved tremendously from ancient herbal preparations and hot iron drainage to modern multi-drug anti-tubercular regimens with aggressive surgical management to prevent deformity and paralysis when needed.
tuberculosis of spine
This document discusses tuberculosis of the spine. Some key points:
- Spinal tuberculosis most commonly affects the dorsal spine in the first three decades of life. It spreads hematogenously from a primary focus.
- Pathology involves formation of tubercles and caseation necrosis, which can lead to bone destruction and deformity like kyphosis.
- Presentation includes non-specific symptoms like back pain as well as neurological deficits in some cases. Investigations include imaging like X-ray and MRI to identify bone changes and abscesses.
- Treatment has evolved from early surgical drainage to current emphasis on early diagnosis and medical treatment with antibiotics to cure the infection while preserving spinal function and structure.
Cutaneous innervation of lower limb
1) Several cutaneous nerves innervate the skin of the lower limb, originating from lumbar and sacral spinal nerves.
2) The femoral, obturator, superior and inferior gluteal nerves innervate the thigh. The sciatic, common peroneal, tibial and sural nerves innervate the leg.
3) Injury to major nerves like the femoral or sciatic can result in sensory loss over large areas, placing the individual at risk for trophic ulcers. Precise patterns of sensory loss depend on the specific nerve injured.
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Evaluation and Management of Facial Nerve Palsy by Dr.Aditya Tiwari.
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Neck Pain and Arm Pain : Cervical Radiculopathy by Pablo Pazmino MD
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Ziekte van Hirayama - Dr. Jo Caekebeke
Juvenile distal segmental spinal muscular atrophy, also known as Hirayama disease, is a rare condition characterized by slowly progressive asymmetric weakness and atrophy of hand and forearm muscles, typically affecting young males. The pathophysiology is thought to involve flexion-induced compression of the lower cervical spinal cord during neck flexion. MRI with neck flexion shows anterior displacement and flattening of the cervical cord. There is no effective treatment, but symptoms typically stabilize within a few years.
AIDPCIDP MMN Stålberg
This document summarizes key information about Guillain-Barré syndrome (GBS) and related acute inflammatory neuropathies. It describes the incidence and subtypes of GBS, including typical symptoms such as weakness and sensory disturbances. Electrodiagnostic findings are outlined, including conduction block, prolonged distal latencies, and reduced nerve conduction velocities supportive of demyelination. The time course of GBS and potential etiologies like infection are mentioned. Chronic inflammatory demyelinating polyneuropathy (CIDP) and multifocal motor neuropathy are also summarized, with details on clinical features and electrodiagnostic patterns that help differentiate these conditions from GBS.
Diseases of Spinal Cord
1) The document discusses the anatomy, imaging, classification, clinical approach, and localization of spinal cord pathology. It covers various spinal cord diseases including compressive myelopathy, non-compressive myelopathy, intramedullary and extramedullary lesions.
2) Special patterns of presentation like Brown-Sequard syndrome, anterior/posterior cord syndromes, and central cord syndrome are explained. Localization of lesions in the cervical, thoracic, lumbar, and sacral regions is outlined.
3) The clinical approach involves considering features like onset, progression, bladder involvement, presence of pain, and nature of paraplegia to classify spinal cord diseases. Key points on examination include types of motor and sensory
Spinal cord injuries
This document provides an overview of spinal cord injuries, including relevant anatomy, classification, examination, management, and complications. It discusses the mechanism and types of incomplete spinal cord injuries such as central cord syndrome. Diagnostics like X-rays and MRIs are outlined. Initial management includes steroid administration, immobilization, and possible surgical decompression or stabilization. Complications can include respiratory arrest, autonomic dysreflexia, and long-term issues like contractures.
LAST.pptx
This document summarizes the post-operative course of a 16-year-old male who was admitted following a motor vehicle accident with multiple injuries including a head injury. On post-operative day 1, the patient was stable with no pain and normal vital signs. On post-operative day 2, the patient remained stable and comfortable with slightly dilated pupils on the right side. Potential differential diagnoses discussed include local anesthetic systemic toxicity, total spinal anesthesia, and brachial plexus injury resulting in Horner's syndrome.
