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NABILAH HANIS BINTI
ZAINUDDIN
BATCH 23 (C1)
ORTHOPAEDICS PRESENTATION
1
HISTORY
 29 y/o malay lady, a pre-school assistant
teacher
 Complaint of right-sided low back pain for 1
month
 Pain - ...
 H/O heavy weight lifting 1 month ago d/t
rearrangement of workplace following which
pain started the next day.
 No chan...
EXAMINATION
• Alert, cooperative, moderately built and
nourished
INSPECTION:
Antalgic gait
Posterior:
Spine appears normal...
PALPATION:
Right paravertebral tenderness
No tenderness over spinous process, facet joints
or sacroiliac joints
No palpabl...
SPECIAL TESTS:
1) Straight leg raising test
-Pain in right leg at 30º
1) Crossed SLR: -ve
2) Ankle dorsiflexion/ sciatic s...
Sensation: Sensation over anterolateral
aspect right leg is less compared to left side
Reflex: Knee and ankle reflexes are...
PROVISIONAL DIAGNOSIS
Lower lumbar prolapsed intervertebral disc with
compression of L5 nerve roots
• Backpain with sciati...
INVESTIGATIONS
1) Plain xray spine-
AP & lateral views
showing lumbosacral
junction
1) MRI of lower spine
 MRI lumbosacral spine (axial view)
10
TREATMENT
Conservative
Adequate bed rest
Analgesic
Physiotherapy
Surgery
Open discectomy with/without spinal fusion
THANK U
12
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10. ortho (1)

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10. ortho (1)

  1. 1. NABILAH HANIS BINTI ZAINUDDIN BATCH 23 (C1) ORTHOPAEDICS PRESENTATION 1
  2. 2. HISTORY  29 y/o malay lady, a pre-school assistant teacher  Complaint of right-sided low back pain for 1 month  Pain - intermittent (2-3x/wk), severe (7/10), lasting for appx 3 hrs each episodes, radiating to right leg & feet, aggravated by sitting, lying supine, standing & relieved by analgesic & left lateral position  Associated with numbness & weakness of right LL.  Currently pain is no longer relieved by analgesic thus patient sought for treatment. 2
  3. 3.  H/O heavy weight lifting 1 month ago d/t rearrangement of workplace following which pain started the next day.  No changes in bowel or bladder habits, no deformity of trunk noticed, no early morning stiffness, no fever, no pain or swelling of joints, no chronic cough, night sweat or evening rise in temperature, no LOA or LOW. 3
  4. 4. EXAMINATION • Alert, cooperative, moderately built and nourished INSPECTION: Antalgic gait Posterior: Spine appears normal, in midline position No shoulder tilt or pelvic tilt No scoliosis No muscle wasting,scars,swellings or sinuses, Lateral: Normal thoracic kyphosis & lumbar lordosis No gibbus
  5. 5. PALPATION: Right paravertebral tenderness No tenderness over spinous process, facet joints or sacroiliac joints No palpable step MOVEMENT: Forward flexion limited to 30º Lateral flexion limited to 20º on left side, normal on right side Extension limited to 20º Rotation, 45º both sides
  6. 6. SPECIAL TESTS: 1) Straight leg raising test -Pain in right leg at 30º 1) Crossed SLR: -ve 2) Ankle dorsiflexion/ sciatic stretch test: +ve 3) Bow string test: +ve 4) Femoral stretch test: -ve NEUROLOGICAL EXAMINATION OF LL Tone: normal
  7. 7. Sensation: Sensation over anterolateral aspect right leg is less compared to left side Reflex: Knee and ankle reflexes are normal in both sides Power: Nerve root Action Right limb Left limb L1, L2 Hip flexion 5 5 L3 Knee extension 5 5 L4 Ankle dorsiflexion 5 5 Inversion 5 5 L5 Great toe extension 4 5 S1 Ankle plantarflexion 5 5 Eversion 5 5
  8. 8. PROVISIONAL DIAGNOSIS Lower lumbar prolapsed intervertebral disc with compression of L5 nerve roots • Backpain with sciatica • H/O heavy weight lifting • Tenderness on paravertebral area • Limited movement of spine • Positive straight leg raising (30 o ), sciatic stretch, bow string & femoral stretch tests • Reduced sensation over anterolateral aspect right leg, weak right great toe extension, normal ankle reflex
  9. 9. INVESTIGATIONS 1) Plain xray spine- AP & lateral views showing lumbosacral junction 1) MRI of lower spine
  10. 10.  MRI lumbosacral spine (axial view) 10
  11. 11. TREATMENT Conservative Adequate bed rest Analgesic Physiotherapy Surgery Open discectomy with/without spinal fusion
  12. 12. THANK U 12

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