1. NABILAH HANIS BINTI
ZAINUDDIN
BATCH 23 (C1)
ORTHOPAEDICS PRESENTATION
1

2. HISTORY
 29 y/o malay lady, a pre-school assistant
teacher
 Complaint of right-sided low back pain for 1
month
 Pain - intermittent (2-3x/wk), severe (7/10),
lasting for appx 3 hrs each episodes,
radiating to right leg & feet, aggravated by
sitting, lying supine, standing & relieved by
analgesic & left lateral position
 Associated with numbness & weakness of
right LL.
 Currently pain is no longer relieved by
analgesic thus patient sought for treatment. 2

3.  H/O heavy weight lifting 1 month ago d/t
rearrangement of workplace following which
pain started the next day.
 No changes in bowel or bladder habits, no
deformity of trunk noticed, no early morning
stiffness, no fever, no pain or swelling of
joints, no chronic cough, night sweat or
evening rise in temperature, no LOA or
LOW.
3

4. EXAMINATION
• Alert, cooperative, moderately built and
nourished
INSPECTION:
Antalgic gait
Posterior:
Spine appears normal, in midline position
No shoulder tilt or pelvic tilt
No scoliosis
No muscle wasting,scars,swellings or sinuses,
Lateral:
Normal thoracic kyphosis & lumbar lordosis
No gibbus

5. PALPATION:
Right paravertebral tenderness
No tenderness over spinous process, facet joints
or sacroiliac joints
No palpable step
MOVEMENT:
Forward flexion limited to 30º
Lateral flexion limited to 20º on left side, normal on
right side
Extension limited to 20º
Rotation, 45º both sides

6. SPECIAL TESTS:
1) Straight leg raising test
-Pain in right leg at 30º
1) Crossed SLR: -ve
2) Ankle dorsiflexion/ sciatic stretch test: +ve
3) Bow string test: +ve
4) Femoral stretch test: -ve
NEUROLOGICAL EXAMINATION OF LL
Tone: normal

7. Sensation: Sensation over anterolateral
aspect right leg is less compared to left side
Reflex: Knee and ankle reflexes are normal in
both sides
Power:
Nerve
root
Action Right limb Left limb
L1, L2 Hip flexion 5 5
L3 Knee extension 5 5
L4 Ankle dorsiflexion 5 5
Inversion 5 5
L5 Great toe extension 4 5
S1 Ankle plantarflexion 5 5
Eversion 5 5

8. PROVISIONAL DIAGNOSIS
Lower lumbar prolapsed intervertebral disc with
compression of L5 nerve roots
• Backpain with sciatica
• H/O heavy weight lifting
• Tenderness on paravertebral area
• Limited movement of spine
• Positive straight leg raising (30 o ), sciatic stretch,
bow string & femoral stretch tests
• Reduced sensation over anterolateral aspect right
leg, weak right great toe extension, normal ankle
reflex

9. INVESTIGATIONS
1) Plain xray spine-
AP & lateral views
showing lumbosacral
junction
1) MRI of lower spine

10.  MRI lumbosacral spine (axial view)
10

11. TREATMENT
Conservative
Adequate bed rest
Analgesic
Physiotherapy
Surgery
Open discectomy with/without spinal fusion

12. THANK U
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