When Radiculopathy Isn’t Radiculopathy: A Clinical Series

Have you ever treated a patient with radiating limb pain, only to find that their symptoms don't match their MRI results? This compelling clinical article challenges the traditional, disc-centric approach to diagnosing radicular-like pain. Clinicians frequently fall into the trap of assuming that all extremity pain, tingling, or weakness is caused by spinal nerve root compression, especially when imaging shows incidental disc degeneration. However, relying solely on dermatomal maps and structural imaging can lead to unnecessary and invasive interventions, like epidural injections or surgeries, which fail to address the actual root cause of the pain. The author introduces the crucial concept of "myogenic pseudo-radiculopathy," highlighting how non-neural tissues—such as the piriformis in the lower body and the subscapularis in the upper body—can perfectly mimic true nerve pathology. This piece is a must-read for practitioners looking to refine their diagnostic accuracy, avoid the pitfalls of over-relying on MRIs, and provide more effective, targeted conservative care.