What are radicular symptoms?

What Are Radicular Symptoms

Radicular symptoms are pain or sensorimotor deficits caused by dysfunction of a spinal nerve root, typically presenting as sharp, shooting pain radiating in a narrow band down the extremity in the distribution of the affected nerve, often accompanied by sensory changes, motor weakness, or reflex abnormalities. 1

Pain Characteristics

The pain has distinctive qualities that help differentiate it from other conditions:

• Sharp, shooting, or lancinating pain that travels in a narrow band down the length of the affected extremity, both superficially and deep 2
• "Electric" quality is characteristic of the neuropathic pain seen in radiculopathy 3
• Dermatomal distribution corresponding to the specific nerve root involved 1

Location-Specific Presentations

Cervical Radiculopathy

• Neck pain radiating into one arm in the distribution of the affected cervical nerve root 1
• Most commonly affects C5-C6 and C7 nerve roots 3
• Can cause scapular pain with specific patterns: suprascapular region (C5), suprascapular to posterior deltoid (C6), interscapular region (C7), and interscapular/scapular regions (C8) 4

Lumbar Radiculopathy

• Back pain radiating down the leg (sciatica) in a dermatomal pattern 1
• Pain extending below the knee is characteristic 5

Associated Neurological Features

Radicular symptoms extend beyond pain alone:

• Sensory deficits: numbness, tingling, or altered sensation in the affected nerve root distribution 1
• Motor deficits: weakness in specific muscle groups innervated by the affected root 1
• Reflex abnormalities: diminished or absent deep tendon reflexes corresponding to the affected level 1
• These objective findings constitute radiculopathy (conduction block), which may coexist with the radicular pain 2

Underlying Pathophysiology

The mechanism involves more than simple compression:

• Irritation of the sensory root or dorsal root ganglion causes ectopic nerve impulses perceived as pain 2
• Compression sensitizes the nerve root to mechanical stimulation and stretching 2
• A chemically mediated noncellular inflammatory reaction contributes to symptoms 2

Common Causes

• Disc herniation or bulging 1
• Foraminal stenosis from facet or uncovertebral joint hypertrophy 1
• Degenerative spondylosis 1

Critical Clinical Pitfalls

Physical examination findings correlate poorly with imaging in radiculopathy, with high rates of both false-positive and false-negative MRI findings. 1

• Disc abnormalities are common in asymptomatic individuals over age 30 1
• Spondylotic changes on imaging correlate poorly with symptoms 1
• Progressive neurological deficits warrant urgent evaluation to exclude cauda equina syndrome or myelopathy, which require different management algorithms 1

Red Flags Requiring Urgent Assessment

Certain presentations indicate more serious pathology:

• Progressive neurological deficits 3
• New changes in bladder or bowel function 3
• Loss of perineal sensation 3
• Bilateral symptoms or signs of myelopathy 3
• Unilateral arm and leg symptoms together (raises concern for cervical myelopathy rather than simple radiculopathy) 3

Natural History

• Most cases (>50%) resolve spontaneously with conservative treatment within 3-4 months 1
• Cervical radiculopathy has an annual incidence of 83.2 per 100,000 people 1
• Acute cervical radiculopathy generally has a self-limited clinical course, with up to 75% rate of spontaneous improvement 6

Timing for Specialist Referral

Severe radicular pain (disabling, intrusive, preventing normal everyday tasks) or patients with neurological deficit (sensory or motor changes) should be referred within 2 weeks of presentation. 7

• Patients with less severe radicular pain should be referred to specialist services not later than 3 months (earlier if pain is severe) 7
• Patients with neurological deficit in the affected territory warrant earlier referral 7