Lumbar Radiculopathy Assessment

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Top Contributors - Jess Bell, Matt Huey and Wanda van Niekerk  

Introduction

Lumbar radiculopathy is commonly defined when a person is experiencing pain symptoms that radiate into the legs. There can be variances in the descriptions from sharp, shooting, shocks, numbness, and tingling, which are based upon a patient's interpretation of the symptoms. It affects approximately 3-5% of the population and is the most common issue that spine surgeons evaluate. Patients also may or may not experience back pain along with radiculopathy but roughly 12-40% of people with back pain experience radiculopathy symptoms as well.

Causes of Radiculopathy

The primary cause of lumbar radiculopathy is compression of the nerve root. It is commonly believed to be caused by a disc herniation or bulge pressing on the nerve but there can be a variety of causes such as:

• Degenerative conditions: Spondylolisthesis, Spinal Stenosis
• Trauma: Fractures
• Tumors
• Infections
• Vascular conditions: hemangioblastoma, arteriovenous malformations

Assessment for Radiculopathy

Sensation

Patients may experience a change in sensation in their lower extremities with a lumbar radiculopathy. A common complaint with lumbar radiculopathy is numbness and tingling in the legs along a dermatomal pattern. Patients may also state they feel "weird" sensations in their lower extremities as well, such as the feeling of bugs crawling on them, tenderness, or "it doesn't feel right."

Light touch can be utilized to determine if sensation is altered.

• Have the patient in the supine or seated position
• Inform them what you will be doing. "I will be brushing along your legs in certain areas, let me know if it feels the same on both sides."
• Can have the patient close their eyes or obscure their view so they are not biased to the testing
• Use your fingertips or a cotton swab to apply a light touch to a dermatome.
• Test each side and compare if it feels the same.
• To ensure consistency, utilize the same dermatomal map with each patient

Dermatome

L1	Greater trochanter
L2	Front of thigh to knee
L3	Anterior thigh and Knee, medial lower leg
L4	Lateral thigh, medial leg, dorsum of foot, big toe
L5	Posterior and lateral thigh, lateral aspect of leg, dorsum of foot, medial half of bottom of foot, toes 1-3
S1	Posterior thigh

Deep Tendon Reflexes

Reflexes may or may not be altered with a lumbar radiculopathy, however, it can be beneficial to assess. If the nerve root is being compromised then the patient may demonstrate diminished reflexes.

Repeated Movement

The use of repeated movement testing is a hallmark of Mechanical Diagnosis and Therapy (MDT or the McKenzie Method). The goal with utilizing repeated movement testing, is to determine if the person is able to centralize their radicular symptoms. There is evidence that utilizing repeated movement testing can be both useful in the assessment and treatment for lumbar radiculopathy. Repeated movement testing can be useful even if a patient is only experiencing symptoms in their lower extremity.

Several things must be considered when performing repeated movement:

• Direction. Often a mistake is only performing repeated extension.
• Loaded or unloaded. Standing is considered a loaded position of the lumbar spine whereas supine/prone is considered unloaded.
• Time and/or repetition. Another mistake that can be made is not giving enough time or the proper number of repetitions to exhaust a movement.