diagnosing lumbar conditions in primary care
Post on 03-Jun-2015
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Diagnosing Lumbar Conditions in Primary Care
Michael BryantBrizbrain & Spine
? Dermatome
? Myotomes
Lumbar Assessment
• Can take as little as 3 minutes• Time poor– 10 minutes per patient• History• Management plan• Where does examination fit in ?
History
• Many diagnoses are able to be established with history alone
• Often exam can tailored looking for specific findings I expect to see
• 80% of diagnoses from history alone
• Roughly 35% of lumbar problems at L4/5 and 25% of problems at L5S1
L4/5 disc
• L5 nerve – Buttock pain– Pain or sensory changes• lateral thigh• Lateral calf• Dorsum of foot
– Non specific clues• Occasionally difficulties up stairs• Stubbing toes
L5S1 Disc
• Pain or sensory changes– Posterior thigh– Posterior calf– Sole of foot
L3 and L4 Nerves
• 30% of presentations• Pains or sensory changes– Lateral to anterior thigh to knee (L3)– Lateral to anterior thigh to knee
then beyond to medial calf
• Nonspecific history– leg collapsing (quadriceps)
L1 and L2 Nerves
• 5-10% of lumbar spine problems
• Groin pains (L1)• Anterior Thigh pains (L2)
Examination
L2
• Hip flexors• Pain/sensory changes in the anterior
thigh
L3
• Knee extensor weakness• Reduced knee jerk• Pain/sensory changes anterior thigh to
knee
L4
• Ankle dorsiflexion weakness• (Possible) Reduced knee jerk• Pain/Sensory changes anterolateral
thigh and medial calf
L5
• Great toe dorsiflexion wekaness– Ankle dorsiflexion weakness
• Pain/sensory changes buttock/lateral thigh/lateral calf/top of foot
S1
• Ankle plantar flexion weakness• Pain/Sensory changes posterior
thigh/calf and sole/lateral aspect of the foot
• Reduced ankle jerk
Facet Pain
• Pain in extension and rotation
Other Findings
• Spinal cord issues– Brisk reflexes across the groups– Extensor plantar response– Go looking for sensory levels
Other Findings
• Cortical Problems– Weakness or sensory changes across
multiple dermatomes/myotomes– Often matching upper limb changes
Questions
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