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doom_child

Re: What would YOU diagnose?

It's most likely herniation of an intervertebral disk in the region of L5 - S1. Problem occurs as patients get older, IVD's decrease in size and compress (reduced turgor as well). Also the reason for reduced height in the elderly.

Cause of the pain would mean the herniation has extended into the central canal of the the spinal cord (Through the Anulus fibrosus, posteriorly). Can be accompanied by muscle spasms under load.

The pain he experiences in his lower limb will be referred pain as the hernia is now obstructing the nerve that feeds off from L5 to that region of the lower limb.

Not sure why an extension will cause greater pain though.

Mystique

What would YOU diagnose?

Hi all,
I thought it'd be interesting to post some clinical problems that have arisen whilst working at my hospital and see what you would diagnose for the following. These are fairly easy!

Scenario 1:
A 45-year-old man suddenly experienced severe pain in his lower back when carrying a large load. Later, he developed a dull ache in the posterolateral aspect of his left thigh that extended along the calf of his leg into his foot. Lateral deviation of the lumbar region of his vertebral column was also noticed. He limped when he walked because he could not fully extend his thigh. The following observations were made by a specialist:
a) back muscles in spasm
b) site of most severe pain was in the lower lumbar region
c) no ankle reflex was observed on the left side
d) increased pain when the extended left leg was raised
e) radiographs showed a slight narrowing of the space between the vertebral bodies of L5 and S1
f) the nucleus pulposus of the L5/S1 disc was protruding


Using what I have given you, try and answer the following:
1) What is the anatomical basis for the protrusion/herniation of the disc and the resulting lower back pain?
2) What produced the lumbar deviation?
3) Why did the patient experience pain in the posterolateral aspect of his thigh, leg and foot?
4) Why did the pain increase when the specialist raised the patient's extended lower limb?