Neural symptoms, neural symptoms are those produced b a nerve and include tingling, numbness and weakness. These symptoms are common in those with a slipped disc and tend to be in the how areas described above, in line with areas of pain. Weakness in the foot is especially common, with difficulty lifting the foot (known as foot drop) often reported in those with L4/L5 herniation. Pain patterns, pain often occurs after a relatively simple movement, such as bending over to pick up something light off the floor. It is often aggravated by sitting, bending, lifting and coughing or sneezing. It is often eased by lying down, especially on the unaffected side and may be at its best first thing in the morning. Bladder / Bowel Symptoms.
If the disk herniates far enough it can put pressure on the spinal column where it passes behind the discs and vertebral bodies. It is this pressure on the spinal cord which refers pain and other symptoms into the legs. What are the symptoms? 90 of lumbar spine herniations occur at either L4/L5 or L5/S1. Where the herniation and so spinal cord compression occurs, dictates the symptoms the individual will feel. In most cases some degree of lower back pain will be felt and this may be accompanied by: Leg pain, in the L5/S1 disc herniation the pain is often felt down the back of the leg, often as far as the foot (see sciatica ). With L4/L5 herniations the pain may be felt more on the outside of the leg and down into the shin or top of the foot. L3/L4 herniations often produce pain on the outer hip and round onto the front of the thigh.
Slipped Capital Femoral Epiphysis (scfe), kidsHealth
A slipped disc can manifest itself with a number of symptoms including back pain, leg pain, neural symptoms as well as bowel and bladder problems. Treatment can be conservative which may involve rest and exercises or surgical. What is a herniated Disc? The intervertebral discs are roughly round pads of cartilage which sit between each spinal vertebra (bone). Their job is to provide shock absorbtion and to allow the movements of flexion, extension, side bending and rotation at the lower back. Whilst lumbar disc herniations can occur at any point in the spine, they are most common in the lumbar (lower back) region. Here there are 5 lumbar vertebrae, separated by 5 intervertebral discs.
Each vertebrae has a body (large circular area at the front) and three bony processes which protrude out the back. These are the two transverse processes and the central spinous process. Between the body and these processes is a circular hole, which together with the vertebrae above and below, forms a column through which the spinal cord passes. The intervertebral disc are made up of three parts. The vertebral end plates, the annulus fibrosus and in the centre, the nucleus pulposus. It is this central part which may herniate, students through a weakened, degenerated wall (annulus fibrosus).
The majority of patients will be able to bear weight and will present with a limp. When testing hip range of motion, internal rotation, flexion, and abduction are limited. External rotation and adduction are often increased and movement in all directions are painful. Typically, the involved hip will fall into external rotation when the hip is passively flexed beyond 90 degrees. Differential diagnosis Other conditions to rule out 7 : * A groin pull, or groin strain, results from putting too much stress on muscles in your groin and thigh.
If these muscles are tensed too forcefully or too suddenly, a tear or rupture to any one of the adductor muscles is common and ressults in inner thigh pain. Groin pulls are common in people who play sports that require a lot of running and jumping. In particular, suddenly jumping or changing direction is a likely cause. 2B) diagnostic Procedures For a correct and reliable medical diagnosis, medical imaging is necessary, for example radiographs. With radiographs, even a slight displacement of the epiphysis is recognizable. With antero-posterior films, you can examine for scfe. Lateral radiographs are essential to see when the epiphysis is tilted over towards the back of the femoral neck. Radiographs in both the Anterior/Posterior view and the "frog" postion (or lauenstein-projection) of each hip is required. The wilson classification system utilizes the radiographs to classify a mild slip (less than 1/3 displacement moderate slip (between 1/3 - 1/2 displacement and severe slip (greater than 1/2 displacment).
Slipped Capital Femoral Epiphysis
7 Characteristics / Clinical Presentation Typical presentation is a child between the ages of inspiration 10 - 20 years. There are some differences found between the literature about the exact age. This has to do with the maturity of the growth plate (epiphysial line). There is an increased prevalence during the period of rapid growth, shortly after puberty. The disorder is more prevalent in male than females (2:1 ratio). The child usually presents with some combination of hip, knee, thigh, and groin pain. The leg is typically externally rotated and an antalgic gait is noted.
