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Invited Review: Musculoskeletal mimics of lumbosacral radiculopathy
Invited Review: Musculoskeletal mimics of lumbosacral radiculopathy
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Abstract

Electrodiagnostic evaluations are commonly requested for patients with suspected radiculopathy. Understanding lower extremity musculoskeletal conditions is essential for electrodiagnostic medicine specialists, as musculoskeletal disorders often mimic or coexist with radiculopathy. This review delineates radicular pain from other types originating from the lumbosacral spine and describes musculoskeletal conditions frequently mimicking radiculopathy, such as those that cause radiating pain and sensorimotor dysfunction. In clinical evaluation, a history of pain radiating along a specific dermatomal territory with associated sensory disturbance suggests radiculopathy. Physical examination findings consistent with radiculopathy include myotomal weakness, depressed or absent muscle stretch reflexes, focal atrophy along a discrete nerve root territory, and potentially positive dural tension maneuvers like the straight leg raise. However, electrodiagnostic medicine specialists must be knowledgeable of musculoskeletal mimics, which may manifest as incomplete radiation within or beyond a dermatomal territory, non-radiating pain, tenderness, and give-way weakness, in the context of a normal neurological examination. A systematic approach to musculoskeletal examination is vital, and this review focuses on high-yield physical examination maneuvers and diagnostic investigations to differentiate between musculoskeletal conditions and radiculopathy. This approach ensures accurate diagnoses, promotes resource stewardship, enhances patient satisfaction, and optimizes care delivery. Musculoskeletal conditions resembling L1 to S4 radiculopathy are reviewed, emphasizing their distinctive features in history, physical examination, and diagnostic investigation. Among the more than 30 musculoskeletal disorders reviewed are hip and knee osteoarthritis, lumbar facet syndrome, myofascial pain syndrome, greater trochanteric pain syndrome, and plantar fasciitis.

Objectives: The objectives of this activity are to:1) Improve the diagnostic evaluation of patients with lower extremity radicular pain through an understanding of musculoskeletal mimics of radiculopathy;2) Consider piriformis syndrome, exertional compartment syndrome, and tibial and/or fibular stress syndrome in the evaluation of patients with symptoms of L5 radiculopathy; 3) Considerhamstring strain or tendionopathy, ischiofemoral impingment, ischiogluteal bursitis, sacroiliac joint dysfunction, and plantar fasciitis in the evaluation of patients with symptoms of S1radiculopathy.


ACCREDITATION STATEMENT
The AANEM is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.


CREDIT DESIGNATION
The AANEM is accredited by the American Council for Continuing Medical Education (ACCME) to providing continuing education for physicians. AANEM designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Credit expires 5/6/2027

DISCLOSURE INFORMATION
The authors had no financial conflicts of interest.


FORMAT
PDF
Authors
Emma A. Bateman MD, FRCPC; Christian D. Fortin MD, FRCPC; Meiqi Guo MD, FRCPC
Summary
Availability: On-Demand
Expires on May 06, 2027
Cost: Member: $0.00
Non-Member: $25.00
Credit Offered:
1 CME Credit
1 CEU Credit


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