- See: Discogenic Pain:
- Discussion:
- predominence of leg pain (nerve pain) over back pain (usually annular pain);
- determine if leg pain is made worse by activities or positions that increase intra discal pressure;
- SLR: is key finding in sciatica, but is also found in:
- myogenic pain;
- ischial burisitis;
- annular tear;
- hamstring tightness;
- critical distinction is made by the sciatic stretch test;
- test is performed after SLR by lowering affecting leg few deg below point that produces leg pain & then dorsiflexing ankle;
- for this test to be pos for dx of herniated disc, leg pain must be greater than back pain;
- neuro exam demonstrates reflex changes, weakness, or seg sensory loss;
- diminished ankle jerk compared to opposite side identifies S-1 lesion;
- weakness of great toe extension identifies an L5 lesion;
- sensation is diminished on medial side of foot & lateral calf for
L5 lesions & on lateral foot & posterior calf for S1 lesions;
- stocking hypesthesia, even envolving entire leg, is not necessarily a sign of hysteri or mlingering.
- caudal equina syndrome:
- should be considered in any patient w/ back pain, especially if disc herniation is present;
- Differential Diagnosis:
- epidural abscess
- epidural hemorrhage;
- ankylosing spondylitis
- multiple myeloma
- vascular insufficiency
- arthritis of the hip
- osteoporosis with stress fractures
- extradural tumors
- peripheral neuropathy
- herpes zoster