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%\usepackage{opensans}          % Can't make this work so far. Shame. Would be lovely.
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% Most of the following are not required for the majority
% of cheat sheets but are needed for some symbol support.
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\usepackage{MnSymbol}           % Symbols
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% Document Info
\author{Siffi (Siffi)}
\pdfinfo{
  /Title (leg-pain.pdf)
  /Creator (Cheatography)
  /Author (Siffi (Siffi))
  /Subject (Leg Pain Cheat Sheet)
}

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% Commands
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% Header and Footer
\pagestyle{fancy}
\fancyhead{} % Set header to blank
\fancyfoot{} % Set footer to blank
\fancyhead[L]{
\noindent
\begin{multicols}{3}
\begin{tabulary}{5.8cm}{C}
    \SetRowColor{DarkBackground}
    \vspace{-7pt}
    {\parbox{\dimexpr\textwidth-2\fboxsep\relax}{\noindent
        \hspace*{-6pt}\includegraphics[width=5.8cm]{/web/www.cheatography.com/public/images/cheatography_logo.pdf}}
    }
\end{tabulary}
\columnbreak
\begin{tabulary}{11cm}{L}
    \vspace{-2pt}\large{\bf{\textcolor{DarkBackground}{\textrm{Leg Pain Cheat Sheet}}}} \\
    \normalsize{by \textcolor{DarkBackground}{Siffi (Siffi)} via \textcolor{DarkBackground}{\uline{cheatography.com/122609/cs/23787/}}}
\end{tabulary}
\end{multicols}}

\fancyfoot[L]{ \footnotesize
\noindent
\begin{multicols}{3}
\begin{tabulary}{5.8cm}{LL}
  \SetRowColor{FootBackground}
  \mymulticolumn{2}{p{5.377cm}}{\bf\textcolor{white}{Cheatographer}}  \\
  \vspace{-2pt}Siffi (Siffi) \\
  \uline{cheatography.com/siffi} \\
  \end{tabulary}
\vfill
\columnbreak
\begin{tabulary}{5.8cm}{L}
  \SetRowColor{FootBackground}
  \mymulticolumn{1}{p{5.377cm}}{\bf\textcolor{white}{Cheat Sheet}}  \\
   \vspace{-2pt}Not Yet Published.\\
   Updated 27th July, 2020.\\
   Page {\thepage} of \pageref{LastPage}.
\end{tabulary}
\vfill
\columnbreak
\begin{tabulary}{5.8cm}{L}
  \SetRowColor{FootBackground}
  \mymulticolumn{1}{p{5.377cm}}{\bf\textcolor{white}{Sponsor}}  \\
  \SetRowColor{white}
  \vspace{-5pt}
  %\includegraphics[width=48px,height=48px]{dave.jpeg}
  Measure your website readability!\\
  www.readability-score.com
\end{tabulary}
\end{multicols}}




\begin{document}
\raggedright
\raggedcolumns

% Set font size to small. Switch to any value
% from this page to resize cheat sheet text:
% www.emerson.emory.edu/services/latex/latex_169.html
\footnotesize % Small font.

\begin{multicols*}{2}

\begin{tabularx}{8.4cm}{p{0.8 cm} p{0.8 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{Lumbar causes}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{{\bf{Pitfalls:}} Herpes Zoster \{\{nl\}\} Spinal Canal Stenosis \{\{nl\}\} Disorders of SIJ and hip joint \{\{nl\}\} Glut Med/Min TrP \{\{nl\}\} Hip pocket wallet syndrome \{\{nl\}\} Nerve Entrapments \{\{nl\}\} NR syndromes} \tn 
% Row Count 4 (+ 4)
% Row 1
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{{\bf{Refer when:}} Leg pain is severe and disabling \{\{nl\}\} Symptoms to Lx radioculopathy that persists without improvement or progression \{\{nl\}\} Clinical Evidence of significant motor deficit \{\{nl\}\} No siginificant response after 4 weeks of conservative care \{\{nl\}\} Incapacitating low back and leg pain} \tn 
% Row Count 10 (+ 6)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{{\bf{Hx:}} When the back pain and leg pain started - twisting/weight lifting at onset? , SOCRATES, Red Flags} \tn 
% Row Count 13 (+ 3)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{8.4cm}{p{0.8 cm} p{0.8 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{Red Flags}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{- Severe, new neurological deficits (Cauda Equina - severe lower extremity weakness/paralysis, saddle anaesthesia, limb sensory loss/numbness, rectal obstipation/incontinence, erectile dysfunction)} \tn 
% Row Count 4 (+ 4)
% Row 1
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{- Bilateral/Multiple root levels Neurological Deficits} \tn 
% Row Count 6 (+ 2)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{- Recent Spinal anaesthesia/spinal tap/back procedures (surgery/injection)} \tn 
% Row Count 8 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{- Ask about GI, Urinary and gynaecological symptoms}  \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{8.4cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{8.4cm}}{\bf\textcolor{white}{L3 Radioculopathy}}  \tn
\SetRowColor{LightBackground}
\mymulticolumn{1}{p{8.4cm}}{\vspace{1px}\centerline{\includegraphics[width=5.1cm]{/web/www.cheatography.com/public/uploads/siffi_1595338830_l3.png}}} \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{8.4cm}}{- Sensation loss in all or part of the areas above \newline - No reflex testing \newline - Weak Quads,Adductors and Iliopsoas}  \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{8.4cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{8.4cm}}{\bf\textcolor{white}{L4 Radioculopathy}}  \tn
\SetRowColor{LightBackground}
