Learning outcome
- Radicular pain from nerve root
- Foot drop
- Lateral spinal stenosis (recess stenosis)
- Central spinal stenosis
- Neurogenic claudication
- Cauda equina syndrome
Special tests
- Lasegue's test
- L3 nerve stretch test (reverse Lasegue)
- Plantar reflex
- Key examinations for nerve root involvement
- Cauda equina tests
Case 7
You are working as a fifth-year student at a general practice office. Your next patient is a 42-year-old man, a farmer. Two years ago, he had lumbago, which lasted four weeks. He now comes because a week ago he experienced acute onset low lumbar back pain after heavy lifting. He has taken paracetamol with little effect. He says that he now mostly has problems with radiating pain in the right leg that goes down to the lateral edge of the foot. The pain in the leg increases when he sits. Normal urination and bowel movements.
- Explain how you would examine this patient to find out if he has a nerve root involvement.
Back examination (lumbar)
- Perform a standard back examination (module 2.4)
- Inspection
- Active movement
- Passive movement
- Isometric movement
- Palpation
- Perform nerve stretch tests
- Conduct key examinations for radiculopathy for levels L2-S2
Nerve stretch tests
L2
L3
L4
L5
S1
S2
Clinical findings
- Expected clinical picture in lumbar radiculopathy?
- There is a positive Lasegue's test, interpretation?
- You find reduced strength for toe walking
- You find reduced sensation on the lateral edge of the foot
- You find weakened Achilles reflex
What is wrong with the patient?
There is suspicion of S1 nerve root involvement, explain the clinical findings that increase the likelihood of this tentative diagnosis.