Referred Pain of the Lower Extremity

Referred Pain of the Lower Extremity Anthony Russo, MD Montana Spinal Institute Montana Orthopedics

Definition Referred Pain: Pain felt at a site other than where the cause is situated.

Objectives Understand spinal causes of lower extremity pain Understand conditions that mimic symptoms of spinal pathology Understand common intrinsic causes of lower extremity pain.

Lower Extremity Referred Pain Spinal Causes Radiculopathy Stenosis Lower extremity causes Intrinsic knee pathology Intrinsic hip pathology Iliotibial band syndromes Piriformis syndrome

Dermatomes and Myotomes

Lower Extremity Radiculopathy Irritation of nerve root as it exits the spinal column Causes Herniated Nucleus Pulposus Lateral Recess Stenosis Neoplasm Infection Trauma

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)

Upper Lumbar Radiculopathy L1,L2, L3 Reflexes Cremasteric Special tests Femoral Stretch Test

Lower Lumbar Radiculopathy L4, L5, S1 Sensory Motor Anterior Tibialis (L4) Extensor Hallucis Longus, Hip Abductors (L5) Peroneals, Gastroc-Soleus (S1)

Lower Lumbar Radiculopathy L4, L5, S1 Reflexes Patellar (L4) Achilles (S1) Special tests Straight Leg Raise

Lumbar Stenosis Neurogenic Claudication Symptoms with standing/walking Relieved with sitting

Lower Extremity Conditions that Mimic Spinal Pathology

Lower Extremity Conditions that Mimic Spinal Pathology Piriformis Syndrome

Lower Extremity Conditions that Mimic Spinal Pathology Trochanteric Bursitis

Intrinsic conditions of the Lower Extremities

Hip causes Arthritis Osteoarthritis Inflammatory arthritis Post-traumatic arthritis Avascular necrosis Femoral acetabular impingement Labral tears Neoplasm Infection Iliopsoas pathology

Arthritis Osteoarthritis Inflammatory arthritis Post-traumatic arthritis Avascular necrosis Femoral acetabular impingement Labral tears Neoplasm Infection Iliopsoas pathology Hip causes

Arthritis Osteoarthritis Inflammatory arthritis Post-traumatic arthritis Avascular necrosis Femoroacetabular impingement Labral tears Neoplasm Infection Iliopsoas pathology Hip causes

Arthritis Osteoarthritis Inflammatory arthritis Post-traumatic arthritis Avascular necrosis Femoral acetabular impingement Labral tears Neoplasm Infection Iliopsoas pathology Hip causes

Knee causes Arthritis Osteoarthritis Inflammatory arthritis Post-traumatic arthritis Popliteal Cysts Iliotibial Bursitis Neoplasm Infection

Questions?

Thank You