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\author{bee.f (bee.f)}
\pdfinfo{
  /Title (5002-case-11.pdf)
  /Creator (Cheatography)
  /Author (bee.f (bee.f))
  /Subject (5002 Case 11 Cheat Sheet)
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    \vspace{-2pt}\large{\bf{\textcolor{DarkBackground}{\textrm{5002 Case 11 Cheat Sheet}}}} \\
    \normalsize{by \textcolor{DarkBackground}{bee.f (bee.f)} via \textcolor{DarkBackground}{\uline{cheatography.com/180201/cs/38654/}}}
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  \mymulticolumn{2}{p{5.377cm}}{\bf\textcolor{white}{Cheatographer}}  \\
  \vspace{-2pt}bee.f (bee.f) \\
  \uline{cheatography.com/bee-f} \\
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  \mymulticolumn{1}{p{5.377cm}}{\bf\textcolor{white}{Cheat Sheet}}  \\
   \vspace{-2pt}Published 23rd February, 2024.\\
   Updated 15th May, 2023.\\
   Page {\thepage} of \pageref{LastPage}.
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  Measure your website readability!\\
  www.readability-score.com
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\begin{document}
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\begin{tabularx}{17.67cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{17.67cm}}{\bf\textcolor{white}{Case}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{17.67cm}}{- 59 y.o., car mechanic\{\{nl\}\}- Lower Lx spine (L\textgreater{}R) into the lateral aspect of L thigh to the anterior shin \& into the toes\{\{nl\}\}- Insidiously 2 months ago} \tn 
% Row Count 4 (+ 4)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{17.67cm}}{{\bf{Back pain}}\{\{nl\}\}- Deep ache \& stiff\{\{nl\}\}- 5/10\{\{nl\}\}- Constant pain\{\{nl\}\}- Stiffness is worse in the morning \& at the end of the day after work\{\{nl\}\}{\bf{Leg pain}}\{\{nl\}\}- Feels like "pinched nerve"\{\{nl\}\}- Shooting pain\{\{nl\}\}- Feeling of "dead leg"\{\{nl\}\}- 8/10\{\{nl\}\}- Pain depends on what he's doing} \tn 
% Row Count 10 (+ 6)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{17.67cm}}{-Getting worse\{\{nl\}\}-{\bf{AF:}} standing, working overhead\{\{nl\}\}- {\bf{RF:}} Sitting down (slouched) diminished leg pain, sleeping on side (firm bed helps)\{\{nl\}\}- {\bf{AA:}} Work; is careful with ADL} \tn 
% Row Count 14 (+ 4)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{17.67cm}}{{\bf{Extra}}\{\{nl\}\}- High BP\{\{nl\}\}- Motorbike accident 10 years ago resulted in a painful L shoulder (resolved itself)\{\{nl\}\}- Surgery at age 3 for {\emph{pyloric stenosis}}\{\{nl\}\}- Naproxen takes the edge off (GP prescribed)\{\{nl\}\}- 1 cigar / day\{\{nl\}\}- Drinks 1 bottle of wine every day\{\{nl\}\}- Doesn't exercise now due to pain\{\{nl\}\}- Mother passed due to cancer\{\{nl\}\}- Stools are a bit loose atm (needs further investigations; consider risk of bowel cancer due to age)} \tn 
% Row Count 24 (+ 10)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{17.67cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{17.67cm}}{\bf\textcolor{white}{Physicsl Examination Findings}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{17.67cm}}{- High BP\{\{nl\}\}- {\bf{Posture/stance:}} hypolordotic Lx spine; kyphotic Tx spine\{\{nl\}\}- {\bf{Gait:}} reduced arm swing bilaterally; reduced Tx movement (very rigid)} \tn 
% Row Count 4 (+ 4)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{17.67cm}}{{\bf{ROM}}\{\{nl\}\}- {\bf{AROM Lx:}} extension limited \& painful in LB \& down leg into shin\{\{nl\}\}- {\bf{PROM hip:}} full \& pain free bilaterally} \tn 