Spinal Cord Syndromes-An Overveiw
1. The document discusses various spinal cord syndromes including complete cord transection syndrome, Brown-Sequard syndrome, central cord syndrome, posterior column syndrome, posterolateral cord syndrome, combined anterior horn cell-pyramidal tract syndrome, anterior horn cell syndrome, and anterior spinal artery occlusion syndrome.
2. It describes the key features of each syndrome such as the patterns of sensory and motor deficits and common causes.
3. Examples of features mentioned include flaccid paralysis, loss of all sensory modalities, and autonomic disturbances for complete cord transection syndrome and unilateral motor and sensory deficits for Brown-Sequard syndrome.
Useful background information for neurology revision.
This document provides a summary of key topics in neurology for revision purposes. It covers diagnostic reasoning in neurology including the importance of considering tempo of onset and localizing lesions. It also summarizes some key neuroanatomy including ascending and descending pathways. Examination findings like the MRC scale and features of increased tone are defined. Pathological gaits, cerebellar signs, brainstem symptoms, and spinal cord symptoms are also outlined.
Unusual Presentation of Takayasu Arteritis
A 37-year-old female presented with acute onset weakness of all four limbs for 5 hours. On examination, she had flaccid quadriparesis with decreased tone and power in both upper and lower limbs. Investigations revealed hypokalemia, metabolic alkalosis, hypertension, and renal potassium wasting. CT angiogram showed bilateral thinning and stenosis of the subclavian arteries and diffuse aortic wall thickening. This is consistent with Takayasu's arteritis, a large vessel vasculitis most commonly affecting the aorta and its major branches in young females.
A case of LV Non Compaction
The patient presented with altered sensorium, decreased movement in their right side, and deviation of their mouth to the left. Imaging showed a non-hemorrhagic infarct in the left fronto-parietal region consistent with a stroke. An echocardiogram found left ventricular non-compaction (LVNC), a mobile clot attached to the left ventricle, and normal systolic function. The final diagnosis was LVNC, stroke, hyperhomocysteinemia, and hyperlipidemia. LVNC is a rare heart condition where the left ventricle fails to compact during development, leaving prominent trabeculations. It can cause heart failure, arrhythmias, and thromboemb
Caffey Disease ,AVN
Caffey disease, also known as infantile cortical hyperostosis, is a self-limited condition characterized by asymmetric thickening of bone cortices in infants less than 5 months old. It presents as fever, soft tissue swelling, and irritability and typically resolves without sequelae within 6-9 months. Osteopetrosis is a rare genetic disorder where bone resorption is impaired, leading to abnormally dense and brittle bones. It can range from mild to lethal depending on the mutated gene. Legg-Calve-Perthes disease involves osteonecrosis of the femoral head epiphysis in children, commonly presenting with hip pain and limping. It is diagnosed based on imaging findings of femoral
Manievelraaman's APPROACH TO NEUROLOGICAL WEAKNESS
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PPT used for PG symposium of M.D. General Medicine Post-Graduates
Aortic stenosis - case report
This patient presented with progressive chest pain on exertion and shortness of breath. A physical exam revealed a systolic murmur and echocardiogram showed aortic stenosis with a mean gradient of 32mm Hg and valve area of 0.88cm^2. A cardiac catheterization showed severe aortic stenosis with a peak gradient of 68mm Hg and valve area of 0.83cm^2. Given her symptoms and severity of stenosis, surgical aortic valve replacement is recommended. Coronary angiography will also be performed to assess for need for concomitant CABG prior to surgery.
Headache
This document discusses approaches to headache diagnosis and treatment. It defines different types of primary headaches like tension, migraine and cluster headaches. It also covers secondary headaches that can be caused by underlying conditions. The evaluation involves a thorough history, physical exam, and diagnostic tests depending on risk factors. Treatment differs based on whether the headache is primary or secondary, with the goal of identifying any serious underlying causes for secondary headaches.
