Assessment, Diagnosis and Management (ADAM) tool - radicular syndromes

Exclude red flags:

• Emergency conditions including cauda equina syndrome.
• Signs of sinister pathology.
• Signs of myelopathy.
• Signs of specific pathologies – inflammatory disease, osteoporotic fracture.

Mechanism of onset.
Location of symptoms for radicular syndromes.
Severity and longevity of symptoms.
Limitation to function including walking distance for lumbar stenosis.

Check for facial asymmetry, spinal deformity including scoliosis, muscle wasting, lumps, obvious leg length discrepancy, bony tenderness.

Spinal range of movement, check shoulder for neck pain, hip for lumbar pain.

Reflexes, sensation, power, pulses.

Lhermitte’s sign.

Upper motor neurone tests if indicated.

Imaging rarely required as first line assessment.
Plain X-ray does not assist diagnosis of radicular syndromes.

• Referred mechanical pain.
• Neurological disorders.
• Vascular disorders.
• Parsonage-Turner Syndrome (brachial neuritis)
• Peripheral nerve entrapment.
• OA hip.

In absence of red flags:

• Provide reassurance and advice regarding positive prognosis.
• Links to self-management.
• Analgesia/pain management.
• Reassure safe to move and beneficial to remain active.
• Safety net for deteriorating signs.

Refer to MSK Physiotherapy if persisting symptoms after first line management.