GMNR Legacy Series: Radiculopathy for PMR Boards

Gautam Malhotra MD presents "Radiculopathy" to inform Physical Medicine and Rehabilitation written/oral boards and CME about the evidence-based diagnosis, electrodiagnosis, and treatment of Radiculopathy. This was an invited lecture 3/29/2022 by the University of Washington School of Medicine Physical Medicine and Rehabilitation Board Review and CME course. Note that this is NOT as complete as the main Radiculopathy lecture which can be found here. This is tailored to be shorter, faster, and more of a review for those studying for the boards. "GMNR" is a tongue-in-cheek play on words (PM&R) which stands for Gautam Malhotra's Notes and Reviews. The GMNR Legacy Series includes 20 years' of educational content created by Gautam Malhotra MD for Physical Medicine and Rehabilitation trainees (both resident physicians and medical students). 0:00 Intro to lecture and me 0:28 Definition of Radiculopathy and Semantics/Pet Peeves 1:59 Limits of this Lecture and Board/CME relevance 2:52 Advice for PMR Written Boards 3:20 Anatomic Questions on the written boards and clarification of root numbering 5:01 Epidemiology of Radiculopathy 5:30 Review of Neuroanatomy relevant to Radiculopathy 6:46 Neural Connective Tissue 7:02 Review of rootlets, dorsal/ventral roots, DRG, Spinal nerves, and Rami branches 7:58 Common EDx Written Question of Radiculopathy: SNAPs are Normal in Radiculopathy 8:14 Pathophysiology: Injury and Recovery of peripheral neuronal damage 9:32 Reason SNAPs are normal is location of sensory cell bodies. 10:54 Practical points about Nerve Conduction Studies in Radiculopathy 11:40 H-reflex radiculopathy questions 12:38 Approach to Oral Boards for Radiculopathy and in General 13:21 Clinical presentation of Radiculopathy. History, Exam, Differential, Provocative tests 15:34 Surgical Indications: Red Flag symptoms 15:45 Causes of Radiculopathy 16:21 Intervertebral Disk, herniations, asymptomatic herniations, Radiological Nomenclature/Classifications, Imaging, Natural history of Disk herniations. 18:35 Normal spine MRI / Radiculitis 19:35 Spondylosis 20:13 Spinal Stenosis clarified 21:09 Part 2 of the oral boards. Electrodiagnosis overview in Radiculopathy 21:43 Benefits of electrodiagnosis in Radiculopathy 21:56 Needle Electromyography in Radiculopathy 22:32 Part 3: Treatment of Radiculopathy 23:56 Part 5: Ethics question 24:22 Advice and CME for Clinicians 24:34 Frustrations that arise from Anatomic Variations and Referral Patterns 25:40 Abnormal EMG correlates with better treatment outcomes. 25:59 Hard vs Soft signs on EMG 26:27 How many Muscles need to be needled? 26:46 Timing of Electrodiagnostic testing. 27:14 Caveats about Fibrillation potentials 27:48 Prophylactic surgery? 28:34 Challenges with Thoracic Radiculopathy 29:16 About me and thanks to Dr. Ileana Howard 30:05 Bonus Slides for Geeks