Lymph-Werk

04/01/2026

Knee Joint

03/01/2026

01/01/2026

🎊🌲Between Christmas and the beginning of the new year, we traditionally publish our ‘Best of’ series featuring the most influential posts of the year that is coming to an end.

📣 Today 🥇 # rank 7 in 2025

𝗡𝗲𝘂𝗿𝗼𝗹𝗼𝗴𝗶𝗰𝗮𝗹 𝗘𝘅𝗮𝗺𝗶𝗻𝗮𝘁𝗶𝗼𝗻 𝗳𝗼𝗿 𝗖𝗲𝗿𝘃𝗶𝗰𝗮𝗹 𝗥𝗮𝗱𝗶𝗰𝘂𝗹𝗼𝗽𝗮𝘁𝗵𝘆: 𝗔 𝗦𝗰𝗼𝗽𝗶𝗻𝗴

Cervical radiculopathy is a prevalent neuromusculoskeletal disorder characterized by segmental neurological deficits due to impaired conduction in one or more cervical nerve roots. Classical epidemiological studies have reported incidence rates between 0.63 and 5.8 per 1,000 people, with variability influenced by diagnostic criteria, geographical characteristics, and occupational factors (https://pubmed.ncbi.nlm.nih.gov/32710604/; Schmid et al., 2018). Despite its frequency in clinical practice, diagnostic approaches remain inconsistent. Many clinical guidelines and research studies continue to emphasize radicular pain distribution rather than the loss-of-function signs (https://pubmed.ncbi.nlm.nih.gov/22531897/, https://pubmed.ncbi.nlm.nih.gov/28838857/) emphasized by the International Association for the Study of Pain (IASP), which defines radiculopathy as sensory and/or motor deficit caused by impaired axonal conduction (https://pubmed.ncbi.nlm.nih.gov/37235637/).
Previous reviews have predominantly focused on provocative tests or neurodynamic assessments. Both are designed to detect predominantly gain of nerve function, not loss of function and is therefore incompatible with the IASP definition.

Bedside neurological examination (BNE) comprising sensory, motor, and tendon reflex testing—provides the only direct clinical evaluation of nerve-root function loss.

📘 A brand-new scoping review by Yousif et al. (https://pubmed.ncbi.nlm.nih.gov/40188056/) aimed to map the literature regarding the diagnostic accuracy, components, and performance of the bedside neurological examination (BNE) for cervical radiculopathy (CR).

📊 𝗞𝗲𝘆 𝗙𝗶𝗻𝗱𝗶𝗻𝗴𝘀

From an initial 12,365 records, six cross-sectional studies met the inclusion criteria. These studies compared the BNE to either electrodiagnostic tests (Needle EMG and NCS) or Magnetic Resonance Imaging (MRI).

𝗗𝗶𝗮𝗴𝗻𝗼𝘀𝘁𝗶𝗰 𝗔𝗰𝗰𝘂𝗿𝗮𝗰𝘆 𝗼𝗳 𝗕𝗡𝗘 𝗖𝗼𝗺𝗽𝗼𝗻𝗲𝗻𝘁𝘀

✅ 𝗧𝗲𝗻𝗱𝗼𝗻 𝗥𝗲𝗳𝗹𝗲𝘅𝗲𝘀

Tendon reflex deficits (most commonly biceps, brachioradialis, and triceps) consistently demonstrated high specificity, ranging from 81% to 99%, depending on the reference standard. Sensitivity, however, was uniformly low, typically between 21% and 28% when compared with electrodiagnostic testing, although one MRI-based study reported a higher sensitivity of 67%. Positive likelihood ratios ranged widely, from 1.38 to 10, with the highest values seen when reflex loss was matched to a specific nerve-root level. Negative likelihood ratios were poor (around 0.80–0.95), indicating that a normal reflex does not rule out radiculopathy.

✅ 𝗦𝗼𝗺𝗮𝘁𝗼𝘀𝗲𝗻𝘀𝗼𝗿𝘆 𝗧𝗲𝘀𝘁𝗶𝗻𝗴

Sensory testing—primarily using light touch or pinprick across dermatomes—showed the lowest sensitivity of all BNE components. Sensitivity commonly fell between 25% and 52%, even when combining modalities. Specificity ranged from 46% to 89%, making sensory loss only modestly helpful for diagnostic confirmation. Positive likelihood ratios were generally low, between 0.69 and 2.27, indicating minimal change in post-test probability. Negative likelihood ratios hovered around 0.78–1.35, reinforcing the limited value of normal sensation for excluding radiculopathy.

