Dear Dr Sood:
The primary complaints appears to be pain upon extension. Relief with
flexion, ie sitting. Although xrays have been done, nothing has been said
about the possibility of lumbar stenosis. I would suggest stenosis as a cause
for this patient's complaints.
Good Luck
Charles Filippone PT OCS
Dr Sood Wrote:
opinion of the list is sought regarding following case;
60yrs old lady complains of back &leg pain of 20yrs ,increase in symptoms and
difficulty in
standing straight since last 2yrs.She is nondiabetic normotensive,no H/O
trauma,surgery
or any major significant disease.
On Lying down,
on lying on side she has pain in right leg
just above ankle,develops paresthesia
both legs.On prone lying pain is felt in both calves.
On sitting; she has no pain or paresthesia,but right leg gastronemius
muscle fasciculation like
involuntary continuos muscle contraction are felt.
On standing ; she stands only in flexed position as soon as she try to
stand straight by extending
she has severe pain in buttocks and hamstrings ,hence she again assumes
flexed position to relieve
her pain.While standing for long time she suffers paresthesia in right leg
extending upwards till vagina .
Walking : After walking in this position for few yards paresthesia is felt in
right leg which subsides after sitting for few minutes with spine in flexed
position.
On examination ;
gait ; walk with spine held in flexion.Bladder & bowl ; Normal
Movement loss'
Flexion; minor
Extension; Major
Side gliding left&right ;minor
Deviation in flexion; nil
Deviation in Extension: Extension is limited.
Test Movements:
FIS; Pain felt in post.thigh
RFIS; -do-
EIS;pain in right leg.
REIS'pain increased in right leg no pareresthesia
FIL;Paresthesia both feet only
RFIL;-do-
EIL;buttock pain both sides.
REIL;pain increased in both buttocks
SGISLEFT; pain felt in calf
SGIS(R); Pain in L5/S1
Other joints
Hip & Knee joints within Normal limits as per age.
X-Rays
1.secularization of l5 vertebra on left side
2.scoliosis with convexity to right side
3spondlolithiasis of L4 overL5.
she can't afford MRI.
Waiting for your response.
Dr.Sarveshwar Sood
Orthopaedic Surgeon & Head Department of Physical
Medicine & Rehabilitation,
Member American Academy Of Pain Management.
S.B.L.S.Hospital
812/1,Housing Board Colony
Model Town,Jalandhar city
Punjab State.India
E-mail [log in to unmask]
http://Personal.vsnl.com/sarvesh
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