UNIVERSITY OF GUYANA

NAME OF LECTURER: MR. AKHILANAND P. RAGHUNANDAN

NAME OF COURSE: CLINICAL INTERNSHIP

COURSE CODE: BMP 4105

NAME OF STUDENT: SATRUPA SINGH

REGISTRATION #: 10/0537/1865

TOPIC:

SACROLUMBAR SCIATICA

BACKGROUND INFORMATION ON SCIATICA

Sciatica can be defined as pain that radiates along the path of the sciatic nerve, that branches from your lower back through your hips and buttocks and down each leg.

Sciatica most commonly occurs when a herniated disk, bone spur on the spine or narrowing of the spine (spinal stenosis) compresses part of the nerve. This causes inflammation, pain and often some numbness in the affected leg.

Although the pain associated with sciatica can be severe, most cases resolve with non-operative treatments in a few weeks. People who have severe sciatica that's associated with significant leg weakness or bowel or bladder changes might be candidates for surgery.

PATIENT’S DEMOGRAPHICS

PATIENT’S NAME

ADDRESS DOB & AGE

SEX/ GENDER

INFORMANT MEDICAL Dx REFERRED BY

BIBI KARIMA ALI

LOT 11 CINEW

10/10/1953

FEMALE PATIENT NERVE IMPINGEMENT

DR.JEFFEREY

SUBJECTIVE CURRENT MEDICAL HISTORY (CMHx)

- On the 11/09/2015, pt refers that she suffered a fall resulting in pain the following day in her lower back radiating down to the knee bilaterally.

- One week after (18/09/2015) she sought a medical attention (Dr.Jeffery) and was referred for PT Tx.

- Pain is dominant more in left than right side

- Pain scale (1-10): Pt’s grade – 10

- pain when standing and walking

- pain in supine position with flex knees

SUBJECTIVE CONT’DSOCIAL MEDICAL HISTORY (PMHx) & MEDICATIONS

FUNCTIONAL HISTORY (FHx)

FAMILY MEDICAL HISTORY (FMHx)

PAST MEDICAL HISTORY (PMHx)

- No drinking & smoking

- Lives in a flat concrete house with spouse, daughter and grandchildren

- Housewife- Pt does brisk walking

2-3 weekly (20mins/less)

- Medications: Metaphormin (DM) : Pt did not present nor remembered the other names.

Pt completes movements, mobility transfers, self-care and home management independently with pain however for balance, pt would use support from furniture when dressing lower limbs.

- + DM (Siblings & Mother)

+ HPN (Siblings & Mother)

+ CVA (Mother – deceased)

- + HPN- + DM- + CHOLESTEROL- + Surgery for Gall Bladder

(25 yrs ago)- Suffered form a fall (15 yrs

ago) resulting in injury in the lumbar region and diagnose with disc herniation (L4-L5 & L5-S1)

OBJECTIVE

BLOOD PRESSURE (BP)

RESPIRATORY RATE (RR)

HEART RATE (HR)

- 118/92 - 12 bpm - 68 bpm

SYSTEM REVIEW: CARDIOVASCULAR/PULMONARY SYSTEM

BLOOD PRESSURE (BP) RESPIRATORY RATE (RR)

HEART RATE (HR)

- 120 mm Hg systolic pressure/80 mm Hg diastolic pressure

- 12 – 16 breathes per min

- 60 to 100 beats per minute

NORMAL RATES:

OBJECTIVE: SYSTEM REVIEW CONT’D

MUSCULOSKELETAL SYSTEMJOINT AROM PROM STRENGTH

R & L HIP

Conserved with pain towards the end range

Conserved with pain Flex – G3Ext – G3

Abd & Add – G4Lat & Med Rotation – G4

R & L KNEE

Conserved with pain Conserved Flex – G3Ext – G3

R & L TRUNK

- Conserved with severe pain

- Not conserved with severe pain

- Conserved with severe pain

- Not conserved with severe pain

Flex – G3

Ext, Lat flex & Rotation – G2

OBJECTIVE: SYSTEM REVIEW CONT’D

NEUROMUSCULAR SYSTEM- Gait : Normal- Movements are co-ordinated with slight pain especially when walking or standing

