PHYSIOTHERAPY ASSESSMENT IN PATIENT WITH CAUDAL EQUINAL SYNDROME

1. PHYSIOTHERAPY ASSESSMENT IN PATIENT
WITH CAUDA EQUINA SYNDROME
(CES)
PRESENTED
BY
ISMAILA MUHAMMAD BINJI
DEPARTMENT OF PHYSIOTHERAPY
NEUROPHYSIOTHERAPY UNIT
USMANU DANFODIYO UNIVERSITY TEACHING HOSPITAL,
SOKOTO STATE.
6th APRIL 2024

2. OUTLINE:
Introduction
Definition
Brief Anatomy
Epidemiology
Etiology
Signs & Symptoms
Complication
Differential diagnosis
Physiotherapy assessment
Recommendation
Conclusion
Reference

3. INTRODUCTION
Caudal equina syndrome (CES) is an uncommon but serious
neurological condition affecting the bundle of nerve roots at
the lower end of the spinal cord. The Caudal equina (CE)
provides innervation to the lower limbs, sphincter and it
controls the function of the bladder, distal bowel, and
sensation to the skin around the perianal region.
(Woodfield et al., 2022)

4. INTRODUCTION CONT’D
higher risk of depression and poorer mental health post-
decompression usually occur.
With Physiotherapists working increasingly in first-contact and
specialist roles, assessment of back pain including effective CES
screening is essential. Failure, or delays, in diagnosis are often the
top cited factor in litigation claims
(leech et al., 2021)

5. Definition
Cauda equina syndrome occurs when there is dysfunction of
multiple lumbar and sacral nerve root of the equina.

6. BRIEF ANATOMY

7. EPIDEMIOLOGY
Cauda equina syndrome is an extremely rare condition. It is
reported in approximately 0.04% of all patients presenting
with low back pain in England. Cauda equina syndrome occurs
in approximately 2% of cases of herniated lumbar discs. At
one year, bladder dysfunction remained in 50% of patients,
bowel dysfunction in 43% and sexual dysfunction in 51%. In
addition, of those patients in employment before their CES
diagnosis, 21% were not able to return to work at 1 year
(Woodfield et al., 2023)

8. ETIOLOGY
 Traumatic injury
 lumbar intervertebral disc herniation
 Tumors
 Spinal stenosis
 Postoperative lumbar spine surgery complication
 E.T.C

9. SIGN & SYMPTOMS
Severe low back pain Saddle anesthesia
Bladder and bowel dysfunction
Sexual dysfunction
Paraplegia or paraparesis

10. COMPLICATIONS
• Sensory and motor impairment
• Urinary and fecal incontinence.
• Genital disorder, such as decrease libido
• Depression
Cauda equina solicitors England

11. DIFFERENTIAL DIAGNOSIS
• conus medullaris syndrome
• Spinal cord injury
• Guillain barre syndrome
• Multiple sclerosis
• Pott’s disease
• Transverse myelitis

12. PHYSIOTHERAPY ASSESSMENT
SUBJECTIVE ASSESSMENT
 Bio data
 Chief complain
 History of presenting complain
 Past medical history
 Family/social history

13. ASSESSMENTS CONT’D
OBJECTIVE ASSESSMENT
 GENERAL OBSERVATION
 TEMPERATURE
 PAIN (VAS)
 PALPATION
Tenderness (soft tissue tenderness grading scheme)
Muscle Tone
Edema
Atrophy
 SENSATION
Deep
Superficial
 AROM & PROM

14.  MYOTOME
 PROPRIOCEPTION
 REFLEX
Cremasteric reflex (L1,2)
Bulbocavernosus reflex (S2-S4)
Anal reflex (S4-S5)
Myotactic reflex (L2 - 4)
Achiles tendon reflex (S1,2)

15. Bulbocavernosus reflex (S2-S4)
Cremasteric reflex L1,2
Anal reflex S4-S5

16. Myotactic reflex (L2 - 4)
Achiles tendon reflex (S1,2)

17.  FUNTIONAL ASSESSMENT
 INVESTIGATION:
X- RAY
MRI
CT SCAN

19. Potts disease diagnosis with MRI
Pursey., et al 2010

20. CT SCAN

21. Conclusion
A proper rehabilitation results in making the patient
functionally able in performing activities of daily
living with ease

22. Recommendation
early physiotherapy intervention is needed in patient
with (CES). especially in aspect of incontinent,
muscle weakness and sexual dysfunction which may
some times lead to social, psychological and marital
issues.

23. Reference
• Fraser s, Roberts L, Murphy E. Cauda Equina Syndrome: A
Literature Review of Its Definition and Clinical Presentation.
Archives of Physical Medicine and Rehabilitation 2009 90(11),
pp.1964–1968.
• Germon T, Ahuja,S, Casey A, Rai A. British Association of Spine
Surgeons standards of care for cauda equina syndrome. The
Spine Journal 2015 15 (3), pS2-S4.
• Todd, N V; Dickson, R A . Standards of care in cauda equina
syndrome. British Journal of Neurosurgery. 2016, 30 (5), p518-
522.
• Parke WW, Gammell K, Rothman RH. Arterial vascularization
of the cauda equina. J Bone Joint Surg Am 1981; 63: 53–62.
• Brash J Jamieson E,(ed) Cunninghams Text book of Anatomy
7th edition. Oxford Medical Publications. 1937.

24. • Rider IS, Marra EM. Cauda Equina And Conus Medullaris
Syndromes. Available
from: https://www.ncbi.nlm.nih.gov/books/NBK537200/ (la
st accessed 26.1.2020)
• Physiotutors. Cauda Equina Syndrome | Signs & Symptoms.
Available
from: https://www.youtube.com/watch?v=zJp3Q3jdd8I
• ↑ Levack P, Graham J, Collie, D, et al. 2002. Don’t wait for a
sensory level-listen to the symptoms: a prospective audit of
the delays in diagnosis of malignant cord compression. Clin.
Oncol. 2002;14:

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