\mymulticolumn{1}{p{8.4cm}}{\vspace{1px}\centerline{\includegraphics[width=5.1cm]{/web/www.cheatography.com/public/uploads/siffi_1595338959_l4.png}}} \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{8.4cm}}{- Sensation loss in all or part of the areas above \newline - Hyporefflexia of Patella reflex \newline - Weak Quads}  \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{8.4cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{8.4cm}}{\bf\textcolor{white}{L5}}  \tn
\SetRowColor{LightBackground}
\mymulticolumn{1}{p{8.4cm}}{\vspace{1px}\centerline{\includegraphics[width=5.1cm]{/web/www.cheatography.com/public/uploads/siffi_1595339337_l5.png}}} \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{8.4cm}}{- Sensation loss in all or part of the areas above \newline - Hyporeflexia of hamstring reflex \newline - Weakness of Tib post + anterior + hip abductors}  \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{8.4cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{8.4cm}}{\bf\textcolor{white}{S1 Radiculopathy}}  \tn
\SetRowColor{LightBackground}
\mymulticolumn{1}{p{8.4cm}}{\vspace{1px}\centerline{\includegraphics[width=5.1cm]{/web/www.cheatography.com/public/uploads/siffi_1595339844_S1.png}}} \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{8.4cm}}{- Sensation loss in all or part of the areas above \newline - Hyporeflexia in Achilles reflex \newline - Muscle weakness in hip extensors + ankle plantarflexion}  \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{8.4cm}{p{0.8 cm} p{0.8 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{Examination}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{- Observation} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{- AROM, PROM, RROM} \tn 
% Row Count 2 (+ 1)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{- Passive accessory movement testing} \tn 
% Row Count 3 (+ 1)
% Row 3
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{- SMR} \tn 
% Row Count 4 (+ 1)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{- Nerve Tension Testing} \tn 
% Row Count 5 (+ 1)
% Row 5
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{- Special Tests} \tn 
% Row Count 6 (+ 1)
% Row 6
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{- Pathological reflex testing} \tn 
% Row Count 7 (+ 1)
% Row 7
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{- Palpation} \tn 
% Row Count 8 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{8.4cm}{p{0.8 cm} p{0.8 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{Investigations}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{- X-ray - fractures + dislocations in trauma patients, multiple root levels} \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{- CT - acute fractures, disc herniation} \tn 
% Row Count 3 (+ 1)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{- MRI - be wary of asymptomatic abnormalities, cauda equina, abscess, tumour, haematoma} \tn 
% Row Count 5 (+ 2)
% Row 3
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{- EMG - NR dysfunction} \tn 
% Row Count 6 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{8.4cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{8.4cm}}{\bf\textcolor{white}{Sensitising Movements}}  \tn
\SetRowColor{LightBackground}
\mymulticolumn{1}{p{8.4cm}}{\vspace{1px}\centerline{\includegraphics[width=5.1cm]{/web/www.cheatography.com/public/uploads/siffi_1595338298_sensese.png}}} \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{8.4cm}{p{0.8 cm} p{0.8 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{Signs}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{- {\bf{Fajersztajn's sign}} = Pain on contralateral side when the non-painful side is flexed at the thigh with leg held in extension} \tn 
% Row Count 3 (+ 3)
% Row 1
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{- {\bf{Szabo's sign}} = Loss of sensation on the lateral portion of the foot} \tn 
% Row Count 5 (+ 2)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{- {\bf{Bonnet's sign}} = Pain on adduction of the thigh} \tn 
% Row Count 7 (+ 2)
% Row 3
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{- {\bf{Turyn sign}}  = Pain in buttocks when great toe is hyperextended} \tn 
% Row Count 9 (+ 2)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{- {\bf{Linder sign}} = Pain in lower back/down the leg when the patient is supine} \tn 
% Row Count 11 (+ 2)
% Row 5
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{-{\bf{Braggard's sign }}= An increase of pain when the straight leg is extended and foot is dorsiflexed} \tn 
% Row Count 13 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{8.4cm}{p{0.8 cm} p{0.8 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{Herniated Disc}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{- 90\% of disc herniations occur at L4-5 \& L5-S1} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{- L4 NR = L3-L4 Herniation \{\{nl\}\} L5 NR = L4-5 herniation \{\{nl\}\} S1 root = L5-S1 herniation} \tn 
% Row Count 3 (+ 2)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{- Pain = tearing of pain sensitive outer annulus (nociceptive fibres innervated by recurrent meningeal nerve) \{\{nl\}\} Mechanical compression of discal + adjacent ligamentous tissue \{\{nl\}\} Secondary inflammation due to nuclear extrusion} \tn 
