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Orthopaedics

Lumbosacral Radiculopathy

Built from Pillemer — Physical Signs in Orthopaedics and Neurology

What’s inside

10 sections · 59 slides

  1. 01

    Overview

    • What you will learn

    1 slide

  2. 02

    Understanding radiculopathy

    What is going wrong, and why it matters

    • Start with the root: what 'radiculopathy' means
    • What lumbosacral radiculopathy is
    • What squeezes the root
    • How worried should you be?
    • Red flags: do not miss these
    • The cauda equina triad: three signs that mean 'act now'

    6 slides

  3. 03

    Segmental innervation

    Three jobs every spinal nerve does at its level

    • One nerve level, three functions

    1 slide

  4. 04

    Sensory function

    Dermatomes and autonomous zones

    • Dermatome vs autonomous zone
    • Dermatomes of the lower limb
    • Autonomous zones of the lower limb
    • Autonomous zones, level by level

    4 slides

  5. 05

    Motor function

    Myotomes and Last's segmental rules

    • What a myotome is
    • Last's rules of segmental supply
    • Seeing the rules in action
    • Movements beyond simple flex and extend
    • Segments driving each lower-limb joint
    • The shortcut you can do in your head

    6 slides

  6. 06

    Reflex function

    Tap, twitch and what it tells you

    • One reflex for each root
    • When a reflex seems absent: reinforce it
    • Reinforcement to bring out a reflex
    • When reflexes are too brisk

    4 slides

  7. 07

    The 666 method

    A repeatable routine for radiculopathy

    • Eighteen quick checks, memorised as three sixes
    • How the 666 method works
    • The 666 grid: what each test maps to
    • Testing the knee reflex (L4)
    • Testing the medial hamstring reflex (L5)
    • Testing the ankle reflex (S1)
    • Testing foot inversion (L4)
    • Testing big-toe extension (L5)
    • Testing foot eversion (S1)
    • Sensation over the inner foot (L4)
    • Sensation over the top of the foot (L5)
    • Sensation over the outer foot (S1)
    • What each root shows when it is damaged

    13 slides

  8. 08

    The EDB sign

    An overlooked pointer to L5

    • Wasting of extensor digitorum brevis
    • Extensor digitorum brevis on the foot

    2 slides

  9. 09

    The lumbosacral plexus

    The wiring behind the roots

    • How the plexus is built
    • The lumbosacral plexus
    • The lumbar plexus
    • The lumbar plexus
    • Lumbar branches and the saphenous nerve
    • The sacral plexus and the sciatic nerve
    • The sacral plexus
    • Other branches of the sacral plexus

    8 slides

  10. 10

    Bringing it together

    Takeaways and self-test

    • Key takeaways
    • Weak big-toe extension, numb dorsum of foot, reduced medial hamstring reflex: which root, and what confirms it?
    • Sources referenced in this topic
    • Physical Signs in Orthopedic and Neurologic Disorders: A Practical Guide

    4 slides