Case 18 Lumbar Disc Herniation
Case
18
Lumbar
Disc Herniation
Introduction
ownself
Exposure
– whole body
Hand
scrubbing
Look- Standing
Patient
Comment on
Lumbar Corset
Attitude of the
body - Listing towards one side , trunk
arm distance increased on one side
Look
Alignment - Front
Both shoulders and Pelvis are leveled,
No wasting of Quadriceps muscles
Patella facing forward and at equal
height
Leg, foot and toes look normal with
normal
overlying skin
Side Elbows straight overlying greater
trochanter
Transverse Loin Creases
Knee Straight
Foot Arches maintained
Back
Lumbar spine scoliosis
Lumbar spine flattened
Normal overlying skin on back with no dimpling
, tuft of hair
and swelling
Calf
symmetrical with normal overlying skin
Heel has – Normal varus
Feel
Temperature – Normal
Superficial
Palpation – Paraspinal Muscle spasm +
Bony
Palpation – non tender
Tenderness
at 5th Lumbar Spine
Movement – Flexion and lateral
bending decreased
Gait Normal /
Foot Drop Gait , Disturbance +
Tip toe , heel walking ,
Squating heel at the
same level
Standing – Special
tests -Trendelenburg test
Lie down Patient
SLR – decrease to < 60 degrees
Lasegue’s test
Cross Over
Thomas’s Sign (sciatica on extending
flexed knee with a flexed hip )
Femoral
Nerve Stretch test
FABER
Test
FADIR
– To rule out Pyriformis Syndrome
Movement
Hip / Knee /
Ankle / Toes
LLD
Neurovascular
Assessment
Sensory Examination L
2 – S 5
Motor
Examination - Global muscle
weakness
Power of the Muscles –
Supine Quadriceps ,
TA / EHL
/EDC / TP / Peronei
Lateral
Abductor /Adductor
Prone Gastrosoleus / FHL/FDC
/Hamstring/Gluteal Maixums /Medius/Minimus
Reflexes
Vascular
Examination – DPA / PTA on supine position
Investigations –
Plain X-ray
MRI
Treatment
Non
Operative
Rest
Flexion Exercise
Analgesics
Nerve Root Blocks
Operative
Dissectomy – Open / Microscopic
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