FFinalistSouthampton · 2027
Neurology
AKT · Neurology/Cord & peripherallow yield

Radiculopathy

Nerve-root compression (disc, spondylosis) — dermatomal/myotomal

Overview

Dysfunction of a spinal nerve ROOT, usually from a disc prolapse or degenerative spondylosis, producing pain, sensory change and weakness in that root’s DERMATOME and MYOTOME — distinct from the diffuse pattern of peripheral neuropathy. Most settle conservatively.

Recognise

  • Radiating pain in a dermatomal pattern (e.g. sciatica L5/S1: down the leg), with sensory loss + myotomal weakness + a reduced reflex
  • Worse on movements that load the root (coughing, straight-leg raise for L5/S1)
  • Common: cervical (C6/C7) and lumbar (L5/S1) roots

Red flags

  • BILATERAL symptoms, saddle anaesthesia, bladder/bowel dysfunction → cauda equina (emergency); progressive weakness; cancer/infection features

Differentials & how to tell them apart

Peripheral neuropathysymmetrical glove-and-stocking, not a single dermatome
Cauda equina syndromebilateral + saddle anaesthesia + sphincter signs — emergency
Peripheral nerve entrapment (e.g. carpal tunnel)follows the nerve, not the root
Hip/shoulder joint pathologymechanical, no neurological signs

Investigations

Clinical (dermatome/myotome/reflex). MRI if red flags, progressive deficit, or no improvement after conservative management.

Management

Conservative: analgesia, stay active, physiotherapy; MRI/referral if red flags or persistent

  1. 1Most settle: analgesia, encourage activity, physiotherapy; reassure (natural history is usually good).Gate: Bilateral symptoms, saddle anaesthesia or bladder/bowel dysfunction → this is cauda equina, an emergency — image and refer urgently, do not manage conservatively
  2. 2Persistent (>4–6 weeks) or progressive deficit → MRI and spinal referral (injection or surgery for selected cases).
Analgesia + neuropathic agents — NSAID/paracetamol; amitriptyline/gabapentin for neuropathic pain

Key points

Single dermatome/myotome with a lost reflex = radiculopathy (treat conservatively). The thing not to miss is cauda equina (bilateral + saddle + sphincter).

Monitor & prognosis

Pain, neurological signs, red-flag screen.

Most resolve within weeks; surgery for the refractory minority.

Source: NICE NG59 (low back pain and sciatica)