Which scenario would suggest radiculopathy rather than peripheral neuropathy?

• A. Dermatomal pattern of weakness with reduced reflexes
• B. Isolated weakness in the extensor digitorum muscle
• C. Symmetric distal paresthesias with preserved reflexes
• D. Non-dermatomal patchy sensory loss

Answer: (A)

Distinguishing radiculopathy from peripheral neuropathy hinges on where the deficits appear. A nerve root lesion produces symptoms that map to a dermatomal pattern for sensation and a myotomal pattern for weakness, with reflexes in that same segment often diminished. So a weakness that follows a dermatomal distribution along with reduced reflexes in the corresponding reflex arc points to radiculopathy.

If weakness is limited to a single muscle, that suggests a focal peripheral nerve injury rather than a root. Symmetric distal paresthesias with preserved reflexes fit a length-dependent polyneuropathy, not a root lesion. Non-dermatomal patchy sensory loss also leans toward a peripheral nerve distribution rather than a single root.

Thus, a dermatomal pattern of weakness with reduced reflexes best indicates radiculopathy.