L4 L5 Disk Herniation Case Study

On examination, cervical and lumbar spine is restricted in all planes with increased pain. Muscle guarding is also noted. The patient is not able to heel and toe walk. He is obese and deconditioned. Straight leg raise (SLR) is positive bilaterally. Muscle guarding is noted along cervical paraspinal and trapezius muscle groups bilaterally. Sensation is normal to light touch, pinprick, and temperature along all dermatomes of the bilateral upper extremities, except right C6-8, decreased to

Impressions are lumbar discogenic pain syndrome, left lumbar radiculitis, myofascial pain, lumbar degenerative disc disease, and chronic pain syndrome and shoulder pain.

Robert Trinh is a 34 year-old senior truck driver referred to your outpatient physical therapy office for “chronic low back pain” which started 7 months ago. He was lifting a particularly heavy load that day and felt something “tweaked” in his low back as he was bent over and moving the load from the truck into the sidewalk. He remembered being in a bent over posture and cannot straighten up for about 2 weeks and the posture gradually resolved. Current pain level is 8/10 with sharp burning sensation in the low back (P1= symptom location #1) that radiates down to the posterolateral right lower leg (P2= symptom location #2). The entire right lower leg also feels tingling often. Robert reports that the right lower leg can feel very sensitive at

DOI: 06/23/2011. This is a case of 41-year-old male maintenance worker who sustained injury to the low back while taking off a sliding door of a patio. As per OMNI notes, patient is diagnosed with lumbar disc disorder with myelopathy. MRI of the lumbar spine dated 6/28/15 revealed recurrent left paramedian L4-5 disc herniation with caudal extrusion of a 10 mm fragment into the left L5 lateral recess. As per office notes dated 7/25/16, the patient is status post redo left L5-S1 discectomy performed on 4/20/16. It was also noted that the patient had a prior L5 laminotomy several years ago. He subsequently did well. However, he had recurrence of his pain. Pain is radiating into his left leg worse on the right leg. This was unresponsive to conservative

Diagnoses include failed back surgery, lumbar; degenerative disc disease, lumbar spine; back pain; lumbar radiculopathy; spondylosis without myelopathy or radiculopathy, lumbar region; impingement syndrome of bilateral shoulders; myalgia; xerostomia; erectile dysfunction; testicular hypofunction; chronic anxiety; chronic depression; and chronic insomnia.

Possible symptoms of a herniated disc include pain that radiates through the back and possible down the arms or legs, depending on the location of the herniation. There can also be noted numbness and weakness of the arms and neck. Some people may not even know that they have a herniated disc because not all cases present with leg or back pain. Other signs and symptoms of a herniated disc may include muscle spasms or deep muscle pain. In extreme cases, a patient may present with weakness in both legs and/or the loss of bladder control and bowel control. This is a serious problem called cauda equine syndrome and requires immediate medical attention.

More and more people experience back problems. Often, the real culprit is a herniated disc. Herniated (-- removed HTML --) disc (-- removed HTML --) treatment Venice FL specialist would like people suffering with undue pain in their back to consider seeking out a specialist for more information. A herniated disk is a warning that something is wrong with the rubbery disk that are between the vertebra in the back. The vertebra are the individual bones that join together to make your spine. The spine disks resembles little jelly donuts. For example, the disks have a soft center with a tough exterior. A Herniated disk is a result of the soft center squeezing through a rip to the exterior.

Herniated discs are particularly brutal, due to their position directly behind the spinal cord. When a disc ruptures, the ‘jelly’ inside can spill out into the nerves. This results in severe pain that radiates through the back and sometimes down the legs, as in my case. For more than two years, it felt like I had a knife embedded in my lower back.

In between each vertebrae of the spine lies a fibrocartilaginous cushion, known as an intervertebral disc. However, when there is an issue occurring that causes the intervertebral disc to not function properly as a cushion between the vertebras of the spine, such as intervertebral disc herniation, other complications can arise. Neck and back pain is a common issue faced by adults of various ages. Back pain is accountable for second most frequent cause for visits to the hospital, fifth most common reason for admission to the hospital, and the third most common cause of surgical procedures (Taylor, Deyo, Cherkin, & Kreuter, 1994) Intervertebral disc herniation of the spine is often the culprit of this pain. In this paper the etiology, pathology, clinical course, signs and symptoms, prognosis, occupational therapy treatment protocol, and the overall effect on the person affected by a herniated disc will be discussed.