% Row Count 7 (+ 3)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{17.67cm}}{- {\bf{SLR:}} 90° bilaterally, muscle stretch @ end point\{\{nl\}\}- {\bf{Active SLR:}} same as SLR\{\{nl\}\}- {\bf{Percussion \& vibration Lx:}} negative (-ve)\{\{nl\}\}- {\bf{Trigger points:}} in ES, glut. max. \& glut. med. bilaterally\{\{nl\}\}- {\bf{Spinal palpations:}} L T11-L2 restricted; L L4-S1 restricted \& tender; L SI restricted} \tn 
% Row Count 14 (+ 7)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
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\begin{tabularx}{17.67cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{17.67cm}}{\bf\textcolor{white}{Clinical tests}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{17.67cm}}{{\bf{Kemps}}\{\{nl\}\}- {\bf{Purpose:}} assess Lx spine facet joint pain\{\{nl\}\}- {\bf{Findings:}} L +ve w/ L leg pain into shin; R -ve} \tn 
% Row Count 3 (+ 3)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{17.67cm}}{{\bf{Single leg hyperextension}}\{\{nl\}\}- {\bf{Purpose:}} SI \& Lx nerve root irritation\{\{nl\}\}- {\bf{Findings:}} -ve bilaterally} \tn 
% Row Count 6 (+ 3)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{17.67cm}}{{\bf{Slump's}}\{\{nl\}\}- {\bf{Purpose:}} detect altered neurodynamics or neural tissue sensitivity\{\{nl\}\}- {\bf{Findings:}} pulling in LB (L\textgreater{}R)} \tn 
% Row Count 9 (+ 3)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{17.67cm}}{{\bf{Faber's}}\{\{nl\}\}- {\bf{Purpose:}} diagnose hip pathology by attempting reproducing pain\{\{nl\}\}- {\bf{Findings:}} -ve bilaterally} \tn 
% Row Count 12 (+ 3)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{17.67cm}}{{\bf{SI distraction}}\{\{nl\}\}- {\bf{Purpose:}} provocation of the SIJ\{\{nl\}\}- {\bf{Findings:}} -ve} \tn 
% Row Count 14 (+ 2)
% Row 5
\SetRowColor{white}
\mymulticolumn{1}{x{17.67cm}}{{\bf{Modified Thomas}}\{\{nl\}\}- {\bf{Purpose:}} measures the angle of femur abduction relative to pelvis\{\{nl\}\}- {\bf{Findings:}} tight bilaterally (L\textgreater{}R)} \tn 
% Row Count 17 (+ 3)
% Row 6
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{17.67cm}}{{\bf{Gaenslen's}}\{\{nl\}\}- {\bf{Purpose:}} diagnose SIJ lesion, pubic symph. instability, L4 nerve root lesion\{\{nl\}\}- {\bf{Findings:}} -ve bilaterally} \tn 
% Row Count 20 (+ 3)
% Row 7
\SetRowColor{white}
\mymulticolumn{1}{x{17.67cm}}{{\bf{McGill's}}\{\{nl\}\}- {\bf{Purpose:}} assess radiographic Lx instability\{\{nl\}\}- {\bf{Findings:}} both -ve} \tn 
% Row Count 22 (+ 2)
% Row 8
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\mymulticolumn{1}{x{17.67cm}}{{\bf{Pheasant}}\{\{nl\}\}- {\bf{Purpose:}} indicates an unstable spine segment\{\{nl\}\}- {\bf{Findings:}} increased pain in Lx} \tn 
% Row Count 25 (+ 3)
% Row 9
\SetRowColor{white}
\mymulticolumn{1}{x{17.67cm}}{{\bf{Nerve tension}}\{\{nl\}\}- {\bf{Findings:}} tibial -ve; fibular -ve; sural -ve} \tn 
% Row Count 27 (+ 2)
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\begin{tabularx}{17.67cm}{X}
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\mymulticolumn{1}{x{17.67cm}}{\bf\textcolor{white}{Discussion}}  \tn
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\mymulticolumn{1}{x{17.67cm}}{{\bf{Working diagnosis}}\{\{nl\}\}- L5 radiculopathy\{\{nl\}\}- Most likely 2° to progressive degenerative change occurring in the lower Lx \& mechanical dysfunction, resulting in DNE (dynamic nerve entrapment)} \tn 
% Row Count 4 (+ 4)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{17.67cm}}{- Insidious onset + LB stiffness + pt's age = suggest degenerative change (predisposing cause of the problem)\{\{nl\}\}- Supporting evidence: +ve Kemp's (reproducing pain), -ve Slump's \& SLR} \tn 
