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lumbar disc prolapse clinical manifestation and localizatioin

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lumbar disc prolapse clinical manifestation and localizatioin

  1. 1. CLINICAL MANIFESTATION, CLINICAL EVALUATION AND LOCALISATION OF PIVD By Dr Tejaswi Dussa PG In MS Ortho Gandhi Medical College Secunderabad
  2. 2. CLINICAL MANIFESTATIONS
  3. 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. 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. 5. • Disc compressing the nerve roots • Cervicalgia • Sensation of constriction around the trunk (girdle pain) • Low back pain • Parasthesias • muscle weakness • sensory impairment
  6. 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. 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. 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. 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. 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. 11. CLINICAL EVALUATION
  12. 12. • • • • • • Special Tests: Anvil test Lhermitte’s test Naffziger test Valsalva test Milgram test
  13. 13. Lumbar disc disease • SLR TEST • <40* suggest impingement of protruding disc on a nerve root • >40* indicates tension on nerve root
  14. 14. • LASEGUE’S TEST: • Used to differentiate sciatica from sacro iliac joint disease
  15. 15. • Slump Test: • Sciatic pain • Impingement of the dural lining, spinal cord, or nerve roots
  16. 16. • CROSSED SLR TEST: • Large disc prolapse close to midline
  17. 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. 18. • FEMORAL NERVE STRETCH TEST: •
  19. 19. LOCALIZATION OF DISC PROLAPSE
  20. 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. 21. Because spinal column is shorter than the vertibral column spinal nerves become more vertical caudally
  22. 22. Thoracic dics disease
  23. 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. 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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