- Others not affected

OBJECTIVE: SYSTEM REVIEW CONT’D

INTEGUMENTARY SYSTEM- Callus build up on right heel- Altered sensation on sole of the left foot

OBJECTIVE: SYSTEM REVIEW CONT’D

COMMUNICATION, AFFECT, COGNITION, LEARNING STYLE

- Not affected- Pt was well aware of the environment

TEST AND MEASUREMENTS

Lasegues (Straight leg raise) test (Positive) (Raise straight leg to 60 degrees noting sciatic pain between 20 – 60)

Bragards test (Positive)(Lower leg where pain is present and dorsiflex)

Test & Measurememt cont’dBODY MASS INDEX(BMI) & HEIGHT

UNDERWEIGHT:

NORMAL WEIGHT

OVERWEIGHT OBESE PATIENT’S BMI

PATIENT’S HEIGHT

BMI is less than 18.5

BMI is 18.5 to 24.9

BMI is 25 to 29.9

BMI IS 30 OR MORE

33 (181lbs) 156cm

ASSESSMENT/ANALYSISTHERAPIST DIAGNOSIS/IMPRESSION: SACROLUMBAR

SCIATICA

PROBLEM LIST PROGNOSIS

- SEVERE RADIATING PAIN (Lumbar region to knee bilaterally)

- MUSCLE STRENGTH IN L.E- APROM & PROM OF THE TRUNK (flex,

lateral flex & rotation- HYPOTONIA IN QUADRACEPS- CALLUS BUILDUP ON THE ® HEEL- ALTERED SENSATION IN SOLE OF LEFT FOOT

GUARDED: Patient was given postural education however, she was absent for 2 sessions hence it couldn’t be determine whether or not the prognosis was poor or good.

PLAN OF CARESHORT TERM GOALS LONG TERM GOALS

- PAIN IN 3 WEEKS FROM GRADE 10 – 6

- ROM IN 4 – 5 WEEKS IN L.E

- IMPROVE SENSATION IN LEFT FOOT

- PATIENT EDUCATION ON PROPER POSTURE

- PATIENT EDUCATION ON Tx FOR THE BUILD-UP OF CALLUS ON THE ® HEEL

- MUSCLE STRENGTH

- IMPROVE ADL

- PAIN TO GRADE 2 – 3

PLAN OF CARE CONT’DINTERVENTION

- Hot Pack (Moist heat /humid) applied on sacrolumbar region for 20 mins

- Isometric exercises :Contractions of Quadraceps & Calves; AROM of the trunk(flex), hip, knee & ankle and AAROM of the trunk (Lateral flex, rotation & ext)

- Williams Flexion Exercises (Single Knee to chest and Double knee to chest)

- Diadynamic: Type (Large period) with reverse polarity for 15 mins applied to the origin of the sciatic to posterior aspect of the knee bilaterally

- Ultrasound (0.5w/cm² for 5mins at 3MHz) applied on Lumbar region (Continue only if after 10 sessions and the pain does not decrease)

- Strengthening exercises can be completed if pain reduce to G4 – 5 (ARROM via manually or mechanically(using bicycle/treadmill etc) and theraband used at home)

PLAN OF CARE CONT’DHOME CARE DISCHARGE PLAN

- Re-educate pt on posture orientation, positioning (lying, sitting, standing etc) and footwear orientation

- Referred pt to nutritionist

- Callus build up – inform pt to soak feet using warm water for 10 mins then use a soft shower brush to clean the area.

- When goals are achieved, pt will be discharged with a continued home program on correct posture and footwear.

REFERENCES

http://www.mayoclinic.org/diseases-conditions/sciatica/basics/definition/con-20026478

http://www.webmd.com/back-pain/guide/sciatica-symptoms