% Row Count 8 (+ 4)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{17.67cm}}{- Increased pain on Pheasant's test likely due to extension intolerance \&/or facet pain associated with degenerative change} \tn 
% Row Count 11 (+ 3)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{17.67cm}}{→ Most pts w/ radicular pain have {\bf{associated LBP}}, \&/or Hx of LBP\{\{nl\}\}- {\bf{Typical presentation:}} LBP that progresses to leg pain, w/ leg pain later being more painful than LBP {\bf{(peripheralisation)}}} \tn 
% Row Count 16 (+ 5)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{17.67cm}}{→ Radicular pain that is {\bf{2° to IVF encroachment}}; leg pain may\{\{nl\}\}- {\bf{Relieved:}} sitting \& bringing the knees to the chest (anything that flexes Lx \& increases the IVF space)\{\{nl\}\}- {\bf{Aggravated:}} standing \& walking} \tn 
% Row Count 21 (+ 5)
% Row 5
\SetRowColor{white}
\mymulticolumn{1}{x{17.67cm}}{→ Radicular pain {\bf{2° to disc herniation}}\{\{nl\}\}- {\bf{Aggravated:}} prolonged sitting} \tn 
% Row Count 23 (+ 2)
% Row 6
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{17.67cm}}{{\bf{2 categories of "mechanical" (ortho neurological) nerve root syndromes}} (can coexist)\{\{nl\}\}{\bf{1.}} {\bf{Spondylosis}} \& related {\bf{degenerative}} change: must be more specific \& identify whether there's lateral entrapment or central stenosis (LSS)\{\{nl\}\}{\bf{2.}} {\bf{Disc herniation:}} (lateral entrapment) should identify whether it's likely to be a {\emph{fixed nerve entrapment}} (FNE) or {\emph{dynamic nerve entrapment}} (DNE)} \tn 
% Row Count 32 (+ 9)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
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\begin{tabularx}{17.67cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{17.67cm}}{\bf\textcolor{white}{Learning Outcomes}}  \tn
% Row 0
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\mymulticolumn{1}{x{17.67cm}}{{\bf{Differentials for LBP w/ leg pain}}\{\{nl\}\}- Cauda equina syndrome (CES)\{\{nl\}\}- Lx central stenosis syndrome (LSS)\{\{nl\}\}- Disc herniation\{\{nl\}\}- Spinal stenosis\{\{nl\}\}- Sciatica\{\{nl\}\}- Lx radiculopathy\{\{nl\}\}- Spondylolisthesis\{\{nl\}\}- SIJ dysfunction\{\{nl\}\}- Piriformis Syndrome} \tn 
% Row Count 6 (+ 6)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{17.67cm}}{{\bf{Red flags for pts w/ radicular leg pain}}\{\{nl\}\}- Bowel/bladder dysfunction\{\{nl\}\}- Progressive unilateral / bilateral neurological deficits (e.g. major motor weakness {[}e.g. knee flexion{]})\{\{nl\}\}- Saddle anaesthesia\{\{nl\}\}- Bilateral radiculopathy\{\{nl\}\}- Severe unremitting pain\{\{nl\}\}- Unrelenting night pain\{\{nl\}\}- Sensory changes around rectum\{\{nl\}\}- Major trauma (or mild trauma aged 70+)\{\{nl\}\}- Point tenderness over a vertebra\{\{nl\}\}- Erectile dysfunction\{\{nl\}\}- Unexplained weight loss} \tn 
% Row Count 16 (+ 10)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{17.67cm}}{{\bf{How to screen for cauda equina syndrome (CES)?}}\{\{nl\}\}⏺ {\bf{{\emph{Symptoms:}}}}\{\{nl\}\}- LBP\{\{nl\}\}- Bilateral leg radiculopathy (sharp shooting pain or dull ache that radiates down the legs)\{\{nl\}\}- Saddle anaesthesia\{\{nl\}\}- Bladder/bowel incontinence\{\{nl\}\}- Lower extremity motor \& sensory loss\{\{nl\}\}⏺ {\bf{{\emph{Imaging:}}}}\{\{nl\}\}- {\bf{MRI \& CT}} screening for compression / damage of cauda equina\{\{nl\}\}- {\bf{Cauda Equina Screening Tool (CEST):}} set questions to assess risk of CES\{\{nl\}\}- {\bf{Electromyography (EMG):}} measures electrical activity of muscles \& nerves, detecting nerve damage} \tn 