% Row Count 8 (+ 5)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{8.4cm}{p{0.8 cm} p{0.8 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{Hx}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{Buttock + leg pain in affected NR distribution - leg pain usually worse} \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{Hx of flexion/rotation at onset} \tn 
% Row Count 3 (+ 1)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{May radiate to calf and foot in severe cases} \tn 
% Row Count 4 (+ 1)
% Row 3
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{Pain is sharp and severe} \tn 
% Row Count 5 (+ 1)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{Leg numbness, pins and needles, weakness} \tn 
% Row Count 6 (+ 1)
% Row 5
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{Aggravated by - trunk flexion, coughing, sneezing, sitting} \tn 
% Row Count 8 (+ 2)
% Row 6
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{Relieving - supine with supported hip/knee flexion} \tn 
% Row Count 9 (+ 1)
% Row 7
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{Hx of chronic/repetitive LBP} \tn 
% Row Count 10 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{8.4cm}{p{0.8 cm} p{0.8 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{Examination}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{Antalgic posture - towards leg pain = posteromedial herniation \{\{nl\}\} away from leg pain = posterolateral herniation} \tn 
% Row Count 3 (+ 3)
% Row 1
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{Lx Flexion decreased + painful - increases leg pain. Extension relieves but still restricted} \tn 
% Row Count 5 (+ 2)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{SLR  +ve} \tn 
% Row Count 6 (+ 1)
% Row 3
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{Femoral nerve tension tests provoke leg pain if herniation is at L3/L4} \tn 
% Row Count 8 (+ 2)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{+ve Valsalva} \tn 
% Row Count 9 (+ 1)
% Row 5
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{+ve SMR findings (can be present without them)} \tn 
% Row Count 10 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{8.4cm}{p{0.8 cm} p{0.8 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{DDx}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{- MFPS - Glut med, Piriformis, Glut Min, TFL} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{- Dynamic lateral entrapment} \tn 
% Row Count 2 (+ 1)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{- Central stenosis} \tn 
% Row Count 3 (+ 1)
% Row 3
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{- Peripheral entrapment neuropathy} \tn 
% Row Count 4 (+ 1)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{- Lx facet syndrome} \tn 
% Row Count 5 (+ 1)
% Row 5
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{- SIJ syndrome} \tn 
% Row Count 6 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{8.4cm}{p{0.8 cm} p{0.8 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{Management}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{- NSAIDs} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{- Omega 3 fatty acids} \tn 
% Row Count 2 (+ 1)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{- \seqsplit{Manipulation/mobilisation/activator}} \tn 
% Row Count 3 (+ 1)
% Row 3
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{- Flexion - distraction} \tn 
% Row Count 4 (+ 1)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{- TrP therapy} \tn 
% Row Count 5 (+ 1)
% Row 5
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{- Interferential} \tn 
% Row Count 6 (+ 1)
% Row 6
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{- TENS} \tn 
% Row Count 7 (+ 1)
% Row 7
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{- McKenzie procedures} \tn 
% Row Count 8 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{8.4cm}{p{0.8 cm} p{0.8 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{Spinal Stenosis}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{- Can be central or lateral} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{{\bf{Questionnaire:}} \{\{nl\}\}{\bf{Q1: }}Numbness/pain in the thighs down to the calves and shins \{\{nl\}\}{\bf{ Q2:}} Numbness/pain increases in intensity after walking for a while but are relived by taking a rest \{\{nl\}\} {\bf{Q3:}} Standing for a while brings on numbness and or pain in the thighs down to the calves and shins \{\{nl\}\} {\bf{Q4:}} Numbness/pain reduced by bending forward \{\{nl\}\} 4 mores on Q1-4 = LSS \{\{nl\}\} 4 points on Q1-4 and \textless{}1 on cauda equina questionnaire = radicular type of LSS \{\{nl\}\} \textgreater{}1 on Q1-4 and \textgreater{}2 on cauda equina questions = cauda equina LSS} \tn 
% Row Count 12 (+ 11)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{8.4cm}{p{0.8 cm} p{0.8 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{S\&S}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{- Dominant symptoms below gluteal fold} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{- Hx of intermittent neurogenic claudication} \tn 
% Row Count 2 (+ 1)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{- Centralisation not possible} \tn 
% Row Count 3 (+ 1)
