Referred Pain of the Lower Extremity
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1 Referred Pain of the Lower Extremity Anthony Russo, MD Montana Spinal Institute Montana Orthopedics
2 Definition Referred Pain: Pain felt at a site other than where the cause is situated.
3 Objectives Understand spinal causes of lower extremity pain Understand conditions that mimic symptoms of spinal pathology Understand common intrinsic causes of lower extremity pain.
4 Lower Extremity Referred Pain Spinal Causes Radiculopathy Stenosis Lower extremity causes Intrinsic knee pathology Intrinsic hip pathology Iliotibial band syndromes Piriformis syndrome
5 Dermatomes and Myotomes
6 Lower Extremity Radiculopathy Irritation of nerve root as it exits the spinal column Causes Herniated Nucleus Pulposus Lateral Recess Stenosis Neoplasm Infection Trauma
7 Upper Lumbar Radiculopathy L1,L2, L3 Sensory Anterior thigh between inguinal ligament and knee Motor Iliopsoas (L1,2) Hip adductors (L2,3,4) Quadriceps (L3,4)
8 Upper Lumbar Radiculopathy L1,L2, L3 Reflexes Cremasteric Special tests Femoral Stretch Test
9 Lower Lumbar Radiculopathy L4, L5, S1 Sensory Motor Anterior Tibialis (L4) Extensor Hallucis Longus, Hip Abductors (L5) Peroneals, Gastroc-Soleus (S1)
10 Lower Lumbar Radiculopathy L4, L5, S1 Reflexes Patellar (L4) Achilles (S1) Special tests Straight Leg Raise
11 Lumbar Stenosis Neurogenic Claudication Symptoms with standing/walking Relieved with sitting
12 Lower Extremity Conditions that Mimic Spinal Pathology
13 Lower Extremity Conditions that Mimic Spinal Pathology Piriformis Syndrome
14 Lower Extremity Conditions that Mimic Spinal Pathology Trochanteric Bursitis
15 Intrinsic conditions of the Lower Extremities
16 Hip causes Arthritis Osteoarthritis Inflammatory arthritis Post-traumatic arthritis Avascular necrosis Femoral acetabular impingement Labral tears Neoplasm Infection Iliopsoas pathology
17 Arthritis Osteoarthritis Inflammatory arthritis Post-traumatic arthritis Avascular necrosis Femoral acetabular impingement Labral tears Neoplasm Infection Iliopsoas pathology Hip causes
18 Arthritis Osteoarthritis Inflammatory arthritis Post-traumatic arthritis Avascular necrosis Femoral acetabular impingement Labral tears Neoplasm Infection Iliopsoas pathology Hip causes
19 Arthritis Osteoarthritis Inflammatory arthritis Post-traumatic arthritis Avascular necrosis Femoroacetabular impingement Labral tears Neoplasm Infection Iliopsoas pathology Hip causes
20 Arthritis Osteoarthritis Inflammatory arthritis Post-traumatic arthritis Avascular necrosis Femoral acetabular impingement Labral tears Neoplasm Infection Iliopsoas pathology Hip causes
21 Arthritis Osteoarthritis Inflammatory arthritis Post-traumatic arthritis Avascular necrosis Femoral acetabular impingement Labral tears Neoplasm Infection Iliopsoas pathology Hip causes
22 Arthritis Osteoarthritis Inflammatory arthritis Post-traumatic arthritis Avascular necrosis Femoral acetabular impingement Labral tears Neoplasm Infection Iliopsoas pathology Hip causes
23 Arthritis Osteoarthritis Inflammatory arthritis Post-traumatic arthritis Avascular necrosis Femoral acetabular impingement Labral tears Neoplasm Infection Iliopsoas pathology Hip causes
24 Knee causes Arthritis Osteoarthritis Inflammatory arthritis Post-traumatic arthritis Popliteal Cysts Iliotibial Bursitis Neoplasm Infection
25 Knee causes Arthritis Osteoarthritis Inflammatory arthritis Post-traumatic arthritis Popliteal Cysts Iliotibial Bursitis Neoplasm Infection
26 Knee causes Arthritis Osteoarthritis Inflammatory arthritis Post-traumatic arthritis Popliteal Cysts Iliotibial Bursitis Neoplasm Infection
27 Knee causes Arthritis Osteoarthritis Inflammatory arthritis Post-traumatic arthritis Popliteal Cysts Iliotibial Bursitis Neoplasm Infection
28 Knee causes Arthritis Osteoarthritis Inflammatory arthritis Post-traumatic arthritis Popliteal Cysts Iliotibial Bursitis Neoplasm Infection
29 Knee causes Arthritis Osteoarthritis Inflammatory arthritis Post-traumatic arthritis Popliteal Cysts Iliotibial Bursitis Neoplasm Infection
30 Questions?
31 Thank You
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