Lumbar Radicular Pain Amaresh Vydyanathan, M.D. Erik Romanelli, M.D., M.P.H.
Anatomy There are five moveable lumbar vertebrae which are connected by paired facet joints located between the articular processes of the pedicles and by the anterior and posterior longitudinal ligaments. Intervertebral foramina are formed by notches in the articular processes of adjacent pedicles of two vertebrae; the disk is anterior and medial to the foramen. Nerve roots of L1-L5 descend from the conus medullaris (termination of the adult spinal cord, typically located between T10 and L1 vertebral levels) and exit at the neural foramina of their respective level.
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Radiculopathy can, in actuality, exist without pain—it is more so defined by objective neurologic signs such as loss of sensation and/or motor activity (due to conduction block), weakness, muscle wasting, and loss of reflexes. Similarly, radicular pain can exist in and of itself. Physiologically, radicular pain is typically evoked by ectopic discharges that arise from the dorsal nerve root or its ganglion, and distributes painful sensations along the length of its axon. Etiologies of radicular pain typically involve either compression or irritation of spinal nerve roots, which could be due to numerous causes including disc herniation, formation of osteophytes, degenerative lumbar spondylosis, scar tissue from a previous spinal surgery, foraminal stenosis, thickening of adjacent ligaments, neoplasms, inflammatory conditions (i.e. ankylosing spondylitis, Paget’s disease), and infectious disorders (herpes zoster, Lyme, spinal epidural …show more content…
Immediate MRI should generally be reserved for patients in whom neurologic deficits are progressing, cauda equine is suspected, or there is clinical suspicion of malignancy, infection or inflammatory disorders. Otherwise, three to six weeks of conservative therapy can be implemented and if this fails to control radicular pain or if there is onset or further progression of neurologic symptoms, further diagnostic testing with MRI can be utilized (especially if surgical intervention is contemplated). MRI is highly accurate for identifying abnormalities which may otherwise put the patient at risk for developing lumbar radicular pain, particularly disk herniation. If MRI is contraindicated (i.e. if patient has pacemaker or spinal cord stimulator), a CT myelogram may be appropriate. Patients with normal MRI findings who have persistent unexplained leg pain may benefit from electromyography (EMG). EMG is performed in combination with nerve conduction studies (NMS) to help localize symptoms to specific nerve root levels, measure severity of radiculopathic disease, and additionally rule out alternative diagnoses such as neuropathy or
Availability of nerve block therapy, chiropractic treatment and high dose of pain medicine which will promote numbness, reduce sciatic nerve pain, minimize fatigue and decrease pain sensation. Similarly, implanted pain pumps which delivers a medicine directly to the spinal cord and symptoms can be controlled by smaller dose than needed dose with oral medication.
Based on the initial pain medicine evaluation report dated 06/22/15, the patient complains of constant neck pain which radiates down to the bilateral upper extremity, fingers and hands. Pain is accompanied by intermittent tingling and numbness in the bilateral upper extremities to the level of the fingers and muscle weakness. The neck pain is associated with occipital, temporal and frontal headaches and muscle spasms in the neck area. The patient describes the pain as aching, burning, pins and needles, sharp, and stabbing. The pain is aggravated by activity, flexion/extension, prolonged sitting, pulling, pushing, repetitive head motions and standing. She also reports severe difficulty in sleep.
This portion of the skeletal provides the main structural support for the body while also protecting the central nervous system and vital organs in the thorax (heart, lungs, etc.). Of primary importance is the adult vertebral column, consisting of 33 vertebrae divided into five groups and named according to the region of the body in which they are located. The upper seven are cervical vertebrae, followed in descending order by 12 thoracic vertebrae, five lumbar vertebrae, five sacral vertebrae fused into one bone as the sacrum, and four coccygeal vertebrae fused together into one bone called the coccyx. The sacral vertebrae and coccygeal vertebrae become fused in the adult, so there are only 24 movable vertebrae (Fig given
Spinal Muscular Atrophy, also known as “SMA” is a genetic and also a motor neuron disease that affects the area of the nervous system that controls your voluntary muscle movements such as walking, crawling, and swallowing. When someone acquires this condition their muscles start to shrink as a cause to the muscles not receiving signals from the nerve cells in the spine that control function. Spinal Muscular Atrophy is a rare but serious condition.
What is scoliosis? Scoliosis is a musculoskeletal disorder that causes the back to curve sideways like and “S” or a “C” and cause the body to lean to one side. Scoliosis can eventually if not looked into and not treated colid with your bodily organs like your heart, lungs, and kidneys. This can cause you to slump down into a hump and cause it hard to breath and do physical activity.