% Row Count 28 (+ 12)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{17.67cm}}{{\bf{How to screen for bowel cancer?}}\{\{nl\}\}⏺ Screening starts at 45 y.o.\{\{nl\}\}- {\bf{gFOBT}}(fecal occult blood test): checking for blood in stool\{\{nl\}\}- {\bf{Sigmoidoscopy:}} scope in lower colon\{\{nl\}\}- {\bf{Colonoscopy:}} scope an entire colon\{\{nl\}\}- {\bf{Capsule endoscopy:}} swallow pill-sized camera} \tn 
% Row Count 34 (+ 6)
\end{tabularx}
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\begin{tabularx}{17.67cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{17.67cm}}{\bf\textcolor{white}{Learning Outcomes (cont)}}  \tn
% Row 4
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\mymulticolumn{1}{x{17.67cm}}{{\bf{Understand the pathophysiology of the mechanical \& chemical pathophysiology processes that occur in lateral nerve entrapment}}\{\{nl\}\}⏺ {\bf{Lateral nerve entrapment:}}\{\{nl\}\}- Peripheral nerve becomes compressed or entrapped by surrounding structures\{\{nl\}\}- Can occur due to anatomical abnormalities, trauma, inflammation, or repetitive motion\{\{nl\}\}- {\bf{Sx \& SSx:}} pain, numbness, tingling, muscle weakness, \& loss of function in area supplied by affected nerve\{\{nl\}\}⏺ {\bf{{\emph{Mechanical pathophysiology:}}}}\{\{nl\}\}- {\bf{Compression:}} can disrupt the normal function of the nerve, causing pain \&/or abnormal sensations\{\{nl\}\}- {\bf{Tension:}} tension/stretching of nerve, resulting in irritation \& dysfunction; can arise from muscle imbalances repetitive movements that place strain on the nerve\{\{nl\}\}- {\bf{Ischaemia:}} prolonged compression or tension on the nerve can compromise its blood supply, leading to reduced O2 \& nutrient delivery; Ischaemia (lack of blood flow) can cause nerve damage \& contribute to development of symptoms\{\{nl\}\}⏺ {\bf{{\emph{Chemical pathophysiology:}}}}\{\{nl\}\}- {\bf{Inflammation:}} compression irritation can trigger inflammatory response (cytokines \& prostaglandins) in surrounding tissue; chemicals further irritate nerve \& contribute to amplifying pain / other symptoms\{\{nl\}\}- {\bf{Chemical irritation:}} chemicals (histamine, substance P, bradykinin) released from damaged tissues, directly stimulate pain receptors in the nerve; resulting in pain \& sensitivity\{\{nl\}\}- {\bf{Neurotoxicity:}} metabolic disturbances lead to accumulation of toxic substances within the nerve tissue; can further damage the nerve cells \& exacerbate symptoms} \tn 
% Row Count 33 (+ 33)
\end{tabularx}
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\begin{tabularx}{17.67cm}{X}
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\mymulticolumn{1}{x{17.67cm}}{\bf\textcolor{white}{Learning Outcomes (cont)}}  \tn
% Row 5
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\mymulticolumn{1}{x{17.67cm}}{{\bf{Biopsychosocial issues for this pt}}\{\{nl\}\}⏺ {\bf{{\emph{Biological factors:}}}}\{\{nl\}\}- {\bf{Genetics:}} mother passed from cancer\{\{nl\}\}- {\bf{Physiology:}} loose stools, however appears healthy\{\{nl\}\}⏺ {\bf{{\emph{Psychological factors:}}}}\{\{nl\}\}- {\bf{Mental health:}} feeling anxious (due to episodic leg pain)\{\{nl\}\}- {\bf{Coping mechanisms:}} 1 cigar + 1 bottle of wine / day\{\{nl\}\}- {\bf{Beliefs \& attitudes:}} N/A\{\{nl\}\}⏺ {\bf{{\emph{Social factors:}}}}\{\{nl\}\}- {\bf{Socioeconomic:}} own shop/garage\{\{nl\}\}- {\bf{Support system:}} Wife + 4 healthy children\{\{nl\}\}- {\bf{Cultural background:}} N/A} \tn 
% Row Count 11 (+ 11)
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