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afya Lspine

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20160425222548 Ben  
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''Joint''
pin point, on standing, walking long distance - Ipsi lateral not down leg

''Muscle''
covers large area, improves with gentle mvt, - Contra lateral, not down leg

''Nerve''
Disc prolapse - younger, unilat, Sx down leg, may develop over few days, dec flexion+reflexs+sensation+power
Stenosis - older, worse with standing, eased if slumped (over shopping trolley)

''Exam''
Observe posture and gait (walk on toes S1, on heels L5)
ROM Lspine
slump - myotome, dermatome, reflex
check hip
palpate

while sitting ...
||myotome|dermatome|
|L2|lift knee up||
|L3|lift lower leg up|thigh|
|L4|bend feet up|knee|
|L5|bend big toe up|shin|
|S1|evert foot|lateral ankle|

''Mx''
surgery for leg Sx NOT for back Sx
Xray seldom useful
MRI if red flag or contemplating surgery
note pain may start to settle over 6-12/52 and expected to do so over 3-6/12