Lumbar radiculopathy Flashcards
hx
43 yr old M, L buttock pain, 2 days, radiates down the back of l leg below the knee, felt a pop and acute sense of pain, pain is burning and constant, no saddle anaesthesia, urinary retention, faecal incontinence,
look
antalgic gait
loss of lumbar lordosis
look for scoliosis/ spinal scars
feel
tenderness over l5 centrally and l l5/s1 facet joint
active movement
pain-limited active ROM of lumbar spine movements
passive and resisted movement
not necessary
special tests
SLR testing
left side to 30 degrees
right side normal 90 degrees
other
full neuro exam
hip exam
DRE not indicated
DDx
lumbar radiculopathy
hip OA
Cauda equina syndrome
why is lumbar radiculopathy likely?
typical hx with pain in back, going to buttock, down back of l leg, positive SLR
Why is hip OA unlikely?
buttock pain of acute onset radiating down the leg more indicative of radiculopathy
hip OA = groin pain of insidious onset radiating down ant thigh to knee
why is cauda equine syndrome unlikely?
no bilateral leg pain
no no saddle anaesthesia, urinary retention, faecal incontinence
investigations
only if near signs/ dx doubt do
xray
MRI
Xray AP lumbar spine
loss of lordosis
loss of disc height
lumbar sppondylosis
MRI spine
if pain over 1 month not responding to non-op management infection IVDU, fever, chills malignancy cauda equina syndrome bowel/bladder problems
non-op tx
education takes months to resolve rest analgesia physio refer to ortho/ neurosurgical immediate ED admission if cauda equina corticosteroid injections - epidural/ selective nerve root block
