Talk:Radiculopathy

New Page please fix

This topic deservies its own page, as noted in Talk:Sciatica. So this is a really quick fix. I must admit that the definition (not the forms) is a cut and paste job from [1]. I don't have time to fix, but maybe this is a start.

Root⁴(one) 13:13, 24 March 2007 (UTC)

Ooops

(re-edit) Is there a misclassification? I note from Arcadian's additions that Radiculopathy is primarily diseases of nerve roots (esp. spinal nerve roots) ... My limited research agrees. It makes me think that Carpal tunnel syndrome is not truly radiculopathy but just classified as some form of peripheral neuropathy. Possibly the same goes for Ulnar nerve entrapment, although it could be related to Cervical radiculopathy. This page may need a little cleanup. I removed CTS and UNE, we may also need to remove Piriformis syndrome as well. Root⁴(one) 22:39, 6 June 2007 (UTC)

Revised Treatments

I reworded the treatment section with the goal of putting the 'mainstream medicine' approaches before 'alternative' approaches.

For the record, I just got to this page via wikilink wandering (my term), but I took this liberty because even I, a non-expert, know that chiropracty (chirospractitionship (?)) is considered homeopathic. Shouldn't we always, as a rule, give precedence to mainstream medicine? I have nothing against 'chiropractorship' either, as I can often be found 'adjusting' my own neck and back.

I mostly enjoy the sound.

Straight chiropractic is considered alternative medicine, but not homeopathic (which is about drugs). WhatamIdoing (talk) 00:26, 31 October 2008 (UTC)

I added a part noting that the alternative medicine example used have not been proven. I do not want somebody reading the article thinking that chiropractors are an alternative in radiculopathy like any other. While i understand how adding this my upset some, i thought that it was a better compromise than removing the entire sentence as indeed many people do go to those alternatives.--Bastilleday uky (talk) 09:30, 23 April 2009 (UTC)

Do you have a reliable source to support that claim? Osteopathic manipulative treatment is performed by bona fide physicians, "mixer" chiropractic care is increasingly evidence-based, and the one thing that acupuncture is good at is dealing with screwed up nerve signals. We can't just assert that plausible non-surgical approaches are unproven.

It is my understanding that things must be proven to work, and not proven to not work. Therefore before one can show supportive evidence (from credible sources) for those treatments, I think that they should be labeled as such. I don't think that I (or anyone else) has to prove that they do not work.--Bastilleday uky (talk) 21:12, 26 April 2009 (UTC)

I can support a claim that there was -- ten years ago -- "insufficient data" to evaluate any form of spinal manipulation (PMID 9855673) and "less evidence" for chiropractic in treating radiculopathy than for using chiropractic to treat some other kinds of low-back problems (PMID 19028250), but both of these are specific to lower back radiculopathy. WhatamIdoing (talk) 15:02, 23 April 2009 (UTC)

I'm going to remove the unsupported claim.

Claims like that must have a published reliable source that say that X is not proven. It's not good enough for you and me to say "Well, I've personally never seen anything that proves it works, so therefore it's unproven." WhatamIdoing (talk) 00:59, 30 April 2009 (UTC)

Alright that is a fair point as the other treatments in the article do not have supporting evidence as well. Therefore I propose adding this reference for different surgeries from this comprehensive review, here is the link: http://www.ncbi.nlm.nih.gov/pubmed/19327260?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum

Once this reference is added, I believe that other techniques not cited in this comprehensive review should be simply eliminated. What do you gals/guys think? There is plenty of information on radiculopathy and there is no need to have an article without references.--Bastilleday uky (talk) 03:17, 30 April 2009 (UTC)

I think that this article is far too incomplete to contemplate deleting accurate material. Note, please, that the article doesn't say that these forms of treatment cure the problem — only that they are done, and they certainly are done.

