When was the last time you skipped a neuro examination when evaluating a patient with low back pain/ cervical pain with extremity pain? Hopefully never, as skipping this crucial step can lead to a loss of important details on that case.
A proper neuro exam can help you easily rule in or out peripheral pain referrals related to nerve involvement from other pain producers (like TrPs). A proper nuero exam when evaluating for radicular symptoms should include myotomal muscular testing, dermatomal sensation testing and reflex testing. I recommend installing this into your exam in the form of a pre and post test with a proper repeated motion exam in between. In order to confirm radicular symptoms with a mechanical exam it is helpful to have other baselines than just pain complaints, as radicular symptoms are hard to track as the pain patterns can change rapidly. A pre and post test will allow the clinician to better track radicular symptoms objectively and add to the patient response model. I often find this method to be helpful in determining if a patient falls into a rapid responder category as patients can show improved strength, sensation and reflex in nerve root patterns to correspond with pain reduction. The reliability of your exam should increase as this will help to confirm a potential location for nerve involvement and gives you information to retest at the first follow-up as well. If no changes or abnormalities are found with mechanical and neuro testing with the below tests than you can be confident in saying that the extremity pain is not related to a spinal issue.
