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lumbar disc prolapse clinical manifestation and localizatioin

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  • 1. CLINICAL MANIFESTATION, CLINICAL EVALUATION AND LOCALISATION OF PIVD By Dr Tejaswi Dussa PG In MS Ortho Gandhi Medical College Secunderabad
  • 2. CLINICAL MANIFESTATIONS
  • 3. 1. Symptoms related to disc itself -discogenic pain 2. Symptoms related to nerve root compression -root pain, radiculopathy 3. Symptoms of myelopathy - Compression of spinal cord
  • 4. • Cervicalgia - intermittent neck pain, medial scapular pain, shoulder pain -compression of the sinuvertebral nerves and medial branches of the dorsal rami in the cervical region
  • 5. • Disc compressing the nerve roots • Cervicalgia • Sensation of constriction around the trunk (girdle pain) • Low back pain • Parasthesias • muscle weakness • sensory impairment
  • 6. • Prolapse is large enough and causing central compression of spinal cord - quadriplegia - paraplegia - Anterior cord syndrome - conus medullaris syndrome - cauda equina syndrome bladder disturbance dimnished perineal sensation
  • 7. Hisrory &Spine Examination • More common in middle aged group • Male > female • Onset of pain - acute - chronic • Site of pain • Sharp stabing /shooting pain • Radiation along the roots affected
  • 8. • • • • • • Trauma-Flexion type of injury h/o evening rise of temp h/o weight Loss Look for deformities Stiffness of back other symptoms for  gynaecological  genito-urinary `  vascular disease
  • 9. • Radiculopathy – pain radiating to thigh / leg / foot – root irritation • Neurological deficits – root compression – motor, sensory, reflex • Loss of lumbar lordosis • Scoliosis due to muscle spasm • Paraspinal muscle tenderness
  • 10. • Low back ache – Typical H/O LBA relieved by rest – indicates degeneration of disc • Sudden acute pain on lifting weight – H/O snapping sensation – acute PIVDRupture of annulus • Pain increases on forward bending.
  • 11. CLINICAL EVALUATION
  • 12. • • • • • • Special Tests: Anvil test Lhermitte’s test Naffziger test Valsalva test Milgram test
  • 13. Lumbar disc disease • SLR TEST • <40* suggest impingement of protruding disc on a nerve root • >40* indicates tension on nerve root
  • 14. • LASEGUE’S TEST: • Used to differentiate sciatica from sacro iliac joint disease
  • 15. • Slump Test: • Sciatic pain • Impingement of the dural lining, spinal cord, or nerve roots
  • 16. • CROSSED SLR TEST: • Large disc prolapse close to midline
  • 17. • BOWSTRING TEST: • -most reliable sign of nerve root compression do SLR test At the point where the patient experiences pain, relax the tension by flexing the knee slightly; the pain should disappear. •Then apply firm pressure behind the lateral hamstrings to tighten the common peroneal nerve - the pain recurs in +ve test
  • 18. • FEMORAL NERVE STRETCH TEST: •
  • 19. LOCALIZATION OF DISC PROLAPSE
  • 20. • Spinal nerves C2-7 exit above the pedicle of respective vertebrae - Eg:C6 nerve root exit the foramen between the C5 and C6 -The C8 nerve root exits the foramen between C7 and T1 pedicle • All spinal nerves distal to C8 exit the foramen below the pedicle for which they are named - Eg:L4 nerve root exits the foramen between the L4 and L5 pedicle
  • 21. Because spinal column is shorter than the vertibral column spinal nerves become more vertical caudally
  • 22. Thoracic dics disease
  • 23. • Ex:Abdominal musculature: • Pt attempt to lift his head up from the pillow against the resistance • paralysed lower segment moves upwards • when the upper segment paralysed the umbilicus moves downwards (Beevor’s sign)
  • 24. Lumbar disc disease • Motor testing nerve Root Level • • • • • • L1 L2 L3 L4 L5 S1 Hip flexion Hip flexion Knee extension Dorsiflexion ankle Great toe extension Plantarflexion

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