% Row 3
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{- Symptoms improved when seated and walking with spine in flexion} \tn 
% Row Count 5 (+ 2)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{- Symptoms worse with standing/walking} \tn 
% Row Count 6 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{8.4cm}{p{0.8 cm} p{0.8 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{Hx}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{- Slow, gradual decreasing activity tolerance especiallly with walking and standing} \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{- If occurs before 60 - check for diabetes/metabolic problems} \tn 
% Row Count 4 (+ 2)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{- Numbness /pain in the thighs down to the calves/shins} \tn 
% Row Count 6 (+ 2)
% Row 3
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{- Numbness/pain increase in intensity after walking for a while but relieved by rest} \tn 
% Row Count 8 (+ 2)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{- Standing for a long time brings on numbness/pain in the thighs down to the calves and shins} \tn 
% Row Count 10 (+ 2)
% Row 5
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{- Numbness/pain are reduced by bending} \tn 
% Row Count 11 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{8.4cm}{p{0.8 cm} p{0.8 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{Exam}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{- Usually NAD} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{- SLR +ve, symmetrical weakness and atrophy + diminished reflexes} \tn 
% Row Count 3 (+ 2)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{- Cycle test - cycling distance same in vascular intermittent claudication when spine is flexed/upright - extended spine limits distance in neurogenic claudication} \tn 
% Row Count 7 (+ 4)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{8.4cm}{p{0.8 cm} p{0.8 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{Management}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{- Flexion distraction} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{- Nerve mobilisation - Pt supine while dr dorsiflexes the ankle and flexes hip with the knee extended and raises the leg until a barrier is felt. Foot is moved into plantar flexion + dorsiflexion for several cycles} \tn 
% Row Count 6 (+ 5)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{- Exercises - cat camel + nerve flossing} \tn 
% Row Count 7 (+ 1)
% Row 3
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{- 2-3 times per week for 3 weeks then reduce the time to 1 per week if improved} \tn 
% Row Count 9 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{8.4cm}{p{0.8 cm} p{0.8 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{Lateral Entrapment}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{- Bony encroachment from osteophytes/ ossified spinal ligaments/soft tissue changes - facet joint hypertrophy, PLL thickening, LF thickening and scar tissue from a repair of annulus fibrosus/extruded nucleus pulposus} \tn 
% Row Count 5 (+ 5)
% Row 1
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{- Fixed Lateral entrapment = reduced mobility around IVF is reduced and entraped more - symptoms less related to movement} \tn 
% Row Count 8 (+ 3)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{8.4cm}{p{0.8 cm} p{0.8 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{S\&S}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{- Chronic LBP with radiation to buttock and leg - can radiate to foot , but distal leg pain is more common} \tn 
% Row Count 3 (+ 3)
% Row 1
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{- Pain is burning + tingling/numbess} \tn 
% Row Count 4 (+ 1)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{- Distribution of leg symptoms are related to NR involved} \tn 
% Row Count 6 (+ 2)
% Row 3
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{- Dynamic lateral entrapment - flexion/extension increase pain, Rotation can peripheralise pain} \tn 
% Row Count 8 (+ 2)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{- SMR present but can be absent or small} \tn 
% Row Count 9 (+ 1)
% Row 5
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{- Nerve tension tests can produce minor leg pain} \tn 
% Row Count 10 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{8.4cm}{p{0.8 cm} p{0.8 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{Management}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{- Dynamic entrapment associated with better prognosis than fixed} \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{- SMT if there is no frank neurodeficit} \tn 
% Row Count 3 (+ 1)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{- TrP therapy + myofascial therapy} \tn 
% Row Count 4 (+ 1)
% Row 3
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{- Ultrasound, electrical stimulation} \tn 
% Row Count 5 (+ 1)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{- Flexion-distraction to increase canal and IVF diameter} \tn 
% Row Count 7 (+ 2)
% Row 5
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{- Chronic phase - rehab needed} \tn 
