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Dear Sood
 
I think this lady shows signs of spinal stenosis. Perhaps given the long history and what sounds like quite marked disability she should be investigated further to establish a diagnosis? Can she afford a CT scan rather than MRI?. I agree with my colleague regarding TA & multifidus training etc and avoiding extension postures / exercises. Also if I remember correctly reduced A-P diameter of the cannal on plain x-ray (less than 10mm) is important, I think Porter's work in the UK in the 70's would be interesting to review
 
Chris Barrett
 
 
 -----Original Message-----
From: Sood [mailto:[log in to unmask]]
Sent: Friday, 18 February 2000 5:57 PM
To: [log in to unmask]; [log in to unmask]; [log in to unmask]
Subject: pain & paresthesia.

Dear friends,
                            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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