Here's your ref, by the way, written out in full: <ref name="pmid19327260">{{cite journal |author=Nasca RJ |title=Cervical radiculopathy: current diagnostic and treatment options |journal=J Surg Orthop Adv |volume=18 |issue=1 |pages=13–8 |year=2009 |pmid=19327260 |doi= |url=http://www.datatrace.com/e-chemtracts/emailurl.html?http://www.newslettersonline.com/user/user.fas/s=563/fp=20/tp=37/18-1-3.pdf?T=open_article,50021211&P=article}}</ref>

Presumably it only reviews the kinds of treatments of interest to an orthopedic surgeon, but it looks like a good source. WhatamIdoing (talk) 04:51, 30 April 2009 (UTC)

Lost text

This text was lost under ==See also==. If proper sources can be found to support its claims, and it can be re-written without the jargon, then it can be re-inserted wherever it is appropriate:

A Radiculopathy concerns the IVF^{(what's this?)} as mentioned above, but a radiculopathy can be different than a peripheral neuropathy. By definition a radiculopathy is a lesion at the IVF, which contains nerves from only that segment of the cord. So a peripheral neuropathy of say the ulnar/sciatic nerve contains more than one IVF level of the cord, therefore it is not a radiculopathy.

Sciatica, piriformis syndrome: are peripheral neuropathies, not radiculopathies

WhatamIdoing (talk) 00:54, 30 April 2009 (UTC)

IVF is the intervertebral foramen (otherwise known as transverse foramen - where nerve roots exit the spinal canal to become peripheral nerves). I understand the idea behind the text, differentiating true radiculopathy (caused by a foraminal irritation of the nerve root) from 'pseudo-radiculopathy' or peripheral neuropathy (caused by an irritation of the peripheral nerve, not the nerve root). However, I don't have a source off-hand that puts the idea together like this. I will see if I can find something though.Puhlaa (talk) 06:11, 10 June 2013 (UTC)

Recent Revert

This revert restored what is, in my opinion, incorrect information. By definition, radiculopathy is peripheral nerve symptoms caused by nerve root irritation; referred pain is an entirely different process - one which we don't entirely understand yet. The restored text says "Radiculopathy may also manifest in an extremity through a process called referred pain, where pain is not felt in the spine at all, just in the extremity." - however, this is not correct. If the extremity pain is 'referred pain', then it is not 'radicular pain' and should not be confused with a radiculopathy. Puhlaa (talk) 06:03, 10 June 2013 (UTC)

Do you have a source for that?

The article's definition says that referred pain is "pain perceived at a location other than the site of the painful stimulus".

The situation of nerve root irritation (e.g., at the neck) that manifests as pain elsewhere (e.g., the arm) certainly sounds like "pain perceived at a location other than the site of the painful stimulus" to me. WhatamIdoing (talk) 22:27, 10 June 2013 (UTC)

I do understand what you are saying with your statement "The situation of nerve root irritation (e.g., at the neck) that manifests as pain elsewhere (e.g., the arm) certainly sounds like "pain perceived at a location other than the site of the painful stimulus", they do indeed sound like they should be saying the same thing, however, as I mentioned before, referred pain and radiculopathy are very different. You used the definition of referred pain from the referred pain article to try and draw your comparison, however, did you note that "pain of nerve root origin" is not one of the sections discussed under possible mechanisms of referred pain?

I am actively looking for a source that will articulate this difference for us, but in the meantime, I am confused with your request - You are asking me for a source, but the revert of my edit has restored unsourced text that I have suggested is incorrect. My understanding of policy is that it is the editor who is adding the controversial text that is obligated to provide verification for that text. As such, let me ask, can we find a source that describes referred pain as a manifestation of a radiculopathy? I have never in my studies seen a radiculopathy described as causing referred pain. The entire sentence just blurs the lines between 2 unique mechanisms of extremity pain that are already difficult for people to distinguish from one another without what I consider to be confusing text.Puhlaa (talk) 23:58, 10 June 2013 (UTC)