Spinal cord injuries
This document provides an overview of spinal cord injuries, including:
1. It discusses the anatomy, common causes, and demographics of spinal cord injuries. The most common causes are motor vehicle accidents, falls, violence, and sports injuries. Men ages 16-30 are most commonly affected.
2. It defines different types of spinal cord injuries such as complete vs incomplete, primary vs secondary, and describes various spinal cord syndromes like central cord syndrome, anterior cord syndrome, and Brown-Sequard syndrome.
3. It outlines the initial management of spinal cord injury patients in the emergency department, including immobilization, monitoring, imaging, and use of methylprednisolone within 8 hours of injury.
Myofascial pain syndrome
Myofascial pain syndrome is characterized by painful muscle trigger points that cause pain in the affected muscle and potentially other referred pain in distant areas. Trigger points form due to muscle injury or overuse and maintain a contracted knot within the muscle via a positive feedback loop. Examination involves identifying a taut band within the muscle and locating the most tender point, which may elicit a local twitch response when pressed. Diagnosis is based on identifying a trigger point and reproducing the patient's pain. Treatment involves education, medications, and non-pharmacological therapies like exercise, massage, and dry needling of trigger points.
CRPS/ SUDECKS DYSTROPHY & MYOSITIS OSSIFICANS
The document defines complex regional pain syndrome (CRPS), providing information on its types, synonyms, etiology, clinical features, diagnosis, and treatment. CRPS is characterized by disproportionate chronic pain that spreads beyond an injured body part. It has sensory, vasomotor, sudomotor, motor, and trophic components. While the cause is unknown, it often follows trauma or immobilization. Treatment focuses on rehabilitation, pain management, physical therapy, and in some cases surgery or sympathetic blocks.
PNS disorders Nursing.pptx
The document discusses disorders of the peripheral nervous system (PNS). It defines the PNS and describes its components. Common symptoms of PNS disorders include weakness, numbness and pain localized to parts of limbs. Signs include lower motor neuron signs like atrophy and fasciculations. Select major PNS disorders are then discussed in more detail, including anterior horn cell disorders like ALS, nerve root disorders like radiculopathy, plexopathies, mononeuropathies, peripheral neuropathies, myasthenia gravis, trigeminal neuralgia and Bell's palsy. For each, manifestations, diagnostic tests and treatment approaches are summarized.
HEAD & SPINAL TRAUMA
The document provides information on the assessment and management of head and spinal trauma. It outlines the ABC approach for head trauma and emphasizes preventing secondary brain injury. It describes evaluating the Glasgow Coma Scale and pupillary responses. For spinal trauma, it stresses immobilization and protecting the spine during transport. Key factors include preventing further neurological injury and addressing airway, breathing, circulation issues.
CBD.pptx
This document discusses a case of a 45-year-old female bank officer presenting with weakness and clumsiness in her right hand over the past 3-4 weeks. On examination, she showed wasting of the thenar muscle and weakness of thumb and finger movements. Nerve conduction studies showed reduced motor responses in the median and ulnar nerves without slowing. Electromyography revealed generalized reduction of motor units. The patient was diagnosed with amyotrophic lateral sclerosis based on meeting diagnostic criteria. The document then provides background information on ALS and discusses differential diagnoses considered for the patient's symptoms.
THROMBO ANGITIS OBLITERENS2-1.pptx
This document provides information on thromboangitis obliterans (TAO), including characteristics, clinical findings, investigations, and treatment options. TAO most commonly affects young males who smoke and presents with pain, ulcers, and discoloration of the lower limbs. Diagnosis involves clinical examination, Doppler/duplex ultrasound, angiography and meeting Shionoya criteria. Treatment includes lifestyle changes, medications like antiplatelets, and surgical options like amputation or sympathectomy depending on severity and location of obstruction. The goal of treatment is to relieve symptoms, promote healing, and preserve limb function.
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Useful background information for neurology revision.