% Row Count 8 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{8.4cm}{p{0.8 cm} p{0.8 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{Epidural Compression Syndrome}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{- Should be considered if patient has neurological S\&S of cauda equina/ above L2} \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{- Caused by haematoma, infection/malignancy} \tn 
% Row Count 3 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{8.4cm}{p{0.8 cm} p{0.8 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{S\&S}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{- LL sensorimotor neurological deficits} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{- Saddle Distribution sensory loss} \tn 
% Row Count 2 (+ 1)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{- Bowel incontinence/unexplained loss of rectal sphincter tone} \tn 
% Row Count 4 (+ 2)
% Row 3
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{- Urinary retention/overflow urinary incontinence} \tn 
% Row Count 5 (+ 1)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{- Impotence} \tn 
% Row Count 6 (+ 1)
% Row 5
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{- Soft neurological signs involving \textgreater{}1 dermatome} \tn 
% Row Count 7 (+ 1)
% Row 6
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{- Look for UMNL signs (conus medullaris syndrome)} \tn 
% Row Count 8 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{8.4cm}{p{0.8 cm} p{0.8 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{Cauda Equina}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{{\bf{Hx:}} Low back pain with acute/chronic radiating pain \{\{nl\}\} Unilateral/bilateral lower extremity motor/sensory abnormality (saddle anaesthesia) \{\{nl\}\} Bladder/bowel dysfunction (starting/stopping stream of urine, urinary incontinence)} \tn 
% Row Count 5 (+ 5)
% Row 1
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{{\bf{Questionnaire:}} \{\{nl\}\}{\bf{Q1}} Numbness present in both legs \{\{nl\}\} {\bf{Q2:}} Numbness is present in the soles of both feet \{\{nl\}\} {\bf{Q3:}} Numbness arises around the buttocks \{\{nl\}\} {\bf{Q4:}} Numbness is present but pain is absent \{\{nl\}\} {\bf{Q5:}} A burning sensation arising around buttocks \{\{nl\}\} {\bf{Q6:}} Walking nearly causes urination \{\{nl\}\}} \tn 
% Row Count 12 (+ 7)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{8.4cm}{p{0.8 cm} p{0.8 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{Exam}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{- Pain localised to the low back , local tenderness to palpation/percussion} \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{- Reflex abnormalities - loss of reflexes;  hyperactive linked to spinal cord involvement - excludes CES} \tn 
% Row Count 5 (+ 3)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{- Pain in the legs} \tn 
% Row Count 6 (+ 1)
% Row 3
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{- Sensory abnormality (perineal/lower extremities} \tn 
% Row Count 7 (+ 1)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{- Muscle weakness in affected roots - Quads, foot evertors + dorsiflexors, foot plantarflexion - muscle wasting can occur} \tn 
% Row Count 10 (+ 3)
% Row 5
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{- Poor anal sphincter tone} \tn 
% Row Count 11 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{8.4cm}{x{5.44 cm} x{2.56 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{Neurological bladder dysfunction Qs}}  \tn
% Row 0
\SetRowColor{LightBackground}
- Have a sense of bladder filling & no =neuro bladder \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
- Feel urine passing? & no = neuro bladder \tn 
% Row Count 4 (+ 2)
% Row 2
\SetRowColor{LightBackground}
- Stop the urine passing? & no = neuro bladder \tn 
% Row Count 6 (+ 2)
% Row 3
\SetRowColor{white}
- bladder leakage or suddenly releases? & yes = neuro bladder \tn 
% Row Count 8 (+ 2)
% Row 4
\SetRowColor{LightBackground}
- associated rectal disorder? & yes = neuro bladder \tn 
% Row Count 10 (+ 2)
% Row 5
\SetRowColor{white}
- Disorders of potency? (erectile dysfunction) & yes = neuro bladder \tn 
% Row Count 12 (+ 2)
% Row 6
\SetRowColor{LightBackground}
- Numbness in perineum? & yes = neuro bladder \tn 
% Row Count 14 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{Retention of urine - large "atonic" bladder \{\{nl\}\} Diminised/absent sensation of bladder fullness \newline Considerable residual urine - high risk of infection \newline Continual dribbing incontinence \newline {\bf{Due to:}} Loss of parasympathetic supply to the bladder - LMNL to bladder wall + spincter  \newline Loss of motor control to the external sphincter \newline - No/diminished afferent supply from the bladder}  \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{8.4cm}{p{0.8 cm} p{0.8 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{Non-mechanical CES}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{- {\bf{Nerve Sheath Tumours:}}  Schwannoma, neurofibroma, ganglioneuroma, neurofibrosarcoma \{\{nl\}\} Usually affects middle aged adults, in neurofibromatosis multiple lesions can occur} \tn 
% Row Count 4 (+ 4)
% Row 1
