Abstract
Identifying “where is the lesion” is particularly important in the approach to the patient with focal dysfunction where a peripheral localization is suspected. This article outlines a methodical approach to the neuromuscular patient in distinguishing focal neuropathies versus radiculopathies, both of which are common presentations to the neurology clinic. This approach begins with evaluation of the sensory examination to determine whether there are irritative or negative sensory signs in a peripheral nerve or dermatomal distribution. This is followed by evaluation of deep tendon reflexes to evaluate if differential hyporeflexia can assist in the two localizations. Finally, identification of weak muscle groups unique to a nerve or myotomal pattern in the proximal and distal extremities can most reliably assist in a precise localization. The article concludes with an application of the described method to the common scenario of distinguishing radial neuropathy versus C7 radiculopathy in the setting of a wrist drop and provides additional examples for self-evaluation and reference.
Highlights
Nerve conduction studies (NCS) and electromyography (EMG) are standard tests in the evaluation of focal peripheral neuropathies [1], newer techniques, including peripheral nerve ultrasound and MRI neurography, have started to gain acceptance [2]
The word highlighted in italics indicate commonalities between monoradiculopathy and focal neuropathy, and those in bold indicated the distinguishing examination findings
Reflexes can be differentially affected in nerve and nerve root lesions and clinicians should consider less commonly tested reflexes, including the medial hamstring L5, finger flexor C8, and pectoral C5 reflexes
Summary
Division of Neurology, University Health Network (UHN), University of Toronto, Toronto, ON, Canada. This article outlines a methodical approach to the neuromuscular patient in distinguishing focal neuropathies versus radiculopathies, both of which are common presentations to the neurology clinic. This approach begins with evaluation of the sensory examination to determine whether there are irritative or negative sensory signs in a peripheral nerve or dermatomal distribution. This is followed by evaluation of deep tendon reflexes to evaluate if differential hyporeflexia can assist in the two localizations.
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