Lumbar Disc Herniation

Look

  1. General screening:
    • Check for scars post-discectomy, which may indicate previous surgery.

Feel

  1. Pain in back:
    • Palpate the lumbar spine for tenderness and trigger points.

Move

  1. Range of Motion (ROM) examination:
    • Assess for restricted movements, especially in flexion, extension, and lateral bending.
  2. Walk:
    • Observe gait for any limp, altered stride, or compensation (e.g., limp on the affected side).

Lie Down

  1. Full Neurologic Examination:
    • Perform a detailed sensory, motor, and reflex assessment.
  2. Include sciatic stretch tests:
    • SLR (Straight Leg Raise):
      • Positive if pain radiates down the leg below the knee.
    • Lesague’s test:
      • Extension of the knee with hip flexion increases radicular pain.
    • Cross over test:
      • Positive if pain radiates on crossing the unaffected leg over the affected one.
    • Bowstring test:
      • Relief of pain when the leg is lowered after a positive SLR.
    • Femoral Stretch test:
      • Pain in the anterior thigh when extending the knee from a flexed position at the hip.

Finishing

  1. PR (Per Rectum) and perianal sensation:
    • Check for sacral root involvement and bowel function.
  2. Vascular:
    • Assess pulses, color, and temperature in the legs.
  3. MRI:
    • Recommended for visualization of the herniated disc and surrounding structures.

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