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{- {\bf{Imaging:}} Enlarged IVF, post body erosions} \tn 
% Row Count 5 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{8.4cm}{p{0.8 cm} p{0.8 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{Synovial Cysts}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{- Facet Cysts} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{- Usually affects L4/5 \& L5/S1} \tn 
% Row Count 2 (+ 1)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{- Usually asymptomatic} \tn 
% Row Count 3 (+ 1)
% Row 3
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{- Presents with worsening LBP and leg pain as it expands} \tn 
% Row Count 5 (+ 2)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{- MRI used} \tn 
% Row Count 6 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{8.4cm}{p{0.8 cm} p{0.8 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{Meningioma}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{-Common neoplasm} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{- Slow growing and benign} \tn 
% Row Count 2 (+ 1)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{- Mainly in Tx region - can occur in the cx spine} \tn 
% Row Count 3 (+ 1)
% Row 3
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{- Radicular pain, becoming worse as lesion expands} \tn 
% Row Count 4 (+ 1)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{- MRI} \tn 
% Row Count 5 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{8.4cm}{p{0.8 cm} p{0.8 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{Perineural (Tarlov's cysts)}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{- Most are asymptomatic} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{- Involves sacral/coccygeal NRs} \tn 
% Row Count 2 (+ 1)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{- Causes LBP, leg pain and sacrococcygeal pain} \tn 
% Row Count 3 (+ 1)
% Row 3
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{- Symptoms worsen as lesion expand} \tn 
% Row Count 4 (+ 1)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{- MRI} \tn 
% Row Count 5 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{8.4cm}{p{0.8 cm} p{0.8 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{Mets}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{- More common in lumbar spine} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{- Can cause lateral mono-radiculopathy} \tn 
% Row Count 2 (+ 1)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{- Symptoms get worse as lesion grows} \tn 
% Row Count 3 (+ 1)
% Row 3
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{- Bony destruction + VB collapse occur} \tn 
% Row Count 4 (+ 1)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{- Look for Hx of cancer, cancer risk factors, family hx} \tn 
% Row Count 6 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{8.4cm}{p{0.8 cm} p{0.8 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{VB Osteomyelitis}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{- Infection - look for fever, hx of recent infection/wound/surgery} \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{- Destructive lesions cause an imaging "lag"} \tn 
% Row Count 3 (+ 1)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{- Refer for FBC, ESR, CRP} \tn 
% Row Count 4 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{8.4cm}{p{0.8 cm} p{0.8 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{Infection (Herpes Zoster)}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{- Most common at Tx + CN V - Lx most common at L2-4} \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{-Radicular pain +  vesicular eruptions in the dermatome} \tn 
% Row Count 4 (+ 2)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{- Post herpetic neuralgia in a small percentage of patients} \tn 
% Row Count 6 (+ 2)
% Row 3
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{- Aggressive early treatment - analgesia + retro-virals} \tn 
% Row Count 8 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{8.4cm}{p{0.8 cm} p{0.8 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{Diabetic Radiculo, polyradiculo,amotr}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{- Usually in L2,L3 or L4 NR} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{- Non-insulin dependent diabetic (males)} \tn 
% Row Count 2 (+ 1)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{- Onset of excruciating pain down the front of the thigh to the medial leg} \tn 
% Row Count 4 (+ 2)
% Row 3
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{- Within a few days of onset, the pain gets better and a rapid wasting and weakness of quads occurs} \tn 
% Row Count 6 (+ 2)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{- Weeks prior to onset, Hx of rapid weightloss + general ill health} \tn 
% Row Count 8 (+ 2)
% Row 5
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{- Often improves within 6 months - can take up to 2 years} \tn 
% Row Count 10 (+ 2)
% Row 6
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{- Tight diabetic control  with insulin needed} \tn 
