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CHIR12007

Clinical Assessment and Diagnosis


Portfolio Exercises Week 5

Exercise 1
Compare Maigne’s syndrome and osteoporotic compression fracture of at
the thoracolumbar junction

A. What do these two conditions have in common?


• Both occur at the thoracolumbar junction
• Referred pain through the cuneal nerve to the top of the
sacrum and SI joints
B. What are the features of each
• Maigne’s syndrome
• Manipulable lesion affecting the thoracolumbar junction
• Neuropathic skin changes may be present as the
posterior ramus ends cutaneously causing trophic
changes
• A thickening or nodularity of the skin
• Hair loss
• Swollen puffy appearance
• Hypersensitivity of skin overlying iliac crest
• Compression fracture
• Local spasm and swelling
• Pain usually localised or may radiate to the side
• Local flexion deformity may occur
• Pain on percussion/vibration
• Pain pattern
C. How would you differentiate them?
• Age
• Maigne’s syndrome is manipulable and a compression fracture
is not
• The presence of osteoporosis
• Trauma
Exercise 2

Exercise 3
This exercise will require some investigation on your part
You are required to ask for any additional information in the Q&A moodle chat.
However, when you ask for more information you must identify specifically what
information you want and why (ie. What differential diagnoses are you
considering and what will the information provide to help you)

Case History
Mark, 12yom, presented to your office with his Mum. Mark’s mother explained
that he has been complaining of back pain for the past few weeks, maybe longer.
She is unaware of any particular injury that started this and Mark doesn’t recall
any specific injury either. She explains he is a typical boy, plays soccer and rides
at the mountain bike park a few times a week. She would consider him relatively
active but he does like his ‘devices’ when he’s allowed. Mark says the pain is
‘pretty sore’ sometimes, he guesses it is about 5/10 and when asked to indicate
where it is he runs his hand across the region of the thoracolumbar spine.
 Pain is localised around the thoracolumbar spine but not specifically
poinpointed
 Minor discomfort on the left when rotated to the left
 On palpation, mild tenderness on the left around T11, T12, L1 and
tightness of the erector spinae bilateral but more on the left around
the T/L junction
 Pain is constant aching throughout the day and night. He has
awaken a few nights complaining of the pain.
 All ranges of motion are achieved and are not restricted, however,
there is increased intensity of the pain on both right and left full
rotation.
 No bowel, bladder or changes in urine output or other notable
changes.
 Valsalva is not positive and pain is not reproduced in axial
compression test.
 Pain is constant and he has stopped playing sports because of the
pain.
 Paracetemol eases the aching pain.
 He can touch his toes.
 On observation there is notable mild thoracolumbar spinal curve,
convex to the right.
 No increased kyphosis.
 No home/school issues - cheerful outgoing boy
 No associated system abnormalities
 No yellow flags
 No night sweats
 No previous episodes or previous treatment
 No asymmetry in scapulae height

Differential diagnosis:

 Facet syndrome
 Growing pains

Exercise 4
Explain Peripheralisation and Centralisation as they apply to the clinical
presentation and treatment of LBP with radiculopathy

 The typical feature of lumbar radiculopathy is one of low back pain


which progresses to leg pain. The low back pain is then often much
less noticeable than the leg pain (peripheralization).
 The more distal the pain goes, the more severe the neuropathic
pain process. The goal is treatment is to get the pain to localise in
the lower back (centralisation).

Exercise 5
Besides those examples provided in the lecture, what questions might you ask to
determine if a patient has signs and symptoms associated with Cauda Equina
Syndrome?

 Have you lost control of your bowel or bladder recently?

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