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Exercise 1: CHIR12007 Clinical Assessment and Diagnosis Portfolio Exercises Week 5

Maigne's syndrome and osteoporotic compression fractures at the thoracolumbar junction both involve the spine in the area connecting the lumbar and thoracic regions. Maigne's syndrome is a low back disorder affecting this region, while osteoporotic compression fractures are caused by osteoporosis weakening the bones such that normal pressure can cause fractures. Both present with back pain but they are differentiated based on features such as onset, history, and examination findings.

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44 views

Exercise 1: CHIR12007 Clinical Assessment and Diagnosis Portfolio Exercises Week 5

Maigne's syndrome and osteoporotic compression fractures at the thoracolumbar junction both involve the spine in the area connecting the lumbar and thoracic regions. Maigne's syndrome is a low back disorder affecting this region, while osteoporotic compression fractures are caused by osteoporosis weakening the bones such that normal pressure can cause fractures. Both present with back pain but they are differentiated based on features such as onset, history, and examination findings.

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api-468597987
Copyright
© © All Rights Reserved
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Download as DOCX, PDF, TXT or read online on Scribd
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CHIR12007

Clinical Assessment and Diagnosis


Portfolio Exercises Week 5
Exercise 1
Compare Maigne’s syndrome and osteoporotic compression fracture of at
the thoracolumbar junction

 What do these two conditions have in common?


• Maigne’s syndrome is a low back disorder that affects the area of the spine
which connects the lumbar and thoracic regions (the thoracolumbar
junction).
 A common cause of compression fractures is the disease osteoporosis. This
disease thins the bones, often to the point that they are too weak to bear
normal pressure. The thinning bones can collapse during normal activity,
leading to a spinal compression fracture.
What are the features of each : See Above
How would you differentiate them? See Above
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


episodes chronic, progressive with or w/o saddle
LBP; more recent anaesthesia, bowel/
onset of LE symptoms bladder function
changes, acute or
chronic LBP

Pain Pain and/ or numbness LE symptoms increase Usually radiculopathy


pattern radiating to unilateral with lumbar extension bilateral – pain,
LE below the kneed, and relieved by flexion tingling, numbness,
usually increased with increased with flexion
flexion

Neuro Sensory and/ or motor Sensory and motor Bilateral sensory and/
Exam changes, diminished/ changes or motor changes,
absent DTR unilateral diminished/ absent
reflexes, sensory and
motor changes S3-S4
ROM Guarded/ limited Pain and limited Guarded/ limited
extension

Other SLR Treadmill test SLR


Tests

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)

Additional questions that could be asked are: 

 Have you noticed any changes to bowel motions and/or urine output? 
 Any smells, or blood in either bowel or urine outputs? 
 Is the pain centralized to your spine or is it away from your spine?( Peripherals )

As for a possible diagnosis, it could be:

 tight QL's and other musculoskeletal issues


 possibly a facet syndrome or a pyogenic infection, tumour, or extreme case; cancer
 Possible growing pains

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. \

Exercise 4
Explain Peripheralisation and Centralisation as they apply to the clinical
presentation and treatment of LBP with radiculopathy
Peripheralisation is: when pain spreads outwards towards the peripherals
Centralisation is: when pain recedes inwards towards the centre of the body
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?

Some questions to ask if neurological bladder dysfunction is suspected:


 Do they have any sense of bladder filling? No suggests neurological bladder

 Can they feel the urine passing? No suggests neurological bladder

 Can they stop urine passing in midstream at will? No suggests neurological bladder

 Does the bladder leak continually or suddenly Yes suggests neurological


pass large volumes? bladder

 Is there any associated rectal disorder? Yes suggests neurological bladder

 Is there any disorder of potency in the male? Yes suggests neurological bladder

 Is there any numbness in the perineum? Yes suggests neurological bladder

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