Typical profile of radicular pain discogenic

Age:

• Any age, usually middle-aged History of injury:

• Yes, lifting or twisting

• Can be spontaneous

Site and radiation:

• Unilateral low back, distal radiation along dermatome, tends to have a 'distal' emphasis

Type of pain:

• Deep aching or stabbing pain (episodic) develops soon after rising in morning

Aggravation:

• Activity, lifting, intercourse, sitting, bending, car travel, coughing, sneezing, straining Relief:

• Rest, lying, standing Associations:

• Distal paraesthesia ± numbness, stiffness Physical examination (significant):

• Guarded and restricted movement

• Loss of lumbar lordosis

• Lateral deviation (scoliosis)

• Restricted flexion, extension, lateral flexion

• SLR and slump test positive

± specific muscle/myotomal weakness (typically unilateral) ± reduced distal sensation (typically unilateral) ± reduced ankle jerk (S1) (typically unilateral)

Diagnostic confirmation (for special reasons):

• CT scan, discogram, radiculogram, MRI or myelogram

The two nerve roots that account for most of these problems are L5 and S1. Most settle with time (6 to 12 weeks). The management is outlined at the end of this chapter and under 'Sciatica' (Chapter 60).

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