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More from Alireza Pishgahi
Labor pain relief
This study compared the analgesic efficacy of intravenous paracetamol versus intramuscular pethidine for labor pain in primigravid women undergoing normal vaginal delivery. 80 women were randomly assigned to receive either 1000mg intravenous paracetamol or 50mg intramuscular pethidine for labor pain. Pain levels were assessed after delivery using a visual analogue scale. The average pain score was significantly lower in the paracetamol group compared to the pethidine group. No significant complications occurred in either group. The study concluded that intravenous paracetamol provides more effective labor pain relief than intramuscular pethidine for normal vaginal deliveries.
Needle electromyography
This document provides information about performing and interpreting needle electromyography (EMG). It discusses preparing the patient, electrode placement, different muscle contraction techniques, and Johnson's 5 steps for needle examination. It explains what to look for at rest, with minimal/maximal contractions, and different abnormal findings including fibrillation potentials and complex repetitive discharges. Neurogenic and myogenic recruitment patterns are compared. The overall summary is that this document outlines the procedure and analysis of needle EMG examinations.
Burn rehabilitation
This document discusses various topics related to burn injuries and treatment:
1) It discusses the rule of 9 for estimating total body surface area (TBSA) burned, risks of compartment syndrome, the need for debridement and skin grafting, and calorie needs based on TBSA.
2) It notes increased risks for things like insulin resistance, bone loss, pneumonia, and poor wound healing for burns over 30% TBSA.
3) The document provides guidance on prevention and treatment of hypertrophic scarring and contractures, including various creams, massage, and range of motion exercises.
Cardiac rehabilitation past and present
Cardiac rehabilitation programs have evolved significantly over the past century from strict bed rest to structured exercise-based programs. Exercise-based cardiac rehabilitation is associated with lower risks of cardiovascular death and hospitalization. It can improve cardiac outcomes through mechanisms such as lipid and blood pressure lowering, smoking cessation, reduced inflammation, and improved ventricular function. While cardiac rehabilitation completion is associated with improved survival, utilization rates remain low at only 10-20% due to various barriers.
Cardiac rehabilitation in heart transplantation
This document summarizes cardiac rehabilitation issues after heart transplantation. It discusses how patients have reduced exercise capacity due to denervation of the transplanted heart and use of immunosuppressive drugs. The document outlines a three-phase rehabilitation program starting with pain management and gentle exercises, progressing to monitored exercises targeting 50-80% of maximum heart rate. Methods for assessing exercise capacity such as cycle ergometry and treadmill tests are also described, noting their advantages and limitations. Resistance training is recommended to increase muscle and bone strength. The overall goal of rehabilitation after heart transplantation is to improve exercise capacity and quality of life.
Cardiac rehabilitation
Cardiac rehab programs help heart patients increase physical fitness, reduce cardiac symptoms, and lower future heart risks through education, counseling, and exercise. They focus on aerobic and resistance training prescribed according to FITT principles at intensities determined by risk stratification and target heart rates. Aerobic training should be at 50-80% of VO2 max for 30-60 minutes daily and last at least 8 weeks. Resistance training improves muscle strength and cardiovascular health and begins after 4 weeks of aerobic training. Long term follow up is also provided to support maintenance.
Lower limb fractures
Hip fractures are usually treated with surgery to fix the bone with metal screws or plates, as leaving the fracture untreated for the 8-12 weeks required for healing would risk serious complications from prolonged bed rest. Rehabilitation after hip fracture surgery typically lasts 15-30 weeks and focuses on restoring normal gait, hip range of motion, strengthening, and functional activities like sitting, transfers, and ambulation.
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Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
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1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
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Radiculopathies
- 2. Origins of pain Clinically important tip: What likes root pain? Pure sensory Radiculopathy?
