Lumbar-Radiculopathy.pdf, Slides of Rheumatology

Download Lumbar-Radiculopathy.pdf and more Slides Rheumatology in PDF only on Docsity!

Lumbar Radiculopathy

James J. Lehman, DC, MBA, FACO Director Health Sciences Postgraduate Education University of Bridgeport

Learning Objectives

 Comprehend and practice concepts of

“Evidence-based and patient-centered

health care” in order to provide high quality

patient care.

Learning Objectives

 Perform neuromusculoskeletal evaluation

procedures and record the objective

findings in order to make an

assessment/diagnosis of lumbar

radiculopathy.

 “Diagnosis is the key

to successful

treatment!”

Lumbar Radiculopathy

Radicular pain

often extends

below the knee in

the affected

dermatome.

Definition of Orthopedic Test

 A provocative maneuver (most often)

using stretching, compressing, and

contracting to duplicate the pain and

identify the involved tissues.

North American Spine Society: Evidence-

Based Clinical Guidelines for

Multidisciplinary Spine Care

Clinical Guidelines for Diagnosis and

Treatment of Lumbar Disc Herniation

with Radiculopathy

Disclaimer

 This clinical guideline should not be construed as including all proper methods of care or excluding of other acceptable methods of care reasonably directed to obtaining the same results. The ultimate judgment regarding any specific procedure or treatment is to be made by the physician and patient in light of all circumstances presented by the patient and the needs and resources particular to the locality or institution.

Natural History of Lumbar Radiculopathy

The majority of patients will improve independent of treatment.

Disc herniations will often shrink/regress over time.

Diagnosis and Imaging

In the assessment of diagnostic tests, both accuracy and the effect of testing on the outcome should be considered.

Accuracy Sensitivity and Specificity

Sensitivity refers

to the proportion

of patients with

the target

disorder who will

have a positive

test

Accuracy Sensitivity and Specificity

Specificity refers

to the proportion

of patients

without the target

disorder who will

have a negative

test

Accuracy Sensitivity and Specificity

Tests that have a

high specificity

and positive test

outcomes

effectively rule in

the disease.

Positive Predictive Value (PPV) Negative Predictive Value (NPV)

Performance of a test in a given population can also be stated in terms of positive and negative predictive value, which depends directly on the prevalence of disease in the tested population.