Cervical Radiculopathy Causing LE paresthesias (Full Version)

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Dimedisha -> Cervical Radiculopathy Causing LE paresthesias (June 3, 2008 9:08:11 PM)

Just wanted some advice on a new patient.

Dx:13yo boy with cervical radiculopathy with shoulder trigger points

with worsening symptoms with baseball activities but non-lingering

Symptoms present for the last 4 years with varying degrees

All cervical AROM WNL but with end range motions causing inconsistent paresthesias in both LE into the feet.
Lhermitte's test causes paresthesias and numbness into feet.

ULTTs 1,2,3 all cause paresthesias and numbness into feet.

SLR to approximately 50-60' reproduces cervical pain around C6 C7

Palpation of interscap muscles also reproduced paraesthesias into the feet.

BUE strength testing 3+/5 grossly

Was unable to ilicit UE reflexes but patella and achilles tendon was 1+ on the right LE

The mother said that he has not had any blood work done yet.

My gut says I should refer back to the Ortho MD or does anybody think nerve gliding would be worth a try?
I was looking into a possible MS or RA Differential Dx



Sebastian Asselbergs -> RE: Cervical Radiculopathy Causing LE paresthesias (June 3, 2008 9:50:57 PM)

Could be lots of stuff; my first thought was : tethered cord. Seems to fit the neurodynamic testing you did.



jlharris -> RE: Cervical Radiculopathy Causing LE paresthesias (June 3, 2008 10:38:54 PM)

I agree.  Very unusual to have the UE sx's with LE movement and LE sx's with Cx AROM (for nerve root impingement).  What about Babinski and Hoffman's?

quote:

ULTTs 1,2,3 all cause paresthesias and numbness into feet
and
quote:

Palpation of interscap muscles also reproduced paraesthesias into the feet


Besides any Cx sidebending, these are all peripheral nerve tests and should NOT cause LE sx's.  This is non-physiologic.   Think about it...do interscap mm have ANYTHING to do with LE dermatomes?? No, again, this is a non-physiologic sign.  Also, is it just reports of "numbness" or have you tested (with trials to test consistency) LE dermatomes for light touch/sharp-dull/hot-cold/vibration?

Again, 13 y.o. do not get radiculopathy.  Rule out the worst (push the MD) to evaluate more completely.  With all the non-physiologic findings, you may also want to step back and quit trying to diagnose a neuromusculoskeletal problem and refer back to MD so he/she can find others to better address his complaints.



bonez -> RE: Cervical Radiculopathy Causing LE paresthesias (June 4, 2008 1:35:17 AM)

My concern based on the age and length of symptoms all point toward ominous causes. You can track further long track signs if you wish ( I believe that babinski etc was mentioned , balance, temperature, two point touch,) but remember that there is the first peak for neural tumors, in this case cervical cord, in this age range. Time is of the essense in this case and get the kid back to the primary provider and request a peds neuro consult.
Normally in the age range in question there is significantly more room in the spinal canal for the cervical spine. This makes the lower limb issues extremely concerning. Syringomyelia also comes to mind.



Dimedisha -> RE: Cervical Radiculopathy Causing LE paresthesias (June 4, 2008 9:40:33 PM)

I have notified the MD and he will be reviewing the evaluation.

It is really scary to think cases like this are not being caught at the front lines.

Will keep everyone posted.

Thanks



cclem2000 -> RE: Cervical Radiculopathy Causing LE paresthesias (June 5, 2008 8:45:40 AM)

I think you are wise to refer back to or to another MD. Those symptoms do not seem to correlate with something we can help



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