% Row Count 11 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{8.4cm}{p{0.8 cm} p{0.8 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{When to refer}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{- Sudden onset of Pain, pallor, pulselessness, paralysis, paraaesthesia and coldness} \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{- Worsening intermittent claudication} \tn 
% Row Count 3 (+ 1)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{- Rest pain in foot} \tn 
% Row Count 4 (+ 1)
% Row 3
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{- Presence of popliteal aneurysm} \tn 
% Row Count 5 (+ 1)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{- Evidence of DVT} \tn 
% Row Count 6 (+ 1)
% Row 5
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{- Worsening of hip pain} \tn 
% Row Count 7 (+ 1)
% Row 6
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{- Evidence of disease in bone} \tn 
% Row Count 8 (+ 1)
% Row 7
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{- Severe Sciatica with neurological deficit} \tn 
% Row Count 9 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{8.4cm}{p{0.8 cm} p{0.8 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{Hx}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{Acute or chronic pain?} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{If acute  - trauma related or unusual activity?  If not, consider vascular causes} \tn 
% Row Count 3 (+ 2)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{Pain related to movement? If no consider soft tissue lesion} \tn 
% Row Count 5 (+ 2)
% Row 3
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{Postural pain? Postures that make the pain better or worse? Worse on sitting = disogenic/ischial bursitis, if worse on standing = instablity or local problem, if worse lying down = vascular} \tn 
% Row Count 9 (+ 4)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{Related to walking? No = what is the offending activity? Yes: If immediate - local cause. If delayed = vascular claudication/neurogenic claudication} \tn 
% Row Count 12 (+ 3)
% Row 5
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{Site of pain same site of trauma? If no = lesions in the spine,abdomen, hip and entrapment neuropathy} \tn 
% Row Count 15 (+ 3)
% Row 6
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{Pain arising from bone? If yes, pain is very specific with deep and boring "bone" pain} \tn 
% Row Count 17 (+ 2)
% Row 7
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{Pain arising from joints? AROM + PROM} \tn 
% Row Count 18 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{8.4cm}{p{0.8 cm} p{0.8 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{Investigations}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{- FBC, ESR, D-dimer, CRP} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{- X-rays of spine, knee , hip} \tn 
% Row Count 2 (+ 1)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{- Bone scan} \tn 
% Row Count 3 (+ 1)
% Row 3
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{- EMG} \tn 
% Row Count 4 (+ 1)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{- Duplex ultrasound, ankle brachial index} \tn 
% Row Count 5 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{8.4cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{8.4cm}}{\bf\textcolor{white}{Ankle Brachial Pressure index (ABPI)}}  \tn
\SetRowColor{LightBackground}
\mymulticolumn{1}{p{8.4cm}}{\vspace{1px}\centerline{\includegraphics[width=5.1cm]{/web/www.cheatography.com/public/uploads/siffi_1595694348_abpi.png}}} \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{8.4cm}}{\textless{}0.4 - 0.79 = pain at rest}  \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{8.4cm}{p{0.8 cm} p{0.8 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{Leg pain in children}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{- Common soreness and muscular strains due to trauma or unaccustomed exercise} \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{- Growing pains - usually in the evening in thighs and calves (both legs) lasts for minutes to an hour, most commonly at 9-12yo, massage of the area best treatment} \tn 
% Row Count 6 (+ 4)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{8.4cm}{p{0.8 cm} p{0.8 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{Leg pain in the elderly}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{- Arterial disease with intermittent claudication + neurogenic claudication} \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{- Degenerative joint disease} \tn 
% Row Count 3 (+ 1)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{- Muscle Cramps} \tn 
% Row Count 4 (+ 1)
% Row 3
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{- Herpes Zoster} \tn 
% Row Count 5 (+ 1)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{- Paget's disease} \tn 
% Row Count 6 (+ 1)
% Row 5
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{- PMR} \tn 
% Row Count 7 (+ 1)
% Row 6
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{- Sciatica} \tn 
% Row Count 8 (+ 1)
% Row 7
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{- Retroperitoneal haemorrhage - anticoagulant therapy} \tn 
