The patient is a 42-year-old male who reports to the health facility.
The man complains of lower back pain that he has been experiencing for the past one month.
A forty-two-year-old male patient was well until about a month ago when he started experiencing lower back pain. He describes the pain as being located in his lower back region, a problem that began about a month ago and radiating to his left leg. It would be important to describe the character of the pain. Knowing whether it is a pounding, stabbing or sharp pain goes a long way in establishing a diagnosis.
The timing of the pain would also be important. It is worse during the day, at night or after completion of certain task. It would be important to highlight any exacerbating and relieving factors of the pain. Asking the pain to gauge the severity of his pain in accordance to the pain scale numbered one to ten would also be important to note while taking the history of the patient.
It is vital to look out for other associated symptoms commonly accompanying lower back pain. Weakness, numbness or any tingling sensation in the legs is important to note. It is vital that the patient points out the specific regions, if any, where he is experiencing weakness, numbness or a tingling sensation (Hartvigsen et al., 2018). Any associated fever along with the back pain would be critical to note as it would be an indicator of an infection. Problems controlling bowel and bladder movements are other commonly associated symptoms of lower back pain that are important to ask about and note.
A lumbar radiculopathy also referred to as sciatica occurs following involvement of the nerve roots responsible for formation of the sciatic nerve. The nerve roots exiting from the lower lumbar and upper sacral regions involve L4, L5, S1, S2 and S3 (Berthelot et al., 2018). Lower back pain is usually the commonest presentation of a lumbar radiculopathy. The pain is often radiating to the back of the leg with sciatica commonly affecting one side of the body.
To test for the L4 nerve roots, one would test the loss of sensation in the dermatome supplied by L4. This includes the area around the thigh, knee, leg and foot anteromedially. It is important to also conduct the straight leg raise test, the femoral nerve stretch test, the knee reflex and to test the power of the muscle involved in ankle dorsiflexion to test for the credibility of the L4 nerve root.
The test for the L5 nerve root involves testing for the presence or absence of sensory sensation in the dermatome area supplied by L5. This area includes the buttocks, posterior and lateral aspects of the thigh, lateral part of the leg, dorsum of the foot, medial half of the sole including the first, second and third toes. It would also be advisable to conduct the straight leg raise test and test for the power of the muscle on hip abduction, dorsiflexion at the ankle, ankle eversion and extension of the big toe.
Testing for the S1 nerve roots involves testing for sensory loss in the dermatome area supplied by S1 (Tampin et al, 2020).. This includes the area around the lateral aspect of the foot, the heel and majority of the area of the sole. It would be important to carry out the straight leg raise test, ankle reflex and test for power of muscles involved in extension of the hip, knee flexion, plantarflexion at the ankle joint and ankle eversion.
Testing for dermatomes is usually done using a pin and cotton wool. The patient is asked to close their eyes and give response after stimulation by various stimuli. Dermatome testing should be conducted on specific dermatomes and the results compared with the opposite side. The pin prick test involves gently pricking the patient with a pin and asking for the patient’s feedback whether it is a sharp or a blunt pain. Light touch sensation test involves rubbing a piece of cotton wool against a specific area on the skin.
The straight leg raise test is a neurodynamic test conducted to asses mechanical movement of the neurological tissues and their sensitivity to mechanical stress (Parashkevova et al., 2019). Testing is conducted on both lower limbs with the normal limb being assessed first. Patient lies in a supine position with the hip medially rotated and the knee extended. The physician then elevates the patient’s limb by the posterior ankle with t
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