PRESENCE OF TENDER NQULES - In parasplnal muscles and along iliac crest may be found in sclatica due to inflammation ofmuscular and fascial structures

PRESENCE OF TENDER NQULES - In parasplnal muscles and along iliac crest may be found in sclatica due to inflammation ofmuscular and fascial structures 5 RECTAL EXAMINATION • in older patients. III. lnvesugations - 1 Imaging of spine - (a) Straight X-rays - for deteocting disc narrowing in lumbar spine, or lesion öf sacro-iliac or hip joinl (b) Myelography to localise level of disc pratrusion and to dflferentiate such lesions from tumours (c) Nuclear magnetic resonance imagjng -usetful in assessment öf rool lesion. 2 CSF -may show lncreased protein with normal cellcounl In farge protrude intervertebral disc 3. EMG -may be usad to contirm presence öf denervation in affected muscles 4 Procaine injection test - for diagnosis of fibrositic pain, contaact with needie aggravates local pain and elicits referred pain, procaine suppresses both. and freedom o lag and apina movemenl \s restored Differential Diagnose öl conoBions causing Sciatfca - 1 DQc tesion - Hecunem boufä of Iowar back pain (lumbago) followed by unilateral sciatica, or pain first in calf or thigh or both without any lumbar symptoms SLR limiled Naurological signs absent if small protrusion. present if large displacernent compressing the root severely A huge hemiation may squeeze the root so hard that it becomes anaesthietic from ischemia and tha pain ceases, SLR becomes once again of full ränge al tha same time äs cutaneous analgesiä and loss öl power and rgflexes supervene 2 Spondytolisthesis Signs of disc lesion - together with lumbar deformity When spondylolisthesis causs intrinsic symptoms backache after prolonged standing, or bilateral sciatica X-ray taken with the patient standing dagnostic 3 Attrtion öf disc - Füll approxlmatlon öf the vertebrai bodies following attrition öf dlsc allows posterior longitudnal ligamenr to be unduly long Sciatica caused by standing due to compression causing posterior bulga of the disintegrated disc which is pushad back into position when posterior longirtudinal ligament is taughtened by lying down X-ray - Diminished joint space with marked anterior beaking at the affected level 4. Sacro-iliac arthrits- Altemation öf pain significant. ie.. pain comes in ona buttock and postenor thlgh, then it transfers tself to tha other side Signs of involvement öf 1st and 2nd säcral segments No lumbar signs Pressure on anterior iliac spines provokes pain in tha buttock SLR normal 5 Secondary deposits in spine - Gradually increasing central backacha, tendency to radiate to lower limö. soon to both Marked llmitation of movements at lumbar spine