✅ 𝗠𝘂𝘀𝗰𝗹𝗲 𝗦𝘁𝗿𝗲𝗻𝗴𝘁𝗵 𝗧𝗲𝘀𝘁𝗶𝗻𝗴

Myotomal strength testing demonstrated moderate sensitivity when compared with electrodiagnostic studies (typically 54% to 73%) and higher specificity, often between 61% and 93%. When MRI served as the reference standard, sensitivity varied more widely (from 30% to 81%), with specificity around 72%. Positive likelihood ratios ranged from 1.05 to 7.71, with the highest values associated with strong, focal weakness in a representative myotome (e.g., biceps or triceps). Negative likelihood ratios were consistently above 0.40, indicating only limited rule-out capacity.

✅ 𝗖𝗼𝗺𝗯𝗶𝗻𝗲𝗱 𝗕𝗡𝗘 𝗖𝗼𝗺𝗽𝗼𝗻𝗲𝗻𝘁𝘀

When multiple deficits were present—for example, concurrent sensory loss and reduced reflexes—specificity increased markedly, often reaching 97–99%, with positive likelihood ratios as high as 14–22. Sensitivity in these combinations, however, was very low (generally 7–22%), meaning that absence of combined deficits does little to exclude radiculopathy.

💡𝗢𝘃𝗲𝗿𝗮𝗹𝗹 𝗜𝗻𝘁𝗲𝗿𝗽𝗿𝗲𝘁𝗮𝘁𝗶𝗼𝗻

✏️ The diagnostic profile of BNE components demonstrates that deficits in tendon reflexes or muscle strength meaningfully increase the likelihood of cervical radiculopathy, particularly when they occur together or in anatomically congruent patterns. In contrast, normal findings—especially for sensory testing—do not substantially lower the probability of disease. Clinically, 𝗕𝗡𝗘 𝗶𝘀 𝘁𝗵𝗲𝗿𝗲𝗳𝗼𝗿𝗲 𝗯𝗲𝘀𝘁 𝘂𝘀𝗲𝗱 𝘁𝗼 𝗿𝘂𝗹𝗲 𝗶𝗻 𝗿𝗮𝘁𝗵𝗲𝗿 𝘁𝗵𝗮𝗻 𝘁𝗼 𝗿𝘂𝗹𝗲 𝗼𝘂𝘁 𝗰𝗲𝗿𝘃𝗶𝗰𝗮𝗹 𝗿𝗮𝗱𝗶𝗰𝘂𝗹𝗼𝗽𝗮𝘁𝗵𝘆.

✏️ The scoping review confirms the 𝗹𝗮𝗰𝗸 𝗼𝗳 𝗮 𝘂𝗻𝗶𝘃𝗲𝗿𝘀𝗮𝗹𝗹𝘆 𝗮𝗰𝗰𝗲𝗽𝘁𝗲𝗱 𝗰𝗿𝗶𝘁𝗲𝗿𝗶𝗮 for CR, the heterogeneity of diagnostic criteria, and the use of suboptimal reference standards (EMG/NCS: testing only large-myelinated fibers, i.e.,A-β and motor fibers and MRI: does not necessarily reflect neural function). The reporting of the BNE procedure itself was poor and vague.

✏️ Despite these limitations, the BNE is considered a 𝘃𝗶𝘁𝗮𝗹 𝗰𝗼𝗺𝗽𝗼𝗻𝗲𝗻𝘁 of the initial diagnostic workup for suspected radiculopathy.

✏️ Future research must establish a consensus on the operational definition of radiculopathy, its reference standard, and the optimal performance of the BNE to determine its full clinical utility.

📷 Illustration: Neurologic examination of the upper extremities. https://shop.elsevier.com/books/millers-review-of-orthopaedics/thompson/978-0-443-11214-0

30/12/2025

SUPRASPINATOUS TENDON RUPTURE

29/12/2025

SHOULDER & UPPER BODY PAIN

27/12/2025

17/12/2025

𝗤𝘂𝗮𝗻𝘁𝗶𝘁𝗮𝘁𝗶𝘃𝗲 𝗮𝗻𝗱 𝗤𝘂𝗮𝗹𝗶𝘁𝗮𝘁𝗶𝘃𝗲 𝗔𝗻𝗮𝗹𝘆𝘀𝗲𝘀 𝗼𝗳 𝘁𝗵𝗲 𝗟𝗮𝘁𝗲𝗿𝗮𝗹 𝗘𝗹𝗯𝗼𝘄

▫️ This post explores an anatomic study by Bernholt et al. focused on the lateral ligamentous complex and extensor tendon origins of the elbow.
▫️ The research was conducted to provide precise, quantitative measurements of these structures relative to bony landmarks, aiding surgeons in the treatment of pathologies like elbow instability and lateral epicondylitis.