My quick web search showed many websites that talk about referred pain due to cervical radiculopathy. But I was hoping that you'd have a good source on the subject at hand, since you seem to know more about this than I do. If they're generally accepted as being separate, then we would ideally have a solidly sourced statement explaining how they're different, in the hope of helping our readers understand the contrast. WhatamIdoing (talk) 00:11, 11 June 2013 (UTC)

I thought it would be easy to find a RS that clearly distinguished these, but I have not yet found one that I am satisfied with. I did find this source, but it only discusses how to differentiate radicular pain from soft-tissue pain referral and not all 'forms' of referred pain. There should be a RS available that explicitly states the difference between 'referred' and 'radicular' pain in a single sentence or two. I will keep looking.Puhlaa (talk) 04:19, 11 June 2013 (UTC)

Here is another source that makes the distinction and a few relevant quotes from the section titled "Identification of painful radiculopathy and assessment of sensory symptoms". These quotes are not suitable for this article, but are relevant for our discussion regarding differences between 'referred' vs 'radicular' pain.

1. "Patients with back pain may suffer from a variety of different pain syndromes which are mechanistically distinct"
2. "Somatic referred pain does not involve compression of nerve roots but is rather explained by a convergent afferent input on central neurons."
3. "From these clinical descriptions it is evident that in some cases it might be difficult to clinically distinguish between somatic referred pain and painful radiculopathy."Puhlaa (talk) 04:41, 11 June 2013 (UTC)

Here is a great source...I knew there would be one out there. I dont have access to the full text, but here is a preview of the first page. A quote: "Radicular pain differs from somatic referred pain both in mechanism and clinical features. Physiologically, it is pain evoked by ectopic discharges emanating from a dorsal root or its ganglion. Disc herniation is the most common cause, and..."Puhlaa (talk) 04:48, 11 June 2013 (UTC)

From your search, do you think these are typical of reasonably good sources, or is making a clear distinction somewhat uncommon? One often encounters distinctions that are ignored in everyday work, but not in a particular type of research, for example. WhatamIdoing (talk) 05:29, 11 June 2013 (UTC)

I think that among academic and medical sources and among health care professionals there is a clear distinction that is important for correct diagnosis and hence proper treatment. By correctly identifying somatic pain referral and ruling out radiculopathy, we can avoid costly and unnecessary procedures. I admit that among internet blogs and discussions among laypeople there is usually no distinction. For example, almost every patient I see with leg pain tells me they have sciatica. However, only about 10% of the patients I see with leg pain actually have a neuropathy that would qualify as sciatica and only about 1/2 of those tests positive for pain of nerve-root origin rather than peripheral irritation. The majority of 'leg pains' are simple somatic pain referral - hence I send them off to the massage therapist instead of the MRI. IMO, it is important that wikipaedia make that distinction, or at the very least, should not blur the distinction. That said, I am happy to see what other editors think about the issue....I am certainly not attached to this article; I would probably not have noticed the revert if it were not for those neat little red indicator lights that we get now :) Puhlaa (talk) 05:55, 11 June 2013 (UTC)

I think that the best thing to do is to explain (on both pages, ideally) the distinction, perhaps with a small hint that the words aren't always used precisely ("Technically speaking, radiculopathy differs from referred pain in that..."). I'm a big fan of compare-and-contrast methods to help readers figure out the boundaries. The fact that it isn't used perfectly needn't stop us from telling people that a very precise definition exists and is used by very precise people. WhatamIdoing (talk) 01:36, 12 June 2013 (UTC)

I agree that it would be good to fix things. However, I am not certain how best to make the distinction in this article? It seems to me that the distinction is really between referred pain and radicular pain and perhaps it is in those articles where this distinction needs to be made? This article describes a radiculopathy as a neuropathy caused by nerve-root pathology and indicates that radicular pain is a symptom. I had originally though to suggest adding the text: "The radicular pain that results from a radiculopathy should not be confused with referred pain, which is different both in mechanism and clinical features." but as I said, this would be more appropriate in the radicular pain article.Puhlaa (talk) 05:25, 12 June 2013 (UTC)

