Neurogenic claudication

Question 1

What is the nerve supply to the urethral sphincters?

Answer 1

S2-4 pudendal nerve

Question 2

Myotomes of the lower leg?

Answer 2

Knee flexion - L5-S1
Knee extension - L3-L4
Dorsiflexion - L5-S1
Plantarflexion - S1-S2
Inversion - L4-L5
Eversion - L5-S1

Question 3

Contents of the posterior compartment of the leg

Answer 3

Gastrocnemius 
Plantaris 
Soleus 
Popliteus 
Tibialis posterior 
Flexor digitorum longus 
Flexor Hallucis 
Tibial nerve 
Posterior tibial artery
Posterior tibial vein and small saphenous vein 

(common fibular nerve and fibular artery travel to the lateral compartment)

Question 4

How does the IVF and canal diameter change with movement?

Answer 4

???

Question 5

ORAL:

What structures can refer pain to the buttock and thigh?

Answer 5

Pain into thigh caused by…

• Lumbar Disc Bulge
• Lumbar Facet Joint Sprain
• Spinal Degeneration (Lumbar)
• Piriformis Syndrome
• Sciatica
• Hip Arthritis
• Labral Tear of the Hip
• Sacroiliac Joint Dysfunction

Pain into the buttocks…

• Lumbar Disc Bulge
• Sciatic type pain
• Lumbar Facet Joint Sprain
• Spinal Degeneration
• Sacroiliac Joint Dysfunction
• Hip Osteoarthritis

??????

Question 6

ORAL:

What is neurogenic claudication?

Answer 6

Compromising of vascular system of the neural tissue.
- Venous back pressure, compressing a nerve that is already going through a narrowed space.
Causes:
- Anything that can cause spinal stenosis, narrow of the nerve passageways and restriction of nerve blood supply. - Hx of cancer, red flag for mets.
Symptom: - leg pain (and occasionally numbness or weakness) on walking or standing, relieved by sitting or spinal flexion, related to neural compression, usually spinal stenosis.

Question 7

ORAL:

What exercises can relive neurogenic claudication?

Answer 7

• Walking uphill: Relieving (body is more flexed)

????

Question 8

ORAL:

Compare neurogenic and vascular claudication

Answer 8

Vascular claudication:

• Site: Distal > Proximal
• Age: >40 yoa
• Rest: Pain disappears almost instantly
• Change in position: No effect - Arterial signs: Decreased skin nutrition, hair loss, decreased pulse.
• Neuro screen: N/a
• Presentation: Bilateral pain on walking - Walking up hill: Very aggravating
• Cause: PVD
• Management: Aspirin, balloon angioplasty, control risk factors, exercise.

Neurogenic claudication:

• Site: Proximal > distal
• Age: 65+
• Rest: Back pressure through venous system so pain takes a while go to away.
• Change in position: aggravated by extension, standing or being supine. Relieved by flexion, bending knees while supine (tensions loose structures which compromise blood vessels)
• Arterial signs: N/a - Neuro screen: LMN ssx, paraesthesia
• Walking uphill: Relieving (body is more flexed)
• Cause: Spinal changes, age related changes (disc height decreases, redundant nerve roots, venous plexus dilates more, PLL and ligamentum flavum stretch).
• Management: anaesthetic block, epidural corticosteroids, surgical decompression, flexion based Lx stabilisation.