CHIR12007

Clinical Assessment and Diagnosis

Portfolio Exercises Week 5

Exercise 1
Compare Maigne’s syndrome and osteoporotic compression fracture of at
the thoracolumbar junction

A. What do these two conditions have in common? Unsure of answer

B. What are the features of each: Maignes syndrome: involvement of
the cluneal nerves giving rise to referred pain in the low back, hips
and groin. (not radicular). Compression Fracture: Mid and anterior
vertebral body loss of height greater than 20% of the posterior
height.
C. How would you differentiate them?

Exercise 2

Differential Diagnosis of LBP with Radiculopathy

Disc Herniation Spinal Stenosis Cauda Equina

Age 30-55 >60 40-60

History Acute or recurrent Insidious onset of Insidious onset LBP with or

eqisodes chronic, progressive without saddle anaesthesia.
LBP; more recent onset bowel/ bladder function
of LE symptoms changes, acute or chronic
LBP
Pain pattern Pain and/ or numbness LE symptoms increase Usually radiculopathy
radiating to unilateral LE with lumbar extension bilateral – pain, tingling,
below the kneed, usually and relieved by flexion numbness, increased with
increased with flexion flexion

Neuro Exam Sensory and/ or motor Sensory and motor Bilateral sensory and/ or
changes, diminished/ changes motor changes, diminished/
absent DTR unilateral absent reflexes, sensory and
motor changes S3-S4

ROM Guarded/ limited Pain and limited Guarded/ limited

extension
 Other Tests SLR Treadmill test SLR

Exercise 3
This exercise will require some investigation on your part
You are required to ask for any additional information in the Q&A moodle chat.
However, when you ask for more information you must identify specifically what
information you want and why (ie. What differential diagnoses are you
considering and what will the information provide to help you)

Case History
Mark, 12yom, presented to your office with his Mum. Mark’s mother explained
that he has been complaining of back pain for the past few weeks, maybe longer.
She is unaware of any particular injury that started this and Mark doesn’t recall
any specific injury either. She explains he is a typical boy, plays soccer and rides
at the mountain bike park a few times a week. She would consider him relatively
active but he does like his ‘devices’ when he’s allowed. Mark says the pain is
‘pretty sore’ sometimes, he guesses it is about 5/10 and when asked to indicate
where it is he runs his hand across the region of the thoracolumbar spine.
Biomechanical/facet joint syndrome due to pain on bilateral rotation. Disc issues
are less likely because there is no radiculopathy and pain aren’t aggravated by
anything. Major issues such as tumour or cauda enquina ruled out because of no
bowl or bladder changes and pain only 5/10. No yellow flags or system
abnormalities rule out most major issues and suggest biochemical differential
diagnoses.

Exercise 4
Explain Peripheralisation and Centralisation as they apply to the clinical
presentation and treatment of LBP with radiculopathy: Centralisation of LBP is in
one spot treatment would be based on orthopaedic findings but would be
manipulation, mobilization and myofascial treatment; compared to
peripheralization which is a feature of lumbar radiculopathy and pain goes down
the leg, with treatment again based off findings reduce the radiculopathy so the
pain in centralised through manipulation, myofascial and mobilization.

Exercise 5
Besides those examples provided in the lecture, what questions might you ask to
determine if a patient has signs and symptoms associated with Cauda Equina
Syndrome? How have your bowl movements been lately? Have you had a loss in
control over your bladder or bowl? Do you have any low back pain?