50yr m c/o lower back pain and right leg sciatica for 2 wks

Discussion in 'Step 3' started by Dr. Anis, Oct 29, 2006.

  1. Dr. Anis

    Dr. Anis Guest

    50 yrs m c/o lower back pain and right leg sciatica for 2 wks. on raising left leg to 40 degrees with left knee in extension causes pain in his lower back that radiates to his right calf. which is true:
    a. patient is not malingering
    b. positive st. leg raising test is more specific for nerve-root compression on the contralateral side than on the ipsilateral side.
    c. result is pathognomonic for sacroiliac sprain syndrome
    d. cauda equina syndrome is present
    e. needs surgical intervention to correct radiculopathy.
  2. Guest

    Guest Guest

    Answer

    The answer is |C|.As the straight leg test is positive & the sciatica sign (+). :oops:
  3. Mazin1010

    Mazin1010 Guest

    This is a test for lumbosacral nerve root irritation for example, due to disc prolapse.

    With the patient laid on their back:

    raise one leg - knee absolutely straight - until pain is experienced in the thigh, buttock and calf
    record angle at which pain occurs - a normal value would be 80-90 degrees - higher in people with ligament laxity
    perform sciatic stretch test - dorsiflex foot at this point of discomfort - test is positive if additional pain results
    flexing the knee will relieve the buttock pain - but this is restored by pressing on the lateral popliteal nerve
    Severe root irritation is indicated when straight raising of the leg on the unaffected side produces pain on the affected side. A central disc prolapse is likely with risk to the cauda equina and consequently, of bladder dysfunction.

    Pain upon straight leg raising before the leg is raised 30 degrees cannot be due to disc prolapse as the nerve root is not stretched within this range. Another explanation of nerve root irritation must then be sought.
    So I think neurosurgical consult (D) is needed

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