|
|
low back pain pt with numbness
|
Logged in as: Guest
|
|
Users viewing this topic:
none
|
|
Login  | |
|
low back pain pt with numbness - August 1, 2007 3:34:32 AM
|
|
|
joshua5
Posts: 52
Joined: April 19, 2004
Status: offline
|
hey guys, was wondering if you could help me...
i have a new pt. 27 female. nursing assistant now on light duty. injured 7/26 pivoting a resident. xrays haven't come back. no mri. pain is constant 6 or 7. just got musc relaxer and hasn't taken yet. takes 800 mg motrin which decreases it to 5. pain on left > right. goes down back of leg with sit to stand but referred pain goes away once in standing. tender at left low back. obese, can't palpate much. 25-30 deg right and left side bend in standing. about 40 deg rot in sit. flex 35 deg in stand. none of these motions change her pain. is frustrated and wants to get back to regular duty asap as she doesn't want to be considered as "not pulling her share of the workload" by her co-workers. walks about 30 min several times a wk but no other regular exercise. here's the thing... she has some numbness on the palmer aspect of her distal fingers and the plantar aspect of her toes since 7/28. i don't want to mess her up. no MRI and my x ray vision isn't what it used to be. haven't run into this presentation before. how much weight do i give this numbness? seems like she's very genuine in wanting to get back to work. is this a bruised couple of nerves that took a while to swell or a shattered vertebra that's sliced completely through her entire spinal cord? numbness should go away with a positive approach? kick back to MD for MRI? any help would be greatly appreciated. thank you for your replies.
|
|
|
|
|
RE: low back pain pt with numbness - August 1, 2007 7:30:56 PM
|
|
|
Kaden
Posts: 348
Joined: June 17, 2007
Status: offline
|
From my experience numbness in the 4th and 5th digits can be pretty common but in this case with UE and LE numbness/tingling it could mean spinal cord symptoms. Your job is to attempt to rule this out with special tests so you can give the MD the most pertinent information to allow for a decision to be made regarding further diagnositcs.
I would look at symptom provocation into the LE with neck flexion, babinski, clonus, Hoffmans and DTR's. If these don't suggest signs of UMN lesion than you are probably fine to proceed with caution.
|
|
|
|
|
RE: low back pain pt with numbness - August 2, 2007 3:34:49 AM
|
|
|
joshua5
Posts: 52
Joined: April 19, 2004
Status: offline
|
thank you! anyone else?
|
|
|
|
|
RE: low back pain pt with numbness - August 2, 2007 9:36:02 AM
|
|
|
Alex Brenner PT MPT OCS
Posts: 1057
Joined: February 29, 2004
From: Kentucky
Status: offline
|
Josh,
I will do my best with the information you provided. I am guessing with the pivot transfer that she injured her lower back; this is very common with nursing staff. The fact that she does not have an MRI is not too concerning. We don't treat the MRI and especially in the lumbar spine they have been shown to have a high false positive with their relationship to disc bulges/herniation. Essentially, a very large group within our population will have disc herniations and will be asymptomatic so don't hinge all of your treatment options on the value of the MRI. It is not that helpful. In fact, I believe there is a study to show that the MRI results can actually impede your efforts to treat low back pain.
With the mechanism of injury that you describe I probably would not be concerned that she has a fractured spine. The only structure in our body that causes numbness and tingling is nerve tissue so it appears that she is having some type of nerve root involvement/irritation that could be contributing to the n/t in the plantar aspect of the foot. I would be sure to conduct a good neuro screen (Manual muscle testing L3-S1; check her reflexes L4,5,S1; and her sensation to dull/sharp over the lower extremity dermatomes).
The n/t in the hand is kind of bizaar but would certainly warrant a good cervical screening. I am not sure what is going on there.
From your description it seems that she responds to extension of the lumbar spine (she centralizes with standing) so I would probably start there and see if I could get her doing some exercises to centralize the pain. There are also some good manual techniques that may help to centralize the pain.
Lastly, I would also see if she is a candidate for spinal manipulation. As John Childs and Tim Flynn et al have shown in their clinical prediction rule studies, acuity is one of the more important factors when determining if spinal manipulation would be helpful. If you have not read these studies, get them and read them.
This is where I would start.
Alex
_____________________________
Alex Brenner, PT, MPT, OCS
|
|
|
|
 New Messages |
 No New Messages |
 Hot Topic w/ New Messages |
 Hot Topic w/o New Messages |
 Locked w/ New Messages |
 Locked w/o New Messages |
|
 Post New Thread
Reply to Message
Post New Poll
Submit Vote
Delete My Own Post
Delete My Own Thread
Rate Posts |
|
0.078
|
Printable Version
