Radicular Syndrome Course

Radicular Syndrome Course

The third course in this program looks at radicular syndrome, that is, pain arising from irritation and/or compression of nerve roots, the dorsal root ganglion and dura mater.

*Prerequisite - Principles of Clinical Diagnosis.

 

 

This is the one condition that international guidelines agree may be diagnosed with some confidence using the history and physical examination. This perspective is a surgical one dating and unchanged from the 1980s. This is an outdated view in my opinion, and you will see as the program develops that we can do much better, given current evidence. However, for now, you must be thoroughly familiar with the standard orthopaedic perspective on radicular syndrome, the terms and concepts that are accepted internationally and the evidence supporting diagnosis, conservative care and surgical intervention.

There are four formal lessons to complete. The lessons are:

  • Introductory concepts of radicular syndrome. Here the distinctions between radicular syndrome, radicular pain and radiculopathy, are clarified using definitions and taxonomy from the international Association for the Study of Pain. The patho-anatomy and physiology of nerve root pain and impairment are covered also.
  • The second lesson looks specifically at disc herniation as the single biggest cause of radicular syndrome
  • The third lesson looks at discectomy, the indications for, and alternatives to discectomy. We look at complications following discectomy also.\
  • The fourth lesson looks at the adherent nerve root. This condition and its treatment was first described by Robin McKenzie. It is probably equivalent to the MRI finding of epidural scarring and occurs in adolescents who develop root compression from disc herniation, and following discectomy

There are three videos to watch. 

  • The first is rare footage from the estate of Dr Stephen Kuslich who reported on the many hundreds of cases he operated on under progressive local anaesthesia on conscious patients. Very important work and fascinating. 
  • The second video is a short video from Rob PT via Utube, on treatment options for adherent nerve root. 
  • The third video shows a rare case where a neurologic deficit is to seen come and go depending on load.

You will also download published guidelines which are an example of accepted international standards for diagnosis and treatment of radicular syndrome.

There is a significant reading list and a quiz to test your understanding.

This is the last of the compulsory courses and completes the realm of what is known as diagnostic triage. The next course you do is entirely up to you. However, regardless of your prior experience, I strongly recommend that the next course you do is the one on mechanical discogenic pain. This course covers the single largest subgroup of the back pain population. That is, those having rapidly reversible and repeatable pain patterns and behaviours. There are several case study videos of the management of cases with acute and persistent deformities.

*Prerequisite - Principles of Clinical Diagnosis.

 
Study time: 6 hrs (approx.)

Duration: 30 days
Price: NZ$115.00