Why not both for now, and if we come up with a better way of explaining it, then we can improve it then? It'd be better than what we've got. Also, I think that the more places we put something like this, the more likely it is that whoever's looking for that information will see it. Some hint about exactly how they differ (maybe an example?) would be good, but maybe that could be just at the other article. WhatamIdoing (talk) 23:17, 13 June 2013 (UTC)

Yes, I agree. I do think tha this article needs some improvement - clarity and sources are both lacking. Extremely busy atm, but I will be back to help work on this asap.Puhlaa (talk) 23:03, 16 June 2013 (UTC)

Just to keep us from getting stuck, I pasted your sentence into the article. We can add the source and other stuff later.

What do you think about including some of the difference as part of a ==Diagnosis== section? My thought was something like "Diagnosis involves this test, which if positive indicates referred pain rather than radiculopathy", or something like that. WhatamIdoing (talk) 14:53, 20 June 2013 (UTC)

Incorrect information under "Mechanism," please fix

The first sentence in the Mechanism section -- "Most often the radiculopathy found in the patients are located in the cervical spine, more along C6-C8." -- refers to a journal article that does not contribute information relevant to this topic. The article, 'Causes of Hand Tingling in Visual Display Terminal Workers,' cites as its primary results, "The causes of hand tingling in order of frequency were: myofascial pain syndrome, 68%; cervical radiculopathy, 27%; rotator cuff syndrome, 11%; tenosynovitis, 8%; and carpal tunnel syndrome, 5%." That data is irrelevant to the Mechanism of radiculopathy itself. — Preceding unsigned comment added by Jtshea05 (talk • contribs) 17:57, 28 September 2015 (UTC)

References

"Epidemiology" data focuses solely on cervical radiculopathy, not the more common lumber form, please fix

This section notes that cervical radiculopathy is less common than its lumbar counterpart, but then focuses solely on the former. There is epidemiological information available on lumbar radiculopathy, such as 'Characterization of the incidence and risk factors for the development of lumbar radiculopathy,' by Schoenfeld AJ, et al. or 'Lumbosacral Radiculopathy,' by Gerard A Malanga et al.. A more qualified editor should edit this section to reflect the more common form of the condition. — Preceding unsigned comment added by Jtshea05 (talk • contribs) 18:20, 28 September 2015 (UTC)

References

Queen's University Student Editing Initiative

Hello, we are a group of medical student’s from Queen’s University. We are working to improve this article over the next month and will posting our planned changes on this talk page. We look forward to working with the existing Wikipedia medical editing community to improve this article and share evidence. We welcome feedback and suggestions as we learn to edit. Thank you. MonStod (talk) 20:18, 23 November 2020 (UTC)

1. We propose to insert the following sentence into the surgery subsection of the treatment section: “Regarding surgical interventions for cervical radiculopathy, the anterior cervical discectomy and fusion procedure is more commonly performed than the posterior cervical foraminotomy procedure. However, both procedures are likely equally effective and without significant differences in their complication rates.” Nurbach (talk) 02:56, 1 December 2020 (UTC)

@Nurbach: thanks for updating this citation. Be sure to log in to Wikipedia before you edit.

Note: Multiple use of the same reference- tech tip. When you add your references while editing, you can see the options "automatic... Manual... Re-use". The first time you add the citation (if it is not already used in an article, click "automatic" and add your PMID, DOI, or website, then click "generate" to fill the template. The second time you want to use the same citation in an article, click "reusue" and search for your citation in the list. This adds in the a,b,c versus duplicating the citation in the list. If possible, practice this in your sandbox before editing live.JenOttawa (talk) 17:44, 7 December 2020 (UTC)

References

2. Under the Radiculopathy#Diagnosis heading, we propose to create an addition of 2 sections called Signs and Symptoms and Investigations. MonStod (talk) 02:20, 5 December 2020 (UTC)

We propose inserting: “Cervical radiculopathy is pain that is present in one or both arms and often in the neck due to an irritation or compression of nerve roots in the cervical spine."MonStod (talk) 02:20, 5 December 2020 (UTC)

We propose to insert the following sentence into the diagnosis section to clarify there are two types of radiculopathy: "Radiculopathy can be divided into cervical and lumbar radiculopathies."

