Herniated disc
Chief complaint
Right leg pain
History of present illness
42 year old female with an eight week history
of mostly right leg pain. The pain radiates to
the sole and outside of her foot and is accompanied
by numbness and tingling. It is made worse with
sitting, and she only has a 15 minute sitting
tolerance. She has had a great deal of difficulty
maintaining her full schedule as a mother and
a secretary. She has had back pain in the past,
but the episodes have always been brief and relieved
with one or two chiropractic manipulations. This
episode of pain started as back pain but within
a week had moved to being mostly in her leg.
She is currently trying to manage her pain with
Motrin and Tylenol, and is only able to work
for three or four hours a day with frequent changes
in position. At night she has trouble sleeping
for more than one or two hours at a time.
Physical exam
42 year old healthy female who stands through
most of the history. She has an absent ankle
jerk on the right leg. There are no focal motor
deficits, and the neurological exam is otherwise
negative. She has a markedly positive straight
leg test and crossed straight leg test (raising
the affected and unaffected leg recreates her
leg pain).
Imaging studies
MRI scan (Figure
1) shows a large disc herniation at L5-S1.
There is also disc degeneration present at the
L5-S1 disc. The axial scan (not shown) shows
that the disc impinges on the right S1 nerve
root. |
