Musculoskeletal System
Student’s Name
Institutional Affiliation
Musculoskeletal System
Case 1: Back Pain
Back pain can be debilitating and can PTSDwith a person’s daily activities. Back pain may limit movement of the back muscles. For this reason, a person may have a hard time taking care of themselves or even working. This case involves a 42-year-old man who has presented to the clinic with acute lower back pain that radiates to his left leg. The pain of this nature is highly likely to be a case of sciatica, as a result of interruption of nerve function in the lower back, with the involvement of nerves supplying the leg.
Nerve roots likely to be involved in sciatica are some of those that contribute to the lumbosacral plexus, which consists of both lumbar and spinal nerves and yields the sciatic nerve. The primary nerve roots here are L4, L5, S1, S2, and S3. Lesions in any of these nerve roots may manifest as pain in their respective areas of supply. Most of the cases occur as a result of spinal disk herniation that compresses a nerve root (Bernstein et al., 2017). It is possible to identify the specific nerve root involved through neurological tests. Sensory and motor testing for each nerve root proceeds by assessing the function of muscles supplied and sensations in respective dermatomes.
Pain is not the only symptom of sciatic. Another common symptom is a sensory loss in areas supplied by the nerves involved. There is often a sensory loss in the skin of the thigh and leg. There might also be difficulties with movement or partial muscle paralysis because of the interruption of motor supply to these muscles (Bernstein et al., 2017). Burning and tingling sensations extending from the hip to the thigh, knee, and leg are common symptoms in patients with nerve root lesions. Pain is not limited to the lower back and the leg. It may involve the buttock and the hip as well.
Many other pathological processes may cause acute lower back pain. Malignancies may cause lower back, especially if metastases to the lower back are present. There is often unexplained weight loss in such cases, and pain is usually unremitting. Spinal epidural abscesses may also cause acute lower back pain. The presence of these requires investigation using magnetic resonance imaging. Shingles that are more common in immunocompromised and elderly patients may also cause acute lower back pain. Lyme radiculopathy causes lower back pain, but a characteristic rash accompanies it. It is important to rule these out before beginning intervention.
The Agency for Healthcare Research and Quality provides guidelines for the examination and management of acute lower back pain. It requires the clinician to palpate, observe the range of motion, inspection and specific neuromuscular evaluation (Chou et al., 2017) The Laségue sign can be investigated during a physical examination to determine whether neurological deficits and nerve root tension are present. In this investigation, the patient lies down on their back. Next, the examiner lifts the patient’s leg with an extended knee. The examiner slowly lifts the leg until it reaches an elevation of ninety degrees. The examiner should observe the patient determine whether the maneuver is causing radiating leg pain. If it does, the Laséuge sign is positive (Chou et al., 2017). Pain between thirty and seventy degrees indicates a herniated disc. If the Laséuge sign is negative, there is likely another cause of the back pain. Raising the straight leg on the unaffected contralateral side may produce pain in the affected leg, which is known as the Fajerstajn sign. These examinations are useful in ruling out other causes of lower back pain.
In conclusion, there are diverse causes of acute lower back pain. If such pain radiates to the leg, the involvement of the sciatic nerve or the lumbosacral plexus is likely. A thorough physical examination is essential in the diagnosis of sciatica. The Laséuge sign is an invaluable tool during such investigations. It is crucial that a health practitioner identifies the cause of the pain and initiates interventions to allow the patient to regain their normal bodily function.
References
Bernstein, I., Malik, Q., Carville, S., & Ward, S. (2017). Low back pain and sciatica: summary of NICE guidance. BMJ, i6748.
Chou, R., Deyo, R., Friedly, J., Skelly, A., Hashimoto, R., Weimer, M., … & Griffin, J. (2017). Noninvasive treatments for low back pain. AHRQ Comparative Effectiveness Reviews, 2016. Report No. 16-EHC004EF.
Troutner, A. M., & Battaglia, P. J. (2020). The ambiguity of sciatica as a clinical diagnosis: A case series. Journal of the American Association of Nurse Practitioners.