From the Guidelines
Radicular signs in the lower limbs, such as absence of ankle jerk, can indeed be intermittent and fluctuate over time.
Key Points
- In some cases, symptoms may resolve spontaneously or with conservative management, including medication such as gabapentin 300-600mg tid or pregabalin 75-150mg bid, and then recur 1.
- The duration of symptom absence can vary, but in general, radicular signs can be absent for periods ranging from days to weeks, only to reappear, often in response to exacerbating factors such as increased physical activity or changes in posture.
- Intermittent radicular signs can be caused by a number of factors, including compression of the nerve roots, which can lead to cauda equina syndrome (CES) 1.
- A thorough physical examination, including assessment of lower limb reflexes, is essential in evaluating patients with suspected CES or other conditions that may cause radicular signs 1.
- Imaging studies, such as MRI or CT, may be necessary to confirm the diagnosis and guide treatment 1.
- It is essential to note that the presence of intermittent radicular signs does not necessarily indicate a less severe condition, and prompt evaluation and treatment are crucial to prevent long-term damage or complications 1.
From the Research
Radicular Signs in Lower Limbs
- The presence of radicular signs in the lower limbs, such as absence of ankle jerk (Achilles tendon reflex), can be an indicator of lumbosacral radiculopathy caused by lumbar intervertebral disc herniation 2.
- These signs can be used to predict nerve root compression in MRI examination, but may not always correlate with abnormal nerve conduction studies (NCS) findings 2.
- Radicular pain syndromes, including lumbar radicular pain, can be caused by herniation of the nucleus pulposus, spinal stenosis, or degenerative changes to the vertebrae, and can be diagnosed through neurological history, exam, and imaging 3.
Intermittent Nature of Radicular Signs
- While the studies do not directly address the intermittent nature of radicular signs, they suggest that radicular pain syndromes can be episodic and may improve or resolve with treatment 3.
- The absence of ankle jerk (Achilles tendon reflex) is listed as one of the inclusion criteria for patients with lumbosacral radiculopathy in the study by 2, but it does not specify whether this sign is constant or intermittent.
- There is no direct evidence in the provided studies to suggest that radicular signs, such as absence of ankle jerk, are intermittent, but it can be inferred that the symptoms of radicular pain syndromes can be variable and may fluctuate over time 3.
Other Relevant Findings
- The studies also discuss the use of imaging modalities, such as MRI and CT, to evaluate lower extremity peripheral arterial disease and radicular pain syndromes 4, 5.
- Other technologies, such as photoplethysmography (PPG) and optical sensors, can be used to monitor vital signs in the lower limbs, but are not directly related to the diagnosis or treatment of radicular pain syndromes 6.