Steemit Learning Challenge-S21W6; Disc Herniation"
Disc herniation is a process in which disc herniate from its actual place and discs are located in between two vertebrae. This condition mein occur as a result of gelly like spinal disc bulge because of rupturing from weak area in outer,tough or hardened layer. Nerves that pass through this route also compress due to herniation pressure which cause pain a business and tingling like sensations in muscles supplied by that nerve root.
| Types of disc herniation |
|---|
Disc herniation can occur at any level in spine but lumber level is at major risk but let's move towards some types of disc herniation.
• Cervical disc herniation:
This is a type of disc herniation that can cause bulge out of disc at any level of cervical region and as nerve that originates from cervical level supply to neck arms axilla and hands so for that reason blood supply comprising in these muscles due to nerve compression will cause pain tingling and numbness sensations in these areas.
• Thoracic disc herniation:
This is a type of disc herniation that can cause bulge out of disc at any level of thoracic region and as nerve that originates from thoracic level supply to chest and abdominal muscles so for that reason blood supply comprising in these muscles due to nerve compression will cause pain tingling and numbness sensations in these areas.
• Lumber disc herniation:
This is a type of disc herniation that can cause bulge out of disc at any level of lumber region and as nerve that originates from Lumber level supply to glutes, thighs, perineal and legs muscles so for that reason blood supply comprising in these muscles due to nerve compression will cause pain tingling and numbness sensations in these areas.
| Causes |
|---|
• Disc herniation can be caused as a result of aging process when spinal disc wear and tear occurs in old age.
• Disc herniation can occurs as a result of getting a sudden injury like while lifting a very heavy object you got any injury at spinal level can also make your disc herniated.
• Disc herniation can also occurs as a result of excessive weight because it can put on more load at disc than requirement.
• Disc herniation can occursin those persons that have poor nutrition as well as they are smokers because it can cause deficiency of minerals in body and hence cause disc degeneration more rapid.
| Symptoms |
|---|
• Patient will feel pain and discomfort and numbness in affected area and surrounding muscles.
• Patient will feel radiating pain pattern which will always be a companed by numbness and tinglings in affected muscles according to level of disc herniation.
• Patient will feel overall fatigue and weakness in affected area with time because due to pain he will not move that area.
• Patient will feel sensory changes in effective area in which there can be complete your partial loss of sensation according to damage or compression to nerve by herniation of disc.
| Diagnosis |
|---|
• It will include taking medical history about any injury or sudden weightlifting to be helpful in making diagnosis.
• It will include assessment of strength sensations and reflexes at particular area which is affected.
• It will include imaging test including x-rays for checking degeneration of particular area, CT scan for studying affected area deeply and MRI for checking soft tissue injuries around that affected area.
| Treatment |
|---|
• It include recommendation of Rest, physical therapy and pain management protocol which including applying hot pack or any other modality.
• It includes epidural injections which are steroid injections for reduction of inflammation.
• Surgical procedure can be performed in severe cases but it can be risky in which there can be discectomy or microdiscectomy for relieving compression from nerve.
• For long term,we can guide patient about their weight management,lifestyle modification and regular exercise according to particular age group.
There are combination of clinical evaluations,assessments,physical examination and imaging studies are helpful for diagnosing this condition so let's have a look at everythin....
| Clinical evaluation |
|---|
• Clinical evaluation should be the first for making diagnosis in which we should take history of patient in which he will tell about his presenting complain, his pain onset and duration as well as about severity and pain pattren that it is radiating or dull aching, burning or another.
• After that in clinical evaluation doctor will evaluate that is there any sensation of numbness, weakness ,tingling and systemically bowl dysfunction present in patient or not or what is neurological behaviour of patient.
| Physical examination |
|---|
• In physical examination it will be important to notice that how patient stands sit or walk means to check posture and gait of patient to know that how patient is compensating his posture and gait due to pain.
• In physical examination doctor will evaluate and assess mobility of spine and level of flexibility present in spine.
• After that it will be important to check muscle power and reflexes in affected limb or area and their will be sensory examination also by doctor to check any sign of sensory change.
• After that some special test can be performed if herniation is at number level because mostly it occurs at this level.Some special tests performed at this level are SLR,Crossed SLR and femoral nerve stretch test.These are applicable if there is herniation at lumber level.
• If herniation is at cervical level then spurling test will be performed by applying pressure downward by therapist by keeping hand at head so if pressure will increase pain then test is positive and most likely there's cervical herniation.
• If herniation is at thoracic level then thoracic extension test will be performed by commanding patient to lay down at his stomach and then patient will try to learn backward while hips and knees will remain straight and patient will maintain it untill resistance will be felt at thoracic spine.Any restriction or limitation along ROM will be noticed by therapist to check test positivity.If there will be 20-30 degree ROM of thoracic spine extension then test will be negative otherwise it's positive as a result of less ROM than normal.
| Imaging tests |
|---|
• X-ray is performed for checking any bony abnormality like fracture or osteoporotic changes that can cause nerve compression.
• MRI is most specific test to diagnose that if there is fix herniation present or not because it is used to study soft tissue injuries.
• Myelogram can be an important test for detecting nerve compression when contrast dye is injected in spinal canal.
• Computed tomography is used to detect any bony abnormality.
| Diagnostic criteria |
|---|
| Clinical evaluation | 10% |
|---|---|
| Physical examination | 20% |
| Symptoms | 10% |
| Imaging studies | 60% |
| Bridging |
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| Piriformis stretch |
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| William flexion or knee to chest exercise |
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• When I performed bridgeing exercises then it engaged my gluteal and low back muscles and hence I also felt improved strength of my core muscles and gluteal muscles at 10 repetitions completion with minimum 6 seconds hold with each repetition.
• When I performed knee to chest or William flexion exercise then I feel increase in flexibility in my lower back after 10 repetitions.
• When I performed priformis stretch then it particularly target my piriformis muscles and I feel that muscular tension in piriformis is reduced and if it will be performed at a patient then his pain will also subside to a greater extent.
Special invitation to
@drhira
@artist1111
@jannat12
Thank you for understanding the lesson and sharing your assignment; I hope that you will enjoy this week's lesson and try to implement it in your life if you see any such case.
Observations
Task 1 (3/3)
You have shared a great knowledge about disc herniation, its symptoms, and and causes, its types. I appreciate your effort.
Task 2 (2.8/3)
In the second question, you tell us about how you have to assess a patient by doing physical examination and history taking, performing investigations and special tests. It would be better if you add explanation of one special test of for lumbar region to assess the disc herniation. Great.
Task 3 (3.7/4)
You try the hip bridging, William Flexion and piriformis stretch exercises . You did the William Flexion. But in hip bridging it would be better to wear clothes that didn't hide the hip movement even if you be best to perform these while wearing a qameez shalwar (shirt trouser) and in piriformis stretch you have to hold the stretch for few seconds otherwise your perform in correct position. Always remember to apply heat pack before performing exercises to relax the muscles and reduce stiffness. I appreciate your efforts.
Overall you made a great attempt to answer all the questions. I appreciate your efforts. But next time try to avoid the above written suggestions. Keep learning and try to implement your knowledge to the people suffering from disc herniation or any type of back pain. Thank you.