❗ 𝗧𝗵𝗲 𝗖𝗹𝗶𝗻𝗶𝗰𝗮𝗹 𝗣𝗿𝗼𝗯𝗹𝗲𝗺

▫️ Elbow dislocations are a frequent injury, representing up to 25% of all traumatic elbow injuries, with damage to the lateral ligamentous complex being the primary lesion associated with these events.
▫️ Improper healing can lead to chronic laxity and posterolateral rotary instability, a condition causing pain and functional limitation.
▫️ While the lateral ulnar collateral ligament is crucial for preventing posterolateral rotary instability, the radial collateral ligament and the overlying extensor musculature also play significant roles in stability.
▫️ Despite the frequency of these repairs, previous studies lacked quantitative descriptions of these attachment sites relative to specific bony landmarks.

🔬 𝗦𝘁𝘂𝗱𝘆 𝗠𝗲𝘁𝗵𝗼𝗱𝗼𝗹𝗼𝗴𝘆

▫️ The researchers utilized 10 fresh-frozen, nonpaired human cadaveric elbows, all male, mean age 42.2 years.
▫️ They employed a 3-dimensional coordinate measuring device to map the footprints of ligaments, tendons, and bony landmarks with high precision.
▫️ The measurements were taken with the elbow clamped in full extension and supination.

🔧 𝗞𝗲𝘆 𝗙𝗶𝗻𝗱𝗶𝗻𝗴𝘀: 𝗟𝗶𝗴𝗮𝗺𝗲𝗻𝘁𝗼𝘂𝘀 𝗔𝗻𝗮𝘁𝗼𝗺𝘆

■ 🔹 Lateral Ulnar Collateral Ligament (LUCL)
▫️ On the humerus, the LUCL footprint was located 7.1 mm anterior and 9.8 mm distal to the lateral epicondyle.
▫️ It was also positioned 8.6 mm proximal to the radiocapitellar joint line.
▫️ On the ulna, the center of the attachment was found near the supinator tubercle, 1.4 mm anterior and 2.4 mm proximal.
▫️ Qualitatively, the LUCL was present in all specimens, though its proximal attachment often blended with the radial collateral ligament, making the distal attachment more distinct.

■ 🔹 Radial Collateral Ligament (RCL)
▫️ The humeral footprint for the radial collateral ligament was found 6.6 mm anterior and 5.6 mm distal to the lateral epicondyle.

■ 🔹 Annular Ligament
▫️ The center of the ulnar attachment for this ligament was located 17.3 mm proximal to the supinator tubercle.

💪 𝗞𝗲𝘆 𝗙𝗶𝗻𝗱𝗶𝗻𝗴𝘀: 𝗠𝘂𝘀𝗰𝘂𝗹𝗮𝗿 𝗔𝗻𝗮𝘁𝗼𝗺𝘆

■ 🔹 Extensor Carpi Radialis Brevis (ECRB)
▫️ This was the only humeral footprint found to cross the radiocapitellar joint line.
▫️ It extended a mean distance of 5.9 mm distal to the joint line and possessed a robust attachment to the elbow joint capsule.
▫️ This capsular attachment comprised roughly 20.4% of the muscle belly.

■ 🔹 Extensor Digitorum Communis (EDC)
▫️ The EDC fibers were closely associated with the thick fascia of the extensor carpi radialis brevis, running deep to the extensor digitorum communis muscle belly.

🏥 𝗖𝗹𝗶𝗻𝗶𝗰𝗮𝗹 𝗜𝗺𝗽𝗹𝗶𝗰𝗮𝘁𝗶𝗼𝗻𝘀

■ 🔹 Anatomic Reconstruction
▫️ By providing measured distances from clinically relevant landmarks, such as the radiocapitellar joint line, which is easily identified intraoperatively, surgeons can more accurately reproduce the native anatomy during ligament reconstruction.

■ 🔹 Lateral Epicondylitis
▫️ The finding that the extensor carpi radialis brevis has a significant capsular attachment extending distal to the joint line is important for surgeons performing injections or debridement for tennis elbow.
▫️ Understanding this anatomy helps define safe zones for arthroscopic procedures to avoid damaging the lateral ulnar collateral ligament.

⚠️ 𝗟𝗶𝗺𝗶𝘁𝗮𝘁𝗶𝗼𝗻𝘀

▫️ The study was limited by a small sample size of 10 specimens, all of which were male.
▫️ Consequently, the reported distances may vary based on the s*x and stature of the patient, and the study could not assess normal anatomic variants across a broader population.

🖼️ 𝘼𝙣𝙖𝙡𝙤𝙜𝙮

▫️ To understand the importance of this study, imagine trying to hang a heavy picture frame on a wall where specific studs are hidden.
▫️ Before this research, surgeons knew roughly where the studs were based on general knowledge.
▫️ This study acts like a precise stud finder blueprint, giving exact millimeter measurements from visible corners of the room, ensuring the picture is hung exactly where it belongs for maximum stability.

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⚠️Disclaimer: Sharing a study or a part of it is NOT an endorsement. Please read the original article and evaluate critically.⚠️

Link to Article 👇

26/11/2025