radiculopathy pearls

Differentiating C5 and C6 radiculopathies may be difficult due to common involvement of the deltoid, biceps, brachialis and brachioradialis. However, the rhomboids implicate the C5 root preferentially, and pronator teres/FCR implicate C6. Be careful because C6 radiculopathies can also mimic C7 radiculopathies with abnormalities in triceps, anconeous, pronator teres and FCR. C7 radiculopathy-- changes are found in triceps, anconeous, FCR, and occassionally pronator teres. The latter two are important because they are median innervated and the diagnosis is not being based on radial muscles only. Extensor indicis proprius, which is C8 is spared here. C8 radiculopathy-- can see changes in radial mm (ext proprius and EPB); median nerve muscles (FPL and +/- APB) plus all the ulnar muscles. The APB is often spared. L2-4 radiculopathies-- abnormalities are often (but not always found in thigh adductors, quadriceps muscles and iliacus. L5 radiculopathy-- affects tibialis anterior, extensor hallucis, peroneus longus and EDB (all of common peroneal) plus FDL, tibialis posterior, TFL, gluteus medius and maximus. Study tensor fascia lata which is sensitive to L5 radiculopathy but is one of two such muscles that do no emanate from the sciatic nerve (the other is the gluteus medius). S1 radiulopathy-- the affected muscles are often the abductor hallucis, ADQ, soleus, gastrocnemius, and the glutei esp maximus, and short head of biceps