herniated nucleus pulposus

how long does it take for *most* patients to feel better? A. 1 month B. 2 months C. 3 months D. 4 months E. 6 months

90% better in 3 months

A patient complains of a new onset of lower back pain. To differentiate between the pain of a lumbar herniated disc and lower back pain from other causes, what would be the best question to ask the patient? A. "Is the pain worse in the morning or in the evening?" B. "Is the pain sharp or stabbing or burning or aching?" C. "Does the pain radiate down the buttock or into the leg?" D. "Is the pain totally relieved by analgesics, such as acetaminophen (Tylenol)?"

C. "Does the pain radiate down the buttock or into the leg?" Lower back pain associated with a herniated lumbar disc is accompanied by radiation along the sciatic nerve and can be commonly described as traveling through the buttock, to the posterior thigh, or down the leg. This is because the herniated disc causes compression on spinal nerves as they exit the spinal column. Time of occurrence, type of pain, and pain relief questions do not elicit differentiating data.

A 35-year-old woman complaining of lower back pain is suspected of herniated nucleus pulposus. Vertebral herniation is most likely found in which areas? A. L1-L2; L4-L5 B. L2-L3; L3-L4 C. L4-L5; L5-S1 D. S1-S2; S2-S3

C. L4-L5, L5-S1 The most common areas of herniation are L4-L5 and L5-S1. Herniated discs usually occur in these areas because it is believed that they bear most of the body's weight.

Patient presents with lateral thigh/leg, hip and groin paresthesias and pain with loss of sensation over the dorsum of the foot. What dermatome is this consistent with?

L5

what are some differentials for low back pain?

Mechanical low back pain (~97%) • Lumbar strain, sprain (70%) • Degenerative facets or disks (10%) • Herniated disk (4%) • Compression fracture (4%) • Spinal stenosis (3%) • Spondylolisthesis (2%) • Spondylolysis (<1%) Nonmechanical spinal conditions (1%) • Cancer (primary or metastatic) (0.7%) • Inflammatory arthritis (0.3%) • Infection (0.01%) Visceral disease (2%) • Pelvic organs: prostatitis, PID, endometriosis • Renal disease: nephrolithiasis, pyelonephritis, perinephric abscess • Aortic aneurysm • Gastrointestinal disease: pancreatitis, cholecystitis, peptic ulcer

what special test can you use during physical examination to re-create pain from HNP? A. Faber Test B. Lachman's C. Cross Over D. Straight leg raise E. Rovsing's

Straight leg raise

What are some red flag signs we should look for in low back pain?

Unrelenting night pain Unrelenting pain at rest Neuromotor deficit Unexplained fever Greater than 6 weeks duration Age >70 Loss of bowel or bladder control Progressive focal neurologic deficits Suspicion of ankylosing spondylitis Trauma History or suspicion of cancer Osteoporosis Chronic corticosteroid use Immunosuppression Alcohol abuse Intravenous drug use

what is a serious complication of herniated lumbar disc and what would that present like?

cauda equina -new onset of urinary or bowel retention/incontinence w/saddle anesthesia, uni/bilateral leg radiation, decreased anal sphincter tone on rectal exam

What range of motion is most commonly limited with HNP? A. Extension B. Lateral bending C. Flexion

flexion it closes down on anterior part of the disc--"squeezes out more jelly from the donut"

what type of pain *pattern* is consistent with a herniated disc? A. Dermatomal B. Stocking-Glove Pattern

pain in dermatomal pattern

Patient has herniation at level L3-L4, what reflex would you assess for?

patellar

where is the weakest point of the anulus?

posterolateral aspect where the spinal nerves exit

clinical manifestations of HNP are consistent with what other disorder?

sciatica

what are some movements that will increase pain in patients with a herniated disc? (list 3)

sitting, coughing, sneezing, sitting