% Row Count 10 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{8.4cm}{p{0.8 cm} p{0.8 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{Hip Pocket Wallet Syndrome}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{- Wallet in back pocket compresses the sciatic nerve} \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{- Presents with buttock and upper posterior thigh pain - without back pain} \tn 
% Row Count 4 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{8.4cm}{p{0.8 cm} p{0.8 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{Exam}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{- Watch patient walk and assess the nature of any limp} \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{- Exam Lx} \tn 
% Row Count 3 (+ 1)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{- Inspect patient's stance and note any asymmetry and other abnormalities - swelling, bruising, discolouration, ulcers, rashes, size and symmetry of legs and venous pattern, ischaemic changes in the foot/LL} \tn 
% Row Count 8 (+ 5)
% Row 3
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{- Palpate for local causes - ischial tuberosity, trochanteric area, hamstrings and tendon insertions, superficial lymphnodes, temperature of LL} \tn 
% Row Count 11 (+ 3)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{- Palpate pulses of LL and look at the veins} \tn 
% Row Count 12 (+ 1)
% Row 5
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{- Auscultate abdomen and iliac, femoral and popliteal vessels for bruits} \tn 
% Row Count 14 (+ 2)
% Row 6
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{- SMR} \tn 
% Row Count 15 (+ 1)
% Row 7
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{- Exam of Hip and SIJs} \tn 
% Row Count 16 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{8.4cm}{p{0.8 cm} p{0.8 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{Piriformis syndrome}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{{\bf{Caused by:}} Trauma \{\{nl\}\} Hormonal changes (pregnancy, menstrual) ,therefore F:M  = 6:1 \{\{nl\}\} Excessive manipulation \{\{nl\}\} Prolonged external rotation of the thigh (driving)} \tn 
% Row Count 4 (+ 4)
% Row 1
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{{\bf{S\&S:}} Deep, boring, ill-defined pain in buttock, posterolateral thigh and calf (rarely to foot) \{\{nl\}\} Burning sensation over greater trochanter \{\{nl\}\} Unable to lie on involved side \{\{nl\}\} Leg externally rotated and reduced internal rotation \{\{nl\}\} Piriformis muscle test demonstrates unilateral shortness \{\{nl\}\} Trigger points in Piriformis \{\{nl\}\} Deep palpation of muscle belly is tender and may reproduce leg pain \{\{nl\}\} +ve Bonnet's test \{\{nl\}\} SIJ Dysfunction often presents ipsilaterally} \tn 
% Row Count 14 (+ 10)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{{\bf{DDx:}} Lx Disc herniation \{\{nl\}\} MFPS \{\{nl\}\} SOL} \tn 
% Row Count 15 (+ 1)
% Row 3
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{{\bf{Management:}} TrP \{\{nl\}\} Spray and stretch \{\{nl\}\} Manipulation of SIJ \{\{nl\}\} Hip mobilisation (if both are stiff) \{\{nl\}\} Ultrasound, electrical stimulation \{\{nl\}\} PIR \{\{nl\}\} Home stretching} \tn 
% Row Count 19 (+ 4)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{8.4cm}{p{0.8 cm} p{0.8 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{Arterial causes}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{PAD is the main cause - build up of plaque in arteries} \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{Tight squeezing pain in the calf, foot , thigh or buttock during exercise, relieved by rest, decreased leg strength and function, poor balance when standing, cold and numb feet and toes, sores that are slow to heal} \tn 
% Row Count 7 (+ 5)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{8.4cm}{p{0.8 cm} p{0.8 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{Overuse injuries}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{- Medial tibial stress syndrome} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{- Stress fractures} \tn 
% Row Count 2 (+ 1)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{- Exertional compartment syndrome} \tn 
% Row Count 3 (+ 1)
% Row 3
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{- Tibialis anterior tenosynovitis} \tn 
% Row Count 4 (+ 1)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{- Chronic muscle strains} \tn 
% Row Count 5 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{8.4cm}{p{0.8 cm} p{0.8 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{Management}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{Rest} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{Myofascial therapy} \tn 
% Row Count 2 (+ 1)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{Exercise program} \tn 
% Row Count 3 (+ 1)
% Row 3
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{Electrostimulation} \tn 
% Row Count 4 (+ 1)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{Correction of prediposing factors - training errors, unsuitable footwear} \tn 
% Row Count 6 (+ 2)
% Row 5
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{Analgesics (NSAIDs)} \tn 
% Row Count 7 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}


% That's all folks
\end{multicols*}

\end{document}