41 - Foot Drop Case Study

Question 1

Describe the L4 nerve root reflex

Answer 1

Reflex
- Quadriceps (knee)

Question 2

Describe the L4 nerve root sensory response

Answer 2

Sensory of the MEDIAL CALF ***

Question 3

Describe the motor component of the L4 nerve root

Answer 3

Motor – Quadriceps (knee extension) and Thigh adduction and tibialis anterior (foot dorsiflexion)

Question 4

What is the pain distribution for an L4 nerve root problem?

Answer 4

Pain distribution – Knee, medial calf, anterolateral thigh

Question 5

What is the reflex for the S1 nerve root?

KNOW THIS - TEST QUESTION ***

Answer 5

Reflex – Gastrocnemius/soleus – ankle ***

REMEMBER S1*****

Question 6

What is the sensory, motor and pain distribution for the S1 nerve root?

Answer 6

• Sensory – Plantar surface of foot and lateral aspect of foot
• Motor – foot plantarflexion, toe flexors, and hip extension
• Pain Distribution – Bottom of foot, posterior calf, posterior thigh, buttocks

Really only emphasized the reflex

Question 7

What are the 4 indications for intervertebral disk surgery?

TEST QUESTION

Answer 7

• Progressive motor weakness from nerve root injury demonstrated on clinical exam or EMG
• Bowel or bladder disturbance or other signs of spinal cord compression
• Incapacitating nerve root pain despite conservative treatment for at least 4 weeks
• Recurrent incapacitating pain despite conservative treatment

KNOW ALL OF THESE *****

Question 8

What is the wrong answer in terms of indications for intervertebral disk surgery?

Answer 8

Pain or chiropractic manipulation is NOT a good reason to go to surgery right away *** (wrong answer)

Question 9

What is on your differential in radicular back pain

Answer 9

Differential of radicular back pain

• Herniated disk or disk disease
• Spinal stenosis
• Herpes Zoster
• Facet hypertrophy