Differentiating Radiculopathy from Lower Extremity Arthropathy

Abstract

Low back and lower extremity pain are among the most common complaints encountered by physicians. Distinguishing pain due to primary extremity pathology versus lumbar radiculopathy can be challenging. Careful physical examination and appropriate imaging with plain radiographs and advanced studies as needed are important in determining the cause of lower extremity complaints. Over-utilization of advanced imaging may reveal otherwise asymptomatic spinal pathology and can lead to an incorrect diagnosis. In patients in whom surgical intervention is being considered by a spine or arthroplasty surgeon, intra-articular or epidural steroid injections may help to reveal the underlying cause of pain via short-term symptomatic relief. Additionally, patients presenting with vague lower extremity pain after recent or distant joint arthroplasty should be considered for potential failure or infection of their implant before assuming the symptoms are coming from the lumbar spine.

The effect of core stabilization exercises and shock wave therapy in patients with radiculopathy

“…Esant juos me ni nei ra di ku lo pa ti jai, daþ niau siai nu ro domi ðie po þy miai: skaus mas [8], pil vo ir nu ga ros rau me nø jë gos ir ið tver mës su ma þë ji mas [9], ði lu mos hi pe ral ge zi ja, di na mi në ar ba me cha ni në alo di ni ja ir hi pe ral ge zi ja L5 ar S1 der ma to mo se, ku rios su tam pa su ner vi nës ðak ne lës iner va ci jos zo na [10]. Taip pat pa ste bë ta, kad dël stu bu rà sta bi li zuo jan èiø rau me nø jë gos dis ba lan so ga li pa di dë ti ko jø trau mø ri zi ka [11].…”

Links between the Hip and the Lumbar Spine (Hip Spine Syndrome) as they Relate to Clinical Decision Making for Patients with Lumbopelvic Pain

“…Healthcare providers are often challenged to differentiate hip and lumbar spine disorders in people who present for evaluation and treatment of lumbopelvic pain . Further, when people present with coinciding symptomatic end stage degenerative disorders of both the hip and lumbar spine it can be difficult to determine which treatment should be recommended and in what order .…”

“…The term “hip‐spine syndrome” is used in studies describing coexisting hip and lumbar spine disorders . Offierski and MacNab were the first to describe the theoretical subgroups of the hip‐spine syndrome including simple, complex, and secondary.…”

“…Healthcare providers are often challenged to differentiate hip and lumbar spine disorders in people who present for evaluation and treatment of lumbopelvic pain. [1][2][3] Further, when people present with coinciding symptomatic end stage degenerative disorders of both the hip and lumbar spine it can be difficult to determine which treatment should be recommended and in what order. 4 For example, in patients with spinal stenosis and neurogenic claudication coinciding with a gait disorder related to painful hip osteoarthritis (OA), knowing which to treat with or without surgery and which to perform first can be difficult.…”

“…The term "hip-spine syndrome" is used in studies describing coexisting hip and lumbar spine disorders. [1][2][3][4]11 Offierski and MacNab 11 were the first to describe the theoretical subgroups of the hip-spine syndrome including simple, complex, and secondary. The simple subgroup includes a structural diagnosis existing in both the lumbar spine and hip, but only one is causing the disability.…”