Low Back Pain

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Nerve Root syndromes

The history and physical examination in patients with sciatica often provide characteristic findings depending upon which nerve root is involved (see Table-4)

Physical Examination

The general physical examination can be as important as the neurological examination, and should include the vasculature (especially the pedal pulses), abdomen, hips, inguinal areas and rectum (especially if a cauda equina syndrome is suspected). The patient should be undressed.

Inspection of movement and Gait _ The way the patient moves, sits and stands provides useful information.


Signs of muscle weakness include atrophy (the calf and thigh circumferences should be measured, looking for asymmetry), fasciculations, pelvic tilt (the "bad" side is down)

Gait testing should include walking on heels and on toes Involuntary knee flexion (to guard against root traction) and scoliosis may be present. Cafe au lait spots, if present, may

indicate neurofibromatosis

Palpation : Palpation of the lower spine, paraspinal muscles, sciatic notches and sciatic nerve, may reveal tenderness, muscle spasms, and radiating pain. Muscle tenderness may be associated with nerve root irritation, affecting calf muscles with S1, anterior tibial muscles with L5, and quadriceps with L4.

Nerve root stretching : Roots may be impinged upon or tethered by herniated discs or other lesions, so that stretching the root causes pain. This should be tested by having the patient bend forward and by one or more of the tests of straight leg raising (SLR).

Straight leg raising _ SLR Lasegue's sign is performed with the patient lying flat on his or her back with the uninvolved knee bent 45 degrees, and that foot resting on the table. The involved leg is raised straight up, while the ankle is kept at 90 degrees of flexion. Disc herniation tends to tether the irritated nerve roots; as a result, stretching the nerve roots with SLR causes radiation of pain into the lower extremity.

Radicular symptoms - involving the leg and/or foot - are precipitated on the left with the straight leg raised to 45 degrees.

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Lyndeanw 

Im a 53 y/o healthy, weight appropriate female. I was diagnosed with degenerative lumbar spinal disease, including stenosis at the age of 38. I have a history of several low back injuries, including dislocation of my coccyx, due to falls from horseback riding
I've also worked as an EMT/Paramedic for over 32 years in several different ED units. Long hours on my feet in physically demanding situations.
I developed right hip pain with occasional leg weakness a few years ago, but managed to perform daily tasks without severe discomfort.
I've started to have increased (R) hip/glut pain in the past three months, radiating laterally through my thigh, calf and ankle. This frequently causes thigh and calf spasms that have been debilitating In all of my daily activities. I've seen my PCP, and an Orthopaedic surgeon, with negative findings on exam and MRI.
Any idea what the possible problem could be? Then, how to manage the pain and be able to work, sleep, clean my home and enjoy life again?
Thank you
Lyndean W

md111 

i am unable to bend my knee without severe pain. Very difficult and painful. My lower back always has a stifness and throbing pressure.
I also have servere shooting pain across my back periodically.

thersea 

I have been diagnosed with spinal stenosis & spondolylesis. I have pain radiating from my butt down leg top of foot. Sometimes bottom of foot & also in the groin area. 1 side or the other every day. The pain is horrible. Sometimes both sides. Can't sit can't stand hardly sleep. Help? Have had 2 cortizone shots in a 6mo. period.1st helped. 2nd to a small degree. Unable to take pain meds.

colatulgupta 

Very good material. I wonder if some photographs and radio graphs could be added. Dr Atul Gupta

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