“The doctor of the future will give no medication, but will interest his patients in the care of the human frame, diet and in the cause and prevention of disease” by Thomas A. Edison. Chiropractors use hands-on spinal manipulation and other alternative treatments on the spine which will enable the body to heal itself without surgery or medication. Chiropractic care began in 1895 when its founder, Daniel David Palmer, claimed any and all diseases could be healed by nothing more than just his hands. Dr. Palmer examined a janitor who was deaf for 17 years after the janitor felt his back was out of place, so Dr. Palmer gave an adjustment to what was felt to be a misplaced vertebra in the upper back. The janitor then observed that his hearing improved thanks to Dr. Palmer. Chiropractors use manipulation to restore mobility to joints restricted by tissue injury caused by sitting without proper back support. Chiropractic is primarily used as a pain relief alternative for muscles, joints, bones, and connective tissue, such as cartilage, ligaments, and tendons. About 22 million Americans visit chiropractors annually
In this case, the claimant presented with a work-related low back pain associated with a right lower extremity radiculopathy. It was mentioned that Lyrica has not improved her radicular symptoms. As such, Lyrica was changed to Gabapentin to further address ongoing neuropathic
Sciatica is a term given to discomfort in the lower back that moves down the leg through the sciatic nerve, which causes pain, tingling, numbness or weakness on either side of your body. Although sciatica cannot be diagnosed as an actual medical condition, it is said to be a symptom of a previous injury or medical condition. The original cause is usually pressure on the sciatic nerve. The largest single nerve in the body is the sciatic nerve, which is composed of individual nerve roots that start by branching out from the spine in the lower back at lumbar 3 (Frymoyer 1992). The nerves that stem from each level of the lower spine intertwine to construct the sciatic nerve, which runs from the lower back down each leg. Down the leg, nerves branch out to innervate different parts of the leg. Depending on where the nerve is injured or pressured determines where the person will feel the symptoms and to what extent they will experience symptoms down the leg. A few alternative names include neuropathy of the sciatic nerve, sciatic nerve dysfunction, herniated disk, or lower back pain of the sciatic nerve (Frymoyer 1992).
The vertebral column of the body remains stable due to the isometric co-contraction of the erector spinae, rectus abdominus and the e...
warm) in the left upper and lower extremities; decreased strength and movement of the right upper and lower extremities and of the left abdominal muscles; lack of triceps and biceps reflexes in the right upper extremity; atypical response of patellar, Achilles (hyper) reflexes in the right lower extremity; abnormal cremasteric reflex in the right groin; fracture in cervical vertebrae #7; and significant swelling in the C7-T12 region of the spinal canal (Signs and symptoms, n.d.). The objective complaint of a severe headache could also be consistent with a spinal cord injury (Headache, nausea, and vomiting,
..., Ducker, T.B., ….. Young, W. (1997). International Standards for Neurological and Functional Classification of Spinal Cord Injury: International Medical Society of Paraplegia, 35, 266 – 274.
Tests after tests including MRI’s, X-rays, and experimental procedures were performed to show I had five ruptured disks in the lower lumbar section of my back. Tedious Examination done by a group of doctors concluded I had a crippling disease of the spinal column called spinal stenosis. Spinal stenosis is a narrowing of the spinal canal that causes compression of the spinal cord. (Lohr,1) If this disease was ignored any longer, it would lead to many other problems affecting other areas of my back to help support this weakness. It was an extremely rare case for an athlete my age.
Simple musculoskeletal back pain has symptoms of pain in the lumbrasacral area of the back (Jackson & Simpson, 2006). The upper thighs and knees are also known to be affected (Jackson & Simpson, 2006). This pain is usually described as a dull pain (Jackson & Simpson, 2006). Spinal nerve root pain is localised down the leg, and usually continues below the knee and into the feet (Jackson & Simpson, 2006). It has been d...
In looking at journals for this research essay I originally searched physical therapy, because it is my degree plan and field of interest. The articles which began standing out to me, were the journals on the spine. The articles just on the spine alone were intriguing, but reading the articles on the lumbar spine really caught my attention. The spine is so complex and has so many things to it, but the main area that people have issues with is the lumbar part of the spine. The article which we will be discussing today will be “Efficiency Methods of Physical Therapy Rehabilitation of Osteochondrosis of The Lumbar Spine” by Annals of Mechnikov Institute.
Negative straight leg raise bilaterally, good range of motion at her hips. She does have pain when flexing both hips while in a lying position.