- 3. EDX important limitation Axonal loss: M&S&R loss Conduction Block: ◦ Non- demeylinating ◦ Demeylinating: M&S&R loss Conduction slowing ◦ Differential: S&R loss, NCV can be normal: ◦ Synchronized ◦ EDX= extension of neurologic examination
- 5. SNAP: ◦ NL>>Amp>latency ◦ C6,C7,C6&C7,C8,T1 ◦ L2-L3, L4,L5,S1 When SNAP dec? ◦ Proximal DRG (severe L5) ◦ Far lateral Herniation ◦ Gangloionopathy (Dm/ herpes)
- 6. CMAP ◦ NL>Amp>absent>latency: Why? ◦ Abnormality in 6-8 days ◦ C8/T1 ◦ L5/S1 ◦ S1/S2
- 7. H reflex:( GCS) ◦ S radiculopathy 30-100% abnormality(definition) ◦ Different pathway from ankle jerk reflex H reflex:( FCR) ◦ C6&C7 radiculopathy :17.4, 0.7 ms Advantage: ◦ sensory radiculopathy Disadvantage: ◦ Sensitivity&Specifity Abnormal H(GCS)
- 8. F wave Fist finding in: GBS/Vasonervoum infarct F-wave abnormality: MMN Advantage: ◦ Immediately, Not readily accessible araes Disadvantage: ◦ Recurrent process ◦ Motor only ◦ If one root AbNl: others can mask it ◦ Dilution ◦ Non specific
- 9. Nerve Root Stim. ◦ C5 SPC5&C6: BB ◦ C6 SPC5-C8:TRC ◦ C7 SPC8&T1:ADM ◦ L5 SP TA ◦ S1 SP GCS(lat) Abnormal: amp/ latency Advantage: ◦ More sensitive than EMG Disadvantage: ◦ Doubt in stim location, only motor, dangers
- 10. Advantage: ◦ Immediately, Sensory Disadvantage: ◦ Not sensitive to mild lesions ◦ Variation ◦ Dilution ◦ No perfect localization ◦ mixed: multi root assessment, ◦ segmental: really uni root, cervical? ◦ Dermatomal?
- 11. Advantage: ◦ Probably the highest Dx yield Disadvantage ◦ Motor only ◦ Not immediately ◦ Sometimes no conformation to H&PE Myotomal charts vs. individual innervation Small number of fibers involved Cyclical presence of Fib/PSW
- 12. Fib/PSW ◦ Advantage Hall mark The most sensitive Before MUAP morphology change ◦ Timeframe: 1/3/-5,6 weeks. Is it questionable? Inc insertional activity ◦ Run of Fib/PSW 50 ms after stopping ◦ First Abnormality after denervation ◦ Don’t base your Dx.
- 13. CRD ◦ Chronic phase, a few muscles: Paraspinal Fasciculation ◦ Chronic phase, a few muscles, not paraspinal ◦ Sometimes the only finding ◦ Rare but if myotomal then highly diagnostic
- 14. Hallmark of radiculopathy: paraspinal denervation (post. rami innervation) Technique: ◦ 1-2 cm ( L: 2.5) lateral&1 cm superior to SP ◦ Angel: 45,60 then withdraw Special technique in cervical; interspinal Instability? ◦ Difficult relaxation ◦ Renervation
- 15. Other diseases : MND, Inflammatory myopathy, DM Trauma, Metastasis iatrogenic : myelogeraphy, LP, Rhizolysis,tomy Dorsal rami entrapment
- 16. Paraspinal findings after operation ◦ Denervation ,anyway Can we say on “recurrence? Techniques: ◦ Lateral placement: 1 & 3 cm:+ in latter recurrence(?) ◦ Semi-quantitive: After 1 y: < 100, if> 300-600 recurrence Better in limbs as might be scar in paraS Avoid it
- 17. Myotomal denervation in first 1-2 m: Axonal loss The same but after >3 m: ongoing or progressive ◦ High Amp ◦ Proximal muscles Care on hematoma
