Comparison of clinical and electrophysiological findings in patients with suspected radiculopathies

Abstract

Cervical and lumbar roots may be irritated or compressed due to the pathological conditions such as disc herniations, degenerative foraminal stenosis, trauma and tumors. Electrophysiologic tests are frequently used in conjunction with imaging modalities for evaluation of low back and neck pain radiating to extremities, primarily for the purpose of establishing the presence or absence of a radiculopathy. In this study, we aimed to evalulate the relationship between clinic and electroneuromyographic (ENMG) findings in patients with suspected radiculopathies. Forty one patients with radicular complaints in the upper extremities and 51 patients with radicular complaints in the lower extremities were included in this study. McNemar test and Kappa coefficients between the two methods were applied to each group of patients, in order to test the significance of the difference between the two diagnostic procedures' ability on finding out the pathology. The McNemar test identified a significant difference between the two diagnostic approaches both for cervical and lumbar radiculopathies (p<0.001). The Kappa coefficients between the two methods were determined as 0.08 and 0.07, respectively. This means, efficacy of anamnesis and neurological examination for the prediction of electrodiagnostic tests was found to be limited. Normal neurological examination results in a patient with suspected radiculopathy can not eliminate abnormal electrodiagnostic test results; likewise, abnormal findings in the neurological examination would not mean finding pathologies in the electrodiagnostic tests. For more accurate approach to a patient, neurological examination and electrodiagnostic tests must be used and interpreted together.

Correlation between Findings in Physical Examination, Magnetic Resonance Imaging, and Nerve Conduction Studies in Lumbosacral Radiculopathy Caused by Lumbar Intervertebral Disc Herniation

“…No statistically significant association was detected in the current study between physical examination and NCS findings; consequently, the physical examination is not a good predictor of abnormal nerve conduction studies. is agrees with the findings of many previous studies [10][11][12][13]. Our study results showed that 56.7% of patients had abnormal findings in physical examination as well as nerve conduction studies, compared with 58% and 89.5% in two previous studies [8,9].…”

Correlation of Electromyography and Magnetic Resonance Imaging Findings in the Diagnosis of Suspected Radiculopathy

“…Studies with a greater number of clinical motor deficits also reported higher sensitivities. According to Nardin et al, (7) compatibility between EMG and MRI findings was highest in patients with 58 (12). We also observed good agreement between diagnostic test results in patients without motor deficits and F-waves in normal ranges.…”

“…Therefore, neither root compression as indicated by MRI, nor clinical symptoms can be considered gold standard findings of radiculopathy. EMG results remain negative if EMG is performed before denervation or after the disappearance of denervation findings, or if reinnervation has not occurred (12,13). Patients with ≥2 months duration of symptoms were chosen in this study to observe denervation potentials and reinnervation.…”

Current Evidence for Diagnosis of Common Conditions Causing Low Back Pain: Systematic Review and Standardized Terminology Recommendations

“…Three systematic reviews and 7 clinical studies evaluated methods for diagnosing lumbar radiculopathy. 12,13,15,26,33,43,45,48,50 Scaia et al synthesized evidence from 7 studies, reporting that the SLR demonstrated a wide range of sensitivity from 0.19 to 0.97 and specificity from 0.10 to 0.89, limiting diagnostic utility. 13 Tawa synthesized evidence from 12 studies reporting poor sensitivity of 0.13 to 0.61 for motor tests and sensitivity ranges of 0.14 to 0.67 and specificity of 0.60 to 0.93 for deep tendon reflexes.…”

“…26 electrodiagnostic testing. 43,50 Petersen et al, in a review of 20 studies, reported sensitivity (0.28-0.50) and specificity (0.83-0.94) for a cluster of 3 or more of 4 findings in the presence of a positive SLR: (1) pain in a dermatomal distribution, (2) corresponding sensory deficit, (3) diminished reflex, and (4) motor weakness. 15 Sensitization.…”