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Re: low back pain with radiculitis
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Re: low back pain with radiculitis - September 30, 2005 10:25:00 AM
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JLS_PT_OCS
Posts: 1684
Joined: January 30, 2005
From: USA
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I agree with Greg's ideas about -itis vs -opathy. However, I am loathe to call it a radiculitis unless it follows a dermatomal pattern AND a neurodynamic test (like SLR) is positive.
Especially if the pain is not distal to knee or to elbow. I think I have no way of knowing whether I am seeing a nerve root involvement or simply referred pain. If no neurodynamic test is positive, then I am less convinced that it is nerve related.
What does everyone here call the LBP patient with "sciatica" pain or N&T to the knee, but no positive SLR? I wouldn't call that a radiculitis or radiculopathy, just referred pain.
From Medline Plus Online Medical Dictionary:
Main Entry: ra·dic·u·li·tis
: inflammation of a nerve root
Main Entry: ra·dic·u·lop·a·thy
: any pathological condition of the nerve roots
Here I guess the "pathological condition" it refers to must be demonstrable on testing, and I guess that testing would be considered EMG/NCV?
J
_____________________________
Jason Silvernail DPT, OCS, CSCS
Homo Vegetus
"It isn't what you're able to do that requires your courage but rather what you have come to understand and are willing to express." - Barrett Dorko, Writer and Physical Therapist
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Re: low back pain with radiculitis - September 30, 2005 7:40:00 PM
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Andrew M. Ball PT PhD
Posts: 855
Joined: July 28, 2002
From: Charlotte, NC
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Strange looking left SI joint and scoliosis, as others have stated, but then again, we've all seen horrific radiographs that are asymptomatic. I agree with Greg's point about normal varience. The top image, while it's clearly an A/P image based upon what's being centered, looks almost A/P in the spine, and not quite like an oblique view of the SI joint. Looking at the complimentary view, however, doesn't look like quite so much torsion.
One point that no one's really touched on much is the left hip. It's hard to tell about the left hip because the image is cut off (e.g. not the focus of the imaging study), but it looks as though there is somewhat of an osteoarthritic radiographic pattern complete with radiodensity through weight bearing areas and surrounding radiolucency. RA, by contrast, tends to look a bit more all encompassing.
One type of hip arthritis is associated with migration of the femoral head in a superior and medial direction (as is not the case here). Anyone want to take a guess?
Drew
_____________________________
Dr. Andrew M. Ball, PT, DPT, Ph.D.
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Re: low back pain with radiculitis - October 2, 2005 2:07:00 PM
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tim
Posts: 17
Joined: September 24, 2004
From: Portland, OR
Status: offline
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Jason, you articulated what I was trying to.....and much clearer :)
I totally agree with you, you need a positive neurodynamic test at the very least.
Drew, The hip SHOULD be on our radar. there have been many cases of hip pathology mimicking deep referred pain from the lumbar spine. The hip is one of the only joints where it is reasonable to have DJD as the primary diagnosis when symptomatic and this should be investigated as well.
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