- 18. MUAP abnormalities ◦ Red.Recruitment Practically Difficult Reference data Not very useful in mild lesions ◦ Variability In acute phase ◦ Incr.Duration Incr.fiber asynchronicity – Polyphasic • NL • Needs Quantitive EMG • Must be myotomal _ Large, polyphasic and high duration MUAPs
- 19. SFEMG: ◦ Jitter : inc ◦ Block + acute ◦ Block – chronic Density If new symptoms in 4-6 w denervation amp matters
- 20. Low sensitivity of EMG ◦ Sensory only, Few fibers, slowly progressive, Temporal ◦ No FP if myotomal denervation Imaging: low specificity _ 30-80% of normal individuals have abnormal MRI H&P/E: not “golden standard” So complimentary
- 22. How to name disks and SNs? ◦ First (Second )disk :between C2 and C3 above ◦ Fist Spinal Nerve between C0 and C1 below Nerve root affection: ◦ most: C7>C6 ◦ least :C8>C5
- 23. C3/C4: ◦ Nerves, tension headache C5: ◦ SS,IS,DeL,BB,SuP,BR if + PT,FCR,ECR then C6 or multi, Paraspinal helpful ◦ Rhomboid: Only (findings matter) ◦ If PT + : R/O isolated C5 C6: ◦ All above, cant separate from C5; H helps
- 24. C7: ◦ AnC, PT, FCR, EDC, plus: FCU& FPD ◦ H ◦ IF TrC - R/O C8/T1: ◦ (FDP,ADM,PQ,APB,OPB) + Trc/EIP ◦ Radial innervated muscles: T1 Less ◦ TrC: C8 less not involved ◦ APB: T1 more
- 25. Singular > Multiple If not singular other side Bilateral? If multiple and bilateral: ◦ Other causes ◦ Neuropathy Lower limb
- 26. DDx ◦ MPS ◦ MSK ◦ Partial plexopathy Upper trunk Middle trunk Lower trunk Paraspinal and SNAP can help Double-crush injury ◦ If C6/C7 then R/O CTS ◦ IF C8/T1 then R/O cubital T.
- 27. Uncommon , T8/T12 ( T11/T12) Cx: ◦ CM. CE / Myelopathy ◦ Band like chest pain> Lower pain>wekness ETX: ◦ DM, Trauma, herpes, V collapse, metastasis, Pott, dislocated rib. EDX: ◦ EMG: paraspinal( relaxation, DM)/ Abdominal muscles/Respiratory muscles ◦ CMAP(abdominal) ◦ SEP(most reliable)
- 28. 90% L5 and S1 due to mainly L4 and L5 discopathy L4 herniation ◦ Superiolateral: L4 ◦ Posterior: L5 ◦ Inferior: S1 ◦ Medial: multiroot bilateral Other side Temporal issue
- 29. L2/3/4 : 12% ◦ ParaS ,IlioP,AL,Gra, Quad ◦ Few nerves, all proximal muscles L5 : ◦ ParaS/Hip girdle/Peroenal:EHL/FHL,FDL,GCS,TP S1 : most common root ◦ L5 :most common disk ◦ ParaS/Hip girdle/TFL/Post calf,EDL.EHL/Foot intr. ◦ H reflex ◦ Cant separate from S2: maybe EDL onlyS1 but L5 S2/3/4 ◦ Anal sphincter/SoL/Foot inter. Always bilateral
- 30. L2/3/4 ◦ Diabetic amyotrophy ◦ Femoral nerve injury ◦ Obturator nerve injury ◦ Lumbar plexopathy: SNAP, paraspinal L5: ◦ Foot drop Peroenal palsy: SNAP of SPN, Block, EMG MND Plexopathy Peripheral polyneuropathy
- 31. L2/3/4 ◦ Diabetic amyotrophy ◦ Femoral nerve injury ◦ Obturator nerve injury ◦ Lumbar plexopathy: SNAP, paraspinal L5: ◦ Foot drop Peroenal palsy: SNAP of SPN, Block, EMG MND Plexopathy Peripheral polyneuropathy
- 32. S1/S2 ◦ Sciatic nerve injury ◦ Sacral plexopathy S2/3/4 ◦ Pudendal nerve injury