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Diagnosing lumbar conditions in primary care
- 1. Diagnosing Lumbar Conditions in Primary Care Michael Bryant Brizbrain & Spine
- 2. ? Dermatome ? Myotomes
- 3. Lumbar Assessment • Can take as little as 3 minutes • Time poor – 10 minutes per patient • History • Management plan • Where does examination fit in ?
- 4. History • Many diagnoses are able to be established with history alone • Often exam can tailored looking for specific findings I expect to see • 80% of diagnoses from history alone
- 5. • Roughly 35% of lumbar problems at L4/5 and 25% of problems at L5S1
- 6. L4/5 disc • L5 nerve – Buttock pain – Pain or sensory changes • lateral thigh • Lateral calf • Dorsum of foot – Non specific clues • Occasionally difficulties up stairs • Stubbing toes
- 7. L5S1 Disc • Pain or sensory changes – Posterior thigh – Posterior calf – Sole of foot
- 8. L3 and L4 Nerves • 30% of presentations • Pains or sensory changes – Lateral to anterior thigh to knee (L3) – Lateral to anterior thigh to knee then beyond to medial calf • Nonspecific history – leg collapsing (quadriceps)
- 9. L1 and L2 Nerves • 5-10% of lumbar spine problems • Groin pains (L1) • Anterior Thigh pains (L2)
- 10. Examination
- 11. L2 • Hip flexors • Pain/sensory changes in the anterior thigh
- 12. L3 • Knee extensor weakness • Reduced knee jerk • Pain/sensory changes anterior thigh to knee
- 13. L4 • Ankle dorsiflexion weakness • (Possible) Reduced knee jerk • Pain/Sensory changes anterolateral thigh and medial calf
- 14. L5 • Great toe dorsiflexion wekaness – Ankle dorsiflexion weakness • Pain/sensory changes buttock/lateral thigh/lateral calf/top of foot
- 15. S1 • Ankle plantar flexion weakness • Pain/Sensory changes posterior thigh/calf and sole/lateral aspect of the foot • Reduced ankle jerk
- 16. Facet Pain • Pain in extension and rotation
- 17. Other Findings • Spinal cord issues – Brisk reflexes across the groups – Extensor plantar response – Go looking for sensory levels
- 18. Other Findings • Cortical Problems – Weakness or sensory changes across multiple dermatomes/myotomes – Often matching upper limb changes
- 19. Questions