Dermatomes Upper Limb | Peripheral Neurological Examination

Summary

This video from PhysiTutors focuses on dermatome testing of the upper extremity, a crucial aspect of neurological examinations for diagnosing cervical radiculopathy. The video discusses the common causes of nerve root pathology, including herniated discs and degenerative disc disease, highlighting their prevalence among different age groups. Despite the low specificity of neurological exams, the presenter emphasizes the importance of dermatome assessment in identifying affected areas. Viewers are encouraged to use specific tools for testing and are introduced to the Wainner diagnostic cluster for cervical radicular syndrome, with a call to like and subscribe for more informative content.

Takeaways

• 👩‍⚕️ Dermatome testing is a crucial part of neurological examinations, particularly for diagnosing radiculopathy.
• 🩺 Changes in sensation within specific dermatomes can help identify pathological disc levels.
• 📉 Herniated discs account for 20-25% of cervical spine nerve root pathologies, while degenerative disc disease accounts for 70-75%.
• 🔄 Herniated discs are more common in younger patients, while degenerative disc disease primarily affects older individuals.
• 📊 The highest incidence of cervical nerve root pathology occurs at spinal segments C5-6 and C6-7.
• 🔍 A systematic review indicated that a complete peripheral neurological examination for cervical radiculopathy has a sensitivity of 83% and specificity of 28%.
• ⚖️ The positive and negative likelihood ratios for cervical radiculopathy assessment are 1.15 and 0.6, respectively.
• 🖌️ To test dermatomes, use a brush (like those found on reflex hammers) to stroke both affected and unaffected limbs.
• 🗣️ Patients should be asked about site-by-site differences in sensation during the assessment.
• 👍 Wainner's diagnostic cluster is highlighted as the best available tool for diagnosing cervical radicular syndrome.

Q & A

What is the purpose of dermatome testing in the upper extremity?

Dermatome testing is used to assess changes in sensation within specific dermatomes, which can help identify the pathological disc level when suspecting radiculopathy.

What are the common causes of nerve root pathology in the cervical spine?

The most common causes are herniated discs, accounting for about 20 to 25 percent of cases, and degenerative disc disease, which accounts for 70 to 75 percent.

Who is more likely to experience herniated discs versus degenerative disc disease?

Herniated discs, also known as soft disc lesions, are more common in younger patients, while degenerative disc disease, or hard disc lesions, primarily occurs in the older population.

Which spinal segments have the highest incidence of cervical nerve root pathology?

The highest incidence is found in spinal segments C5-6 and C6-7.

What are the sensitivity and specificity of a complete peripheral neurological examination for cervical radiculopathy?

According to Lemeunier et al., the sensitivity is 83% and the specificity is 28%.

What do the positive and negative likelihood ratios indicate in the context of cervical radiculopathy assessment?

The positive likelihood ratio is 1.15, and the negative likelihood ratio is 0.6, indicating that while the assessment has some value, it is considered weak clinically.

How should dermatome testing be conducted?

To conduct dermatome testing, stroke the dermatome regions on both the affected and unaffected limbs using a brush like the one found in reflex hammers and ask the patient to report any differences in sensation.

What is the best diagnostic cluster for cervical radicular syndrome mentioned in the video?

The best diagnostic cluster available for cervical radicular syndrome is the cluster of Wainner.

How can viewers support the PhysiTutors channel?

Viewers can support the channel by liking the video, subscribing, and checking links in the video description.

Who presented the information in the video?

The information was presented by Andreas for PhysiTutors.