Musculoskeletal mimics for lumbosacral radiculopathy. Part 2: Specific disorders

Lumbosacral radiculopathy is a common disorder evaluated by the electrodiagnostic medicine (EDX) consultant. Making this task difficult is the abundance of radiculopathy mimics. Peripheral neurologic mimics are common, but musculoskeletal mimics are not rare and may be less familiar to many EDX consultants. Awareness of the most common musculoskeletal mimickers-particularly key historical and physical examination features that can distinguish them from radiculopathies-can lead to an accurate diagnosis for the patient and referring provider. Part 1 of this monograph covered theoretical issues surrounding why radiculopathy mimics occur. This second part reviews the most common musculoskeletal mimics, including facet arthropathy, myofascial pain syndrome, hip pathology, greater trochanteric pain syndrome, piriformis syndrome, sacroiliac joint dysfunction, hamstring pathology, iliotibial band syndrome, and plantar fasciitis. Diagnosis of these musculoskeletal mimickers is complicated by nonspecific physical examination and imaging findings, and diagnostic injections are frequently necessary to confirm the diagnosis. Treatment for most mimickers includes physical therapy, anti-inflammatory medications, guided injections, and other conservative measures, only rarely followed by surgical intervention. EDX consultants can efficiently incorporate a few high-yield maneuvers into their physical examination based on the location of the pain to provide answers to patients presenting with a musculoskeletal mimic of a lumbosacral radiculopathy.