The Back Pain Podcast Annina Schmid – Radiculopathy, The Sensory Exam and What the Results Mean
Dave and Rob are joined by Adam Dobson regular on the podcast and Annina Schmid, physiotherapist and neuroscience researcher who leads the Neuromusculoskeletal Health and Science Lab at the University of Oxford.
They discuss in detail radiculopathy, what it is and how it is diagnosed. With the neurological examination a key clinical diagnosis this is a great opportunity to hear about how Annina effectively uses sensory examination and what the results mean. Learn about radiculopathy and the sensory exam with great content in this informative episode
KEY TAKEAWAYS
- Nerve related pain is usually a radiating pain, not a pain that can be pinpointed to one spot
- Always compare left and right talking to the patient about how the affected side feels compared to the other side
- We need to establish a normative area, you cannot just compare left and right because you may miss a sensory deficit
- Test sensation using something neutral like tissue or cotton wool
- The key to neurological examination is understanding single items in isolation have no relevant value it's putting together the pieces
- You have to make the pieces fit together to understand the picture
- Studies use the reference testing of MRI imaging or inter surgical findings which don’t tell us anything about the loss of function, the definition of radiculopathy
- Radiculopathy is a clinical diagnosis that includes the neurological examination
- The reference standard should be the clinical diagnosis because that’s what radiculopathy is
- For a nerve to be affected it doesn’t need something to be directly encroaching or deforming it
- We are imaging macro structure but a nerve can be affected on the inside so we should be looking further are the inside of the nerve
- Severe motor deficit or progressive motor deficit will be a referral
- We do not need to be specialists but we do need an awareness of what can masquerade as radiculopathy and refer to the right professional
BEST MOMENTS
‘If the patient has lower back pain and it radiates into the buttock it’s enough for me to do an examination’
‘With radiculopathy, the reference standard should be the neurological examination’
‘If there is a pain and it radiates this would trigger a neurological examination’
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RESOURCES FOR THIS EPISODE
Annina Twitter https://twitter.com/AnninaBSchmid
Annina Website http://www.neuro-research.ch/
ABOUT THE HOSTS
Dave Elliott
Dave is the owner of Advanced Chiropractic, a chain of Chiropractic and massage therapy clinics in Essex, UK. Dave still sees patients during the week but has been working hard to talk to as many experts in the field of back pain as possible to help distil all the information and bring it to you in this awesome podcast. You can find Dave on any of the Advanced Chiropractic social media platforms, or you can contact him at hello@thebackpainpodcast.com if you have any questions for him.
Rob Beaven
Rob owns and runs a multidisciplinary clinic, The Dyer St Clinic in Cirencester Gloucestershire. His team of Chiropractors, Physiotherapists, Osteopaths, Doctors, and podiatrists all collaborate on thousands of back pain patients every year. Alongside Dave, he has worked hard to bring to the table experts across all industries to give you the low down on back pain, with steps you can implement today to start feeling better.
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