We propose to insert the following sentence in the diagnosis section:"Lumbosacral radiculopathy refers to a pathologic process involving the lumbo-sacral nerve roots causing radicular symptoms into a lower extremity."

We propose to change the hyperlinks in the diagnosis section second sentense. Instead of having "distribution of" hyperlined to the wikipedia page on dermatomes and "a particular nerve root" hyperlinked to the wikipedia page on myotomes we propose a change to have only "nerve roots" hyperlined to the wikipedia nerve root article. Mcowls (talk) 23:06, 3 December 2020 (UTC)

• Thanks for the suggestions. For your AAFP citation, please re-add it using the DOI or PMID to ensure that all fields are added. You can paste in the PMID and then the citation looks like this with the date of publication, journal title, etc. You can practice in your sandbox before editing live on Monday in the article, or just double check that your citation is formatting in the same way as others in your article when editing. Wikilinks looks good. Generally we link the first time a term appears in an article. Your suggestions make sense to me! JenOttawa (talk) 19:28, 4 December 2020 (UTC)

References

3. Epidemiology section improvements: We noticed that reference # 3 is a a weak journal article and the proceeding sentence is not supported by a stronger source. This is also epidemiological information, therefore, not in the correct section, so we propose to remove reference 3 and the evidence or information shared from it "Most often radiculopathy found in the patients are located in the cervical spine, most commonly affecting C6-C7 spinal nerves."

We propose to replace the first sentence under Epidemiology with the following sentence " Cervical radiculopathy has an incidence of 107.3 per 100,000 for men and 63.5 per 100,000 for women, whereas lumbar radiculopathy has a prevalence of approximately 3-5% within the population." Orville24 (talk) 17:32, 4 December 2020 (UTC)

• Thanks for posting here. This is just a small note: when adding references they should look like this, immediately after the punctuation and no space between references.JenOttawa (talk) 19:33, 4 December 2020 (UTC)

References

4. We propose to combine the information in the Causes and Mechanisms sections, effectively eliminating the mechanisms section. We will further support the causes section with a review article discussing the causes of cervical radiculopathy in addition to the source currently covering lumbar radiculopathy.

This review looks good. Thanks for sharing it here. For combining the two sections, is this because there will be tou much overlap? The medical manual of style on Wikipedia does suggest both headings, but I support this if we do not presently have enough evidence to share in one or the other. See https://en.wikipedia.org/wiki/Wikipedia:Manual_of_Style/Medicine-related_articles#Diseases_or_disorders_or_syndromes for proposed headings. JenOttawa (talk) 19:30, 4 December 2020 (UTC)

References

5. We propose an addition to the first paragraph of the Treatment section of the article. This addition will include the information that there is evidence that epidural corticosteroid injection has been proven to be an effective treatment for lumbar radiculopathy. The addition, which will follow the second sentence in this section (describing treatments for pain caused by radiculopathy) will read as follows: "Evidence also supports consideration of epidural steroid injection with local anesthetic in improving both pain and function in cases of lumbosacral radiculopathy." This evidence can be found in a 2016 systematic review cited below.

References

6. We propose to insert the following content into the Causes and Mechanisms section: "Consistent, long term exposure (5+ years) to certain work related behaviours can put people at high risk of developing radiculopathy. These behaviours include bending over, physically demanding work, and lifting and carrying."Milanamilivoj (talk) 02:14, 7 December 2020 (UTC)