How Are the Radiculopathies Diagnosed?

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Managing Sciatica and Radicular Pain in Primary Care Practice
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Abstract

The first step in diagnosing sciatica and radicular pain is assessing the patient’s clinical history, wherein the focus is on identifying so-called ‘red flags’, which may indicate an increased risk of serious pathology. A herniated disc is such a dominant reason for radiculopathic pain that all other possibly serious spinal pathologies should be ruled out [1].

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References

  1. Mens JMA, Chavannes AW, Koes BW, et al. NHG-Standaard lumbosacraal radiculair syndroom [NHG Guideline on lumbosacral radicular syndrome]. Huisarts Wetenschap. 2005;48:171-178.

    Google Scholar 

  2. Maughan EF, Lewis JS. Outcome measures in chronic low back pain. Eur Spine J. 2010;19:1484-1494.

    Google Scholar 

  3. Sriwatanakul K, Kelvie W, Lasagna L, et al. Studies with different types of visual analog scales for measurement of pain. Clin Pharmacol Ther. 1983;34:234-239.

    Google Scholar 

  4. von Korff M, Jensen MP, Karoly P. Assessing global pain severity by self-report in clinical and health services research. Spine. 2000;25:3140-3151.

    Google Scholar 

  5. Andersson GB. Diagnostic considerations in patients with back pain. Phys Med Rehab Clin N Am. 1998;9:309-322.

    Google Scholar 

  6. Smeal WL, Tyburski M, Alleva J. Discogenic/radicular pain. Dis Mon. 2004;50:636-669.

    Google Scholar 

  7. Miranda H, Viikari-Juntura E, Martikainen R, et al. Individual factors, occupational loading, and physical exercise as predictors of sciatic pain. Spine. 2002;27:1102-1109.

    Google Scholar 

  8. Deyo RA, Loeser JD, Bigos SJ. Herniated lumbar intervertebral disk. Ann Intern Med. 1990;15:598-603.

    Google Scholar 

  9. Picavet HS, Schouten JS. Physical load in daily life and low back problems in the general population: the MORGEN study. Prev Med. 2000;31:506-512.

    Google Scholar 

  10. Vroomen PC, de Krom MC, Knottnerus JA. Diagnostic value of history and physical examination in patients suspected of sciatica due to disc herniation: a systematic review. J Neurol. 1999;246:899-906.

    Google Scholar 

  11. Waddell G. The Back Pain Revolution. Edinburgh, UK: Churchill Livingstone; 1999.

    Google Scholar 

  12. van den Hoogen HM, Koes BW, van Eijk JT, Bouter LM. On the accuracy of history, physical examination, and erythrocyte sedimentation rate in diagnosing low back pain in general practice. A criteria-based review of the literature. Spine. 1995;20:318-327.

    Google Scholar 

  13. Agency for Health Care Policy and Research. Quick Reference Guide Number 14: Acute low back problems in adults: assessment and treatment. Available at: www.ncbi.nlm.nih.gov/books/NBK52134/. Accessed August 23, 2012.

  14. Merskey H, Bogduk N. Classification of Chronic Pain. 2nd edn. Seattle, WA: IASP Press; 1994.

    Google Scholar 

  15. Harstall C, Ospina M. How prevalent is chronic pain? IASP Pain: Clinical Updates 2003;11:1-4.

    Google Scholar 

  16. Ostelo RWJG, de Vet HCW, Knol DL, van den Brandt PA. 24-item Roland Morris Disability Questionnaire was preferred out of six functional status questionnaires for post-lumbar disc surgery. J Clin Epidemiol. 2004;57:268-276.

    Google Scholar 

  17. Beurskens AJ, de Vet HC, Koke AJ. Responsiveness of functional status in low back pain: a comparison of different instruments. Pain. 1996;65:71-76.

    Google Scholar 

  18. Cruccu G, Anand P, Attal N, et al. EFNS guidelines on neuropathic pain assessment. Eur J Neur 2004;11: 13-62.

    Google Scholar 

  19. Haanpää, ML, Backonja MM, Bennet MI, et al. Assessment of neuropathic pain in primary care. Am J Medicine 2009;122:S13–S21.

    Google Scholar 

  20. Bennett M. The LANSS Pain Scale: the Leeds assessment of neuropathic symptoms and signs. Pain. 2001;92:147-157.

    Google Scholar 

  21. Bouhassira D, Attal N, Alchaar H, et al. Comparison of pain syndromes associated with nervous or somatic lesions and development of a new neuropathic pain diagnostic questionnaire (DN4). Pain. 2005;114:29-36.

    Google Scholar 

  22. Freynhagen R, Baron R, Gockel U, Tölle TR. painDETECT: a new screening questionnaire to identify neuropathic components in patients with back pain. Curr Med Res Opin. 2006;22:1911-1920.

    Google Scholar 

  23. Chou R, Qaseem A, Snow V, et al. Diagnosis and treatment of low back pain: a joint clinical practice guideline from the American College of Physicians and the American Pain Society. Ann Intern Med. 2007;147:478-491.

    Google Scholar 

  24. Lauder TD. Physical examination signs, clinical symptoms, and their relationship to electrodiagnostic findings and the presence of radiculopathy. Phys Med Rehab Clin N Am. 2002;13:451-467.

