Prolapsed disc

Question 1

What are the features of a prolapsed disc?

Answer 1

Leg pain worse than back pain

Pain often worse when sitting

Question 2

What are the features of L3 and L4 nerve root compression?

Answer 2

Both:
Positive femoral stretch test
Reduced knee flexion
Weak quadriceps

L3 = sensory loss over anterior thigh
L4 = sensory loss over anterior aspect of knee

Question 3

What are the features of L5 and S1 nerve root compression?

Answer 3

Both:
Positive sciatic nerve straight leg raise test

L5 = sensory loss of dorm of foot, weakness in foot and big toe dorsiflexion, but reflexes are intact
S1 = sensory loss of posterolateral aspect of leg and lateral aspect of foot, weakness in plantar flexion of foot, and reduced ankle reflex

Question 4

What is the management for prolapsed disc?

Answer 4

Analgesia
Physiotherapy
Exercises

If symptoms persist after 4-6 weeks, then refer for MRI