Evaluation of persons with suspected lumbosacral and cervical radiculopathy: Electrodiagnostic assessment and implications for treatment and outcomes (Part I)
Corresponding Author
Timothy R. Dillingham MD MS
Department of Physical Medicine and Rehabilitation, the Perelman School of Medicine, The University of Pennsylvania, Philadelphia, Pennsylvania, USA
Correspondence
Timothy R. Dillingham, University of Pennsylvania, 1800 Lombard St., First Floor, Philadelphia, PA 19146, USA.
Email: [email protected]
Search for more papers by this authorThiru M. Annaswamy MD, MA, FAAPMR
Department of Physical Medicine & Rehabilitation, Electrodiagnostic and Spine Sections, VA North Texas Health Care System, Dallas VA Medical Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA
Search for more papers by this authorChristopher T. Plastaras MD
Musculoskeletal Spine & Sports Rehabilitation Medicine, MossRehab, Einstein Spine Institute, Einstein Healthcare Network, Rehabilitation Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
Search for more papers by this authorCorresponding Author
Timothy R. Dillingham MD MS
Department of Physical Medicine and Rehabilitation, the Perelman School of Medicine, The University of Pennsylvania, Philadelphia, Pennsylvania, USA
Correspondence
Timothy R. Dillingham, University of Pennsylvania, 1800 Lombard St., First Floor, Philadelphia, PA 19146, USA.
Email: [email protected]
Search for more papers by this authorThiru M. Annaswamy MD, MA, FAAPMR
Department of Physical Medicine & Rehabilitation, Electrodiagnostic and Spine Sections, VA North Texas Health Care System, Dallas VA Medical Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA
Search for more papers by this authorChristopher T. Plastaras MD
Musculoskeletal Spine & Sports Rehabilitation Medicine, MossRehab, Einstein Spine Institute, Einstein Healthcare Network, Rehabilitation Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
Search for more papers by this authorAbbreviations: AANEM, American Association of Neuromuscular and Electrodiagnostic Medicine; CRD, complex repetitive discharge; DRG, dorsal root ganglion; EDX, electrodiagnostic; EMG, electromyography; FCR, flexor carpi radialis; MRI, magnetic resonance imaging; NA, neuralgic amyotrophy; NCS, nerve conduction study; PL, peroneus longus; PSW, positive sharp wave; PT, pronator teres; SCI, spinal cord injury; SHBF, short head of the biceps femoris; SNAP, sensory nerve action potential; TA, tibialis anterior; TFL, tensor fasciae lata; TP, tibialis posterior.
Abstract
Persons with back, neck, and limb symptoms constitute a major referral population to specialists in electrodiagnostic (EDX) medicine. The evaluation of these patients involves consideration of both the common and less common disorders. The EDX examination with needle electromyography (EMG) is the most important means of testing for radiculopathy. This test has modest sensitivity but high specificity and well complements imaging of the spine. Needle EMG in combination with nerve conduction testing is valuable in excluding entrapment neuropathies and polyneuropathy―conditions that frequently mimic radicular symptoms. In this first of a two-part review, the optimal EDX evaluation of persons with suspected radiculopathy is presented. In part two, the implications of EDX findings for diagnosis and clinical management of persons with radiculopathy are reviewed.
Abstract
CONFLICTS OF INTEREST
Dr. Plastaras is on Scientific Advisory Board, BioRestorative (travel/meals/lodging, stock options) 2019, co-authored funded research from Spine Intervention Society (SIS) grant to investigate rate of disc degeneration after provocative discography, Senior Medical Consultant for Family owned TLG Associates (professional licensure/membership, CME activity fees/travel/meals/lodging), copyright ownership of the RICPLAS (© 2006) computer software pertaining to outpatient musculoskeletal pain practice. Board of Directors, McKenzie Institute USA.
The remaining authors (Dillingham, Annaswamy) have no conflicts of interest to disclose.
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