All too often we see the word “radiculopathy” offered as a diagnosis when there is a simple complaint of vague lower extremity pain. With this diagnosis, future treatment decisions are made, multiple interventions are pursued, and this could even lead to a surgical protocol. Beyond that, this particular diagnosis drives the impairment rating assigned, somewhat higher.
Here is the rub, while many files offer this as a diagnosis, this assessment is based solely on one or two symptoms and not competent, objective, and independently confirmable medical evidence to support the diagnosis.
What Radiculopathy Actually Means
Unfortunately, we see the word radiculopathy all too often in the Worker’s Compensation realm. What each of us must understand is that radiculopathy occurs when a spinal nerve root becomes injured, compressed, irritated or functionally impaired. Degenerative changes to the osseous structures of the spine do not constitute radiculopathy. There must be objective information demonstrating a particular nerve root compromise. To be clear, leg pain does not equate to a verifiable radiculopathy. If the pain emanated from muscles, ligaments, or other vectors, this is not radiculopathy.
Do the Objective Findings Support the Diagnosis
Before accepting a diagnosis of radiculopathy, very specific clinical findings must be objectified. These would include the affected nerve root not being normally functional, and objective findings such as sensory loss following a specific dermatomal pattern, with measurable muscle weakness consistent with the specific nerve root compromised, diminished deep tendon reflexes or abnormal findings on electrodiagnostic (EMG/NCV) assessment. Without these particular objective measures being noted, the diagnosis cannot be supported.
Looking Beyond Imaging and Symptoms
As part of your assessment relative to the veracity of this assigned diagnosis, one must complete a review of all pertinent clinical factors, so as to ascertain what specific structures are compromised. Plain films, enhanced imaging studies, or other diagnostic endeavors should outline what pathology is present, and if these findings are acute or chronic.
And the presence of pathology alone does not equate to a specific diagnosis of radiculopathy. Understanding that the MRI documents disc herniation, the physical examination did not identify any specific motor loss, sensory loss, or changes to the deep tendon reflexes. Consequently, there is no objective determination of a verifiable radiculopathy.
The symptomatology might indicate a numbness or tingling in the distal extremity, however, if no specific neurologic functional deficits were appreciated, this does not support a diagnosis of radiculopathy.
When Repetition Replaces Objectification
As noted previously, what we see frequently is that the diagnosis had been assigned and repeatedly copied forward throughout the chart. Endorsement or agreement without objectification fails to meet the standards.
The Impact on Treatment and Impairment
The next question becomes why this discussion matters to those claim file handlers managing these cases? The treatment for verifiable radiculopathy is very specific, and there are surgical applications. Therefore, assessments based on symptoms, without supportive objective clinical data must exclude any interventions for that phraseology. And as noted in the impairment rating process, a higher impairment for this diagnosis at the time of maximum medical improvement is assigned.
Following the Clinical Evidence
In summary, the assessment of a diagnosis of radiculopathy should follow all the identified clinical evidence. Understanding that symptoms might raise suspicion of this diagnosis; clear, objective clinical findings must be noted to support this determination. Imaging studies provide context but do not establish this as a firm diagnosis. And as always, take note of the reported mechanism of injury as a starting point in your deliberation relative to this diagnosis.
We frequently see a diagnosis of radiculopathy, and the narrative to support this is frequently misunderstood, and all too often confused with simple radiating pain complaints. This diagnosis is not supported based on a simple symptom presented, or findings on MRI, it is a summation of all appropriate clinical factors.
