Peripheral Herniation: A Case Study

MRI of the lumbar spine obtained on 05/19/15 revealed at L2-3, endplate osteophyte formation and disc bulge contribute to a mild degree of spinal canal stenosis and a mild degree of bilateral neural foraminal compromise. At L3-4, a disc bulge eccentric leftward and endplate osteophytes formation are responsible for a mild degree of spinal canal stenosis, a mild degree of right neural foraminal encroachment, and a moderate degree of left neural foraminal encroachment. At L4-5, there is a diffuse disc bulge and endplate osteophyte formation which effaces the ventral aspects of the thecal sac and are responsible for a moderate-to-severe degree of spinal canal stenosis, a mild degree of right neural foraminal encroachment, and a severe degree of left neural foraminal encroachment. At L5-S1, a shallow disc bulge and endplate osteophyte formation contribute to a mild degree of left neural foraminal encroachment, without compromise of the spinal

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.

DOI: 11/25/2014. Patient is a 47 year old male laborer who sustained injury to his left side of body, back, shoulder, and ankle while he was walking/smoothing tar when he was hit by double bottom truck while working at job site. Per OMNI, he sustained strain to lower back, left shoulder, and left ankle.

Based on the latest follow-up physiatric evaluation report dated 01/11/16, the patient complains of lower back pain which improves temporarily with PT but continues to radiate to his left leg with numbness, tingling and weakness. He attends PT three days per week and participates in a daily home exercise program.

MRI of the cervical spine without gadolinium dated 04/09/2015 showed severe 5mm left lateral recess focal disc protrusion with moderate canal stenosis and flattening of the left ventral cord and mild to moderate left neuroforaminal stenosis at C4-5. At 3-4, there was a moderate 4mm foraminal

Based on the medical report dated 05/ 2616, the patient complains of headaches and stabbing upper back and shoulder blade pain radiating to her lower back. She also has neck pain, described as burning. Pain is rated as 8/10 to the neck, lower and middle back and head. When she is on medications, her neck and mid/low back pain and her headaches reduced to a 4/10. She gets anxiety and it is related to her rapid heart rate, s which makes it feel she is in pain and this

Based on the medical report dated 05/26/16, the patient reports neck pain which places limits her physical activities. Pain is elevated with sitting, standing, lifting, and ambulating. She has noticed stiffness in the mornings and difficulty sleeping due to the nature of the pain. She reports difficulty with bending her neck, side bending, twisting, lifting and carrying. Patient has received multiple treatments including medication prednisone, Neurontin, and Mobic along with physical therapy, however the pain still persists.

Patient is a 55-year-old male assembler who sustained a work-related cumulative trauma injury on 4/3/2012 to his neck, wrists, hands, fingers, upper extremities, right shoulder, nervous system, and sleep. Per OMNI, he was diagnosed with cervical spine sprain/strain; right shoulder/arm sprain; right shoulder rotator cuff tear and labral tear; right elbow lateral epicondylitis; right wrist sprain; carpal tunnel syndrome; and constipation.

DOI: 2/3/2015. Patient is a 36-year old right hand dominant male employee who sustained injury to his right knee, right wrist, left elbow, head, neck and back when he slipped and fell while helping a customer.

 MRI of the lumbar spine date 3/17/16 (no official report) revealed bilateral facet hypertrophy at L2-3, right disc bulge at L3-4 with bilateral facet hypertrophy, ligamentum flavum hypertrophy and canal stenosis. At L4-5 right disc bulge with facet hypertrophy,. ligamentum flavum hypertrophy and L5-S1 disc protrusion.

The pain is better with rest. The upper neck pain is radiating around the skull and triggering frequent headaches, low back pain is radiating to the right posterolateral thigh and calf wrapping around and including dorsum of the right foot and middle toes. The patient also has left wrist pain. Current medications include Menthoderm, Flexeril, Naproxen, hydrocodone-acetaminophen, Bactrim, bupropion “Sr”, and Ventolin “Hfa”. Physical examination revealed that the patient’s gait has a left-sided antalgic gait. He does not use assistive devices. Cervical spine examination revealed asymmetry or abnormal curvature noted on inspection. There is also tenderness and trigger point (a twitch response was obtained along with radiating pain on palpation) is noted on both sides. Lumbar spine examination revealed loss of normal lordosis with straightening of the lumbar spine. Lumbar range of motion is has limited flexion of 60 degrees and limited extension of 10 degrees. The range of motion is limited by pain.

DOI: 7/15/2014. Patient is a 30-year old female circuit board worker who sustained injuries to her neck, lower back and bilateral elbows when she slipped on wet floor and landed on her back.

She is considered permanent and stationary related to her condition. Primarily reports aching sensation along the right side of the cervical spine radiating outwards the right shoulder girdle. She also reports more prominent right occipital region headaches, which radiates to the bilateral temporal region. Numbness in both hands, right greater than left is also reported. A mild aching sensation in the lower lumbar spine is also reported, but this is not a predominant symptoms. She rates the current pain as 4 with ranges between 2 to 8. Her symptoms were managed by Mobic, Elavil, and Percocet. There is overall improvement in pain scale and functional

DOI: 8/21/2007. Patient is a 58-year-old male ramp agent who sustained a work-related injury to his lower back while he was trying to push and pull heavy dolly carts in order to connect them together. As per OMNI, the patient also had hernia and dermatitis.

MRI of the lumbar spine dated 03/03/15 showed L5 to S1 marked disc degeneration with circumferential 4 to 6mm disc bulge with mild central protrusion and facet arthropathy causing marked bilateral lateral recess/foraminal stenosis with suspected S1 nerve root compression. At L2 to L3 and L4 to L5 there is mild disc degeneration with circumferential 2mm disc bulges causing mild bilateral foraminal narrowing, greater at L4 to L5, where mild facet arthropathy is also present.