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Electrodiagnosis of radiculopathy
John-Michael Li1, Jinny Tavee1
1Department of Neurology, Northwestern Feinberg School of Medicine, Chicago, IL, United States.
Handbook of Clinical Neurology
|July 17, 2019
Summary
Accurate diagnosis of radiculopathy relies on needle electrode examination (NEE) findings, particularly myotomal spontaneous activity and neurogenic motor unit potential changes. Optimizing muscle selection for NEE is crucial for increasing diagnostic yield in radiculopathy evaluation.
Area of Science:
- Neurology
- Electrophysiology
Background:
- Nerve conduction studies are part of electrodiagnostic examinations, but diagnosing radiculopathy primarily depends on needle electrode examination (NEE).
- Key abnormalities in NEE for radiculopathy include myotomal spontaneous activity and neurogenic motor unit potential (MUP) changes.
Purpose of the Study:
- To optimize the identification rate of radiculopathy by guiding the selection of appropriate muscles for NEE.
- To enhance the diagnostic yield of NEE protocols for radiculopathy through the use of myotomal charts.
Main Methods:
- Utilizing myotomal charts derived from anatomical, radiographic, and electrodiagnostic studies to guide NEE protocol development.
- Recommending a minimum NEE protocol including at least five proximal and distal limb muscles.
- Routine inclusion of NEE of paraspinal muscles, acknowledging their limitations for isolated diagnosis.
Main Results:
- Selection of appropriate muscles for NEE is paramount for optimizing radiculopathy identification.
- Myotomal charts can aid in developing NEE protocols to increase diagnostic yield.
- Preservation of sensory nerve action potentials is important for lesion localization, though sometimes confounded by age or technical factors.
Conclusions:
- Needle electrode examination is the cornerstone for diagnosing radiculopathy, with specific muscle selection being critical.
- Myotomal charts offer a valuable tool for standardizing NEE protocols and improving diagnostic accuracy.
- Electrodiagnostic findings, including sensory nerve action potentials and specific patterns, aid in localizing nerve root disorders and expediting clinical management.
