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Figure 1 | BMC Musculoskeletal Disorders

Figure 1

From: Assessment of nerve involvement in the lumbar spine: agreement between magnetic resonance imaging, physical examination and pain drawing findings

Figure 1

No MRI-visible nerve involvement though obvious physical examination findings. Figure 1ab: MRI of the lumbar spine of a woman aged 61 years. T2-weighted sagittal (a) and axial L4-5 (b) scans. The radiological assessment noted no visible nerve involvement but a slight paramedial disc protrusion at level L4-5, where an intraosseous disc hernia was also seen. Figure 1c: Pain drawing made by the patient in figure 1ab. The initial impression assessment of the pain drawing was that she had a left-sided L5 radiculopathy. Physical examination findings included: sensibility to touch and pain impaired in the lateral part of the left calf and slightly impaired in the whole left leg and lower left side of the trunk; tibialis posterior reflexes absent bilaterally and Achilles and patellar reflexes impaired bilaterally; motor function impaired for big toe extension and flexion on the left side. Patient history included 23 years of chronic backache, heel and Achilles pain (left side) and also urinary incontinence. Symptoms were initially acute when she fell from 3 meters and landed on her back. Standing, lifting, sitting and other axial loading of the spine increased her symptoms. Lying down relieved her symptoms.

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