Lower back pain: prolapsed disc

Question 1

features

Answer 1

leg pain usually worse than back

pain often worse when sitting

Question 2

features of L3 nerve compression

Answer 2

Sensory loss over anterior thigh
Weak quadriceps
Reduced knee reflex
Positive femoral stretch test

Question 3

features of L4 nerve compression

Answer 3

Sensory loss anterior aspect of knee
Weak quadriceps
Reduced knee reflex
Positive femoral stretch test

Question 4

features of L5 nerve compression

Answer 4

Sensory loss dorsum of foot
Weakness in foot and big toe dorsiflexion
Reflexes intact
Positive sciatic nerve stretch test

Question 5

features of S1 nerve root compression

Answer 5

Sensory loss posterolateral aspect of leg and lateral aspect of foot
Weakness in plantar flexion of foot
Reduced ankle reflex
Positive sciatic nerve stretch test

Question 6

Mx

Answer 6

similar to that of other musculoskeletal lower back pain: analgesia, physiotherapy, exercises

if symptoms persist (e.g. after 4-6 weeks) then referral for consideration of MRI is appropriate