LUMBAR neurogenic claudication Flashcards
1
Q
LUMBAR neurogenic claudication classic presentation
A
- older male patient comes in with severe bowl and bladder disturbances
- walking downhill is painful
- relieved by rest
- long history of intermittent lumbar pain
- poor thigh/calf pain
- pain, tension or weakness in legs when walking
2
Q
similar DDX’s
A
- vascular claudication
- conus medullaris
- cauda equina
3
Q
supporting factors
A
- proximal to distal leg pain
- worse with walking or standing for long periods of time
- better with sitting, flexing forward, lying down, and walking uphill
- bilateral buttock and thigh pain that spreads towards feet/lower legs
4
Q
refuting factors
A
- UMN signs
- pain from distal to proximal
- walking downhill is easier
5
Q
relevant orthos
A
- valsalva’s
- standing kemps
- seated kemps
- storks
6
Q
referrals
A
- x-ray to measure canal size on lumbar
- signs of DJD
- MRI for confirmation of stenosis
- GP for pain medications
7
Q
contraindications
A
- avoid HVLA to lumbar spine (due to compromised canal)
- avoid extension activities
8
Q
technique
A
- adjust to dec. tension and stretch on the NR
9
Q
care plan
A
2 x a week for 4 weeks
10
Q
recommendations
A
recommend exercises of forward flexion
11
Q
prognosis
A
- good