    Google Scholar 

  25. Devillé WL, van der Windt DA, Dzaferagić A, Bezemer PD, Bouter LM. The test of Lasègue: systematic review of the accuracy in diagnosing herniated discs. Spine. 2000;25:1140-1147.

    Google Scholar 

  26. Saal JA. Natural history and nonoperative treatment of lumbar disc herniation. Spine. 1996;21:2S-9S.

    Google Scholar 

  27. Kortelainen P, Puranen J, Koivisto E, Lähde S. Symptoms and signs of sciatica and their relation to the localization of the lumbar disc herniation. Spine. 1985;10:88-92.

    Google Scholar 

  28. Clarkson HM. Musculoskeletal Assessment: Joint Range of Motion and Manual Muscle Strength. Philadelphia: Lippincott Williams & Wilkins; 2000.

    Google Scholar 

  29. de Graaf I, Prak A, Bierma-Zeinstra S, Thomas S, Peul W, Koes B. Diagnosis of lumbar spinal stenosis: a systematic review of the accuracy of diagnostic tests. Spine. 2006;31:1168-1176.

    Google Scholar 

  30. Vroomen PC, de Krom MC, Knottnerus JA. Consistency of history taking and physical examination in patients with suspected lumbar nerve root involvement. Spine. 2000;25:91-96.

    Google Scholar 

  31. Valat JP, Genevay S, Marty M, Rozenberg S, Koes B. Sciatica. Best Pract Res Clin Rheumatol. 2010;24:241-252.

    Google Scholar 

  32. Rudwaleit M, Metter A, Listing J, Sieper J, Braun J. Inflammatory back pain in ankylosing spondylitis: a reassessment of the clinical history for application as classification and diagnostic criteria. Arthritis Rheum. 2006;54:569-578.

    Google Scholar 

  33. Mansour M, Cheema GS, Naguwa SM, et al. Ankylosing spondylitis: a contemporary perspective on diagnosis and treatment. Semin Arthritis Rheum. 2007;36:210-223.

    Google Scholar 

  34. Deyo RA, Diehl AK. Cancer as a cause of back pain: frequency, clinical presentation, and diagnostic strategies. J Gen Intern Med. 1988;3:230-238.

    Google Scholar 

  35. van Tulder M, Becker A, Bekkering T, et al. European guidelines for the management of acute non-specific low back pain in primary care. Eur Spine J. 2006;15:S169-S191.

    Google Scholar 

  36. Koes BW, van Tulder MW, Thomas S. Diagnosis and treatment of low back pain. BMJ. 2006;17:1430-1434.

    Google Scholar 

  37. NICE Clinical Guideline 88. Low back pain: early management of persistent non-specific low back pain. 2009. Available at http://publications.nice.org.uk/low-back-pain-cg88. Accessed August 23, 2012.

  38. Hagen KB, Hilde G, Jamtvedt G, Winnem MF. The Cochrane review of bed rest for acute low back pain and sciatica. Spine. 2000;25:2932-2939.

    Google Scholar 

  39. Kendrick D, Fielding K, Bentley E, Miller P, Kerslake R, Pringle M. The role of radiography in primary care patients with low back pain of at least 6 weeks duration: a randomized (unblinded) controlled trial. Health Technol Assess. 2001;5:1-69.

    Google Scholar 

  40. Kendrick D, Fielding K, Bentley E, Kerslake R, Miller P, Pringle M. Radiography of the lumbar spine in primary care patients with low back pain: randomised controlled trial. BMJ. 2001;322:400-405.

    Google Scholar 

  41. Deyo RA, Diehl AK, Rosenthal M. Reducing roentgenography use. Can patient expectations be altered? Arch Intern Med. 1987;147:141-145.

    Google Scholar 

  42. Jarvik JG. Imaging of adults with low back pain in the primary care setting. Neuroimaging Clin N Am. 2003;13:293-305.

    Google Scholar 

  43. Gilbert FJ, Grant AM, Gillan MG, et al. Scottish Back Trial Group. low back pain: influence of early MR imaging or CT on treatment and outcome–multicenter randomized trial. Radiology. 2004;231:343-351.

    Google Scholar 

  44. Jarvik JG, Hollingworth W, Martin B, et al. Rapid magnetic resonance imaging vs radiographs for patients with low back pain: a randomized controlled trial. JAMA. 2003;289:2810-2818.

    Google Scholar 

  45. Buirski G, Silberstein M. The symptomatic lumbar disc in patients with low-back pain. Magnetic resonance imaging appearances in both a symptomatic and control population. Spine. 1993;18:1808-1811.

    Google Scholar 

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Vos, K. (2013). How Are the Radiculopathies Diagnosed?. In: Laroche, F., Perrot, S. (eds) Managing Sciatica and Radicular Pain in Primary Care Practice. Springer Healthcare, Tarporley. https://doi.org/10.1007/978-1-907673-56-6_4

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  • DOI: https://doi.org/10.1007/978-1-907673-56-6_4

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  • Publisher Name: Springer Healthcare, Tarporley

  • Print ISBN: 978-1-907673-55-9

  • Online ISBN: 978-1-907673-56-6

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