Disc herniation between L3 and L4 vertebra causes compression of the L4 nerve root as it crosses the intervertebral disc before exiting the L4 intervertebral foramina. Numbness may be present over the anteromedial aspect of the leg. Weakness of tibialis anterior muscle may be present as evidenced by absence of heel walking. The quadriceps and hip adductor group, also may be weak and, in extended ruptures, atrophic.Reflex testing may reveal a diminished or absent patellar tendon reflex (L2, L3, and L4) or anterior tibial tendon reflex (L4). Sensory testing may show diminished sensations over the L4 dermatome, predominantly the medial leg and the autonomous zone being skin over medial malleolus.

The most relevant findings from the objective exam lead me to diagnosis the patient with a left sided C5 disc pathology causing secondary radiculopathy symptoms. Nerve roots should normally be able to withstand relative mechanical insults such as compression and stretching.4 Nerve roots can become injured in a multitude of ways including decreased space in the intervertebral foramina or spinal canal secondary to osteophytes or other degenerative changes from nearby structures such as facets or uncovertebral joints which can cause compression on the nerve root in “closing” type movements4. Other methods include herniated discs, synovial cysts or alterations in the chemical environment around the disc.5 Damage to the nerve root can cause sensitivity changes, hyporeflexia and motor weakness in the segment supplied by that specific nerve root. In this patient’s case the C5 nerve root was most indicated because it supplies the anterior shoulder dermatome, motor strength for shoulder abduction and biceps reflex. I believe the peripheralization of the patient’s symptoms laterally down the left shoulder and upper arm is caused by an increase in mechanosensitivity in which “pressure and/or stretch on a nerve produces immediate symptoms.6” When the patient decreases space and potentially compresses the nerves ie., cervical extension, lateral flexion to the left side and rotation to the left side his symptoms are peripheralized and the pain increases. The pain generators at the nerve root with increased sensitivity to these closing movements are referred to as

If you have lower back pain that radiates down your hip and leg, you might have a herniated disc. A disc is a spongy piece of tissue that acts as a cushion between the vertebrae in your spine. The inside of a disc has a substance that is thick like jelly so it can absorb shock. When a disc herniates, the jelly bursts through the covering of the disc so the cushioning effect is lost. Also, the bulging part of the disc rubs against the spine. This causes nerve irritation and pain. Here are some of the ways your doctor can treat a herniated disc.

Very educational post. Looking at all the symptoms and the data given, I would also agree with your priority diagnosis of Sciatica. Here the patient is complaining of acute low back pain which is associated with pain and burning that radiates along the lateral thigh, leg, and foot. Sciatic pain is a sharp, burning pain that radiates down the posterior and lateral leg to the foot or ankle. This Sciatic pain could be related to herniated disk (Dains, Baumann, Scheibel, 2016). According to De Campos (2017), in 90% cases, sciatica is caused by a herniated disc with nerve root compression. Lumbar stenoses and tumors are less likely to cause this. Many people think that the worse the pain, the more likely something bad is going on. However, this

The role of recording is to have a correct way of diagnoses and also select a better way of treatment (10). Inter-vertebral discs are the largest avascular tissues (1,13) but they are metabolically active (10). Thus needed nutrients will be transferred to the cartilage and A.F using the blood vessels surrounding tissues or the body of the lumbar spine through subchondral bone tissue (10). Disruption in normal discs cause pressure. So we will see a decrease in pressure by reduce in height, herniation of the discs and so increase in pressure on annulus (10). With age the central part of the discs will be herniated and that cause slipped discs. Herniated disc at the bottom of the lumbar spine causing pressure on nerves and nerve roots, causing back pain (lumbago) or pain in the legs (sciatica) (8).

ach disc of the spine is designed much like a jelly donut. As the disc degenerates from age or injury, the softer central portion can rupture (herniate) through the surrounding outer ring (annulus fibrosus). This abnormal rupture of the central portion of the disc is referred to as a disc herniation. This is commonly referred to as a "slipped disc." The most common location for a herniated disc to occur is in the disc at the level between the fourth and fifth lumber vertebrae in the low back. This area is constantly absorbing the impact of bearing the weight of the upper body.