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?

- Both cause pain in the thoracolumbar junction region.

- Both have referred pain through tops of the sacrum and SI joints.

B. What are the features of each

Osteoporotic Compression Fracture

- Potentially serious due to narrowing of the spinal cord

- Local spasm and swelling
- Can be localised or can radiate down the side
- Local flexion deformity may occur
- Pain on percussion/vibration

Maigne’s Syndrome

- Unilateral pain referring down into lower back and hip

- Neuropathic skin changes
- Hypersensitivity of skin overlying iliac crest
- Pain provoked by palpation of facet joints

C. How would you differentiate them?

- The age of the presenting patient.

- Maigne’s is a manipulable lesion, osteoporotic compression
fracture is not.
- Presence of osteoporosis
- OCF is tender on percussion whereas, Maigne’s you don’t.
-

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 with or w/o saddle
progressive LBP; anaesthesia,
more recent onset bowel/bladder
of LE symptoms. function changes,
acute or chronic LBP.
Pain pattern Pain and/ or LE symptoms Usually radiculopathy
numbness increase with bilateral – pain,
radiating to lumbar extension tingling, numbness,
unilateral LE and relieved by increased with
below the knee, flexion. flexion.
usually increased
with flexion.
Neuro Exam Sensory and/ or Sensory and Bilateral sensory
motor changes, motor changes. and/ or motor
diminished/ changes, diminished/
absent DTR absent reflexes,
unilateral. sensory and motor
changes S3-S4.
ROM Guarding/ Limited Pain and limited Guarded/Limited
extension
Other Tests SLR Treadmill 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.

- Based on the information provided on the Q&A Mark has

presented with mild thoracolumbar spinal curve, convex to the
right upon observation. Mark is experiencing discomfort on the
left when rotating to the left, tenderness on the left side between
T11 & L1 along with bilateral tightness to the erector spinae.
- History
L = Thoracolumbar junction
O = Idiopathic
D = Past few weeks
C = N/A
T = 5 out of 10 pain
R = N/A
A = N/A
P = N/A
P = N/A
A = N/A

- Diagnosis
I would be looking into the possibility of patient suffering from
growing pains or the possibility of facet joint degeneration in
adolescent idiopathic scoliosis.

Exercise 4
Explain Peripheralisation and Centralisation as they apply to the clinical
presentation and treatment of LBP with radiculopathy

- Peripheralisation = Pain that presents laterally and or down

the extremity away from the source of pain
 - Centralization = Caring for the patient and the peripheral pain
starts to diminish and or directing backwards towards the pain
source.

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?

- Have you had any difficulty with bowel movements and passing
stools? Either easier or more difficult?
- Do you have any difficulty with urine retention?