There is some association with endocrine disorders, such as Hypothyroidism, hypopituitarism, hupogonadisme and metabolic disorders resulting from the English disease or treatment of story chemotherapy or radiation. These situations lead to weakening of the growth plate. However, this is not a prevalent finding. There are several classification systems to determine the severity of a scfe: Acute, acute-on-chronic, and chronic Acute signifies the scfe occurred with trauma and results in immediate pain and decreased hip rom (abduction and internal rotation). Acute-on chronic describes a patient having symptoms for months and then has an increased slip due to trauma. Chronic is identified as the most common presentation, and the child has had symptoms for several months 8 The preferred classification system is stable/unstable, which is based on the stability of the physis 9 (L.O.E.2A). A classification of stable is given to those who can bear weight with/without an assistive device on the affected leg. Those who cannot are deemed unstable.
Native americans geographic locations (higher rates in the north and western parts of the United States and different seasons (late summer and. However pathogenesis is most likely multifactorial, mechanical factors (mainly obesity and growth surges/abnormal morphology of the proximal femur and acetabulum) seem to play a determinant role. Other factors that either reduce the resistance to shear or that increase the stresses across the proximal femoral physis are, for example endocrine disorders, (hypothyroidism, growth hormone supplementation, hypogonadism, panhypopituitarism less commonly. There are several factors that can contribute to developing a scfe: Those who cannot ambulate with crutches or other assistive devices are deemed unstable. Antropometric risk factors can be a long, small person, but the most widely recognized factor is obesity. It is hypothesized that as weight increases, shearing forces across the physis are also increased, causing it to weaken. Other mechanical contributors to this condition are retroversion of the femur and increased physeal obliquity. Changes in hormone levels (spikes in testosterone) during growth spurts can having a weakening effect on the physis.
In the femur of a growing child, the femoral growth plates are placed between the epiphysis and metaphysis 3 (L.O.E.5). As we grow, the growth plate builds bone on top of the end of the metaphysis, which assures bone lengthening. The strength of the cartilage epiphyseal plate itself is inferior to those of its surrounding bone parts. Subsequently, increased force on the hip at a time when the femoral head is not fully ready to support these forces makes the femoral head fail at the weakest point, through the epiphyseal plate. In addition, the capital femoral epiphysis is a special one. It is one of the only epiphyses in the body that is inside its joint capsule. The blood shredder vessels that go to the epiphysis run along the side of the femoral neck and are in real danger of being torn or pinched off if something happens to the growth plate. When this happens, it can result in a loss of the blood supply to the epiphysis which leads to an avascular necrosis and chondolysis.
Slipped capital femoral epiphysis : MedlinePlus Medical
Contents, definition/Description, slipped, capital Femoral Ephysis, the most common hip disorder affecting adolescents, (scfe) is a disorder of the immature hip in which persuasive anatomic disruption occurs through the proximal femoral physis. The physis, also known as the growth plate, is the part of the bone which is responsible for lenghtening (see figure). Scfe is associated with a highly variable degree of posterior translation of the epiphysis and simultaneous anterior displacement of the metaphysis. In scfe, there is a spectrum of each of the following elements: temporal acuity physical stability of the slipping physis degree of displacement between the proximal femoral neck and the epiphysis and the amount of deformity that the protruding anterior metaphyseal prominence presents to the. Fortunately, scfe can be treated and the complications averted or minimized if diagnosed early. In most of the cases surgery is necessary to stabilize the hip and prevent the situation from getting worse. 1 (L.O.E.2A clinically relevant Anatomy, the hip joint, a ball and socket synovial joint at the juncture of the leg (femur) and pelvis (os coxa) is one of the most flexible joints in the human body. In addition to being flexible, the hip joint must be able to support half of the bodys weight along with any other forces acting upon the body 2 (L.O.E 5) During running and jumping, for example, the force the forces that are created by the. The hip joint must be able to accommodate these extreme forces repeatedly during intense physical activities.