A case of Knee bucklingdisc extrusion L3 – L4
Vinod NaneriaGirish Yeotikar
Arjun WadhwaniChoithram Hospital & Research Centre,
Indore India
Case summary
• A 40 years old male C/o acute pain in the right knee associated with frequent fall since last 7 days.
• No history of trauma.• He was scared to walk with out support. • Patient was limping and had insecurity while
walking.• Now pain was gradually reducing.
Clinical examination
• Right knee was cold, (no inflammation)• no deformity, • no effusion, • no tenderness,• no laxity and had full range of movements. • Patello-femoral joint was normal.
Clinical examination
• Examination of hip:• full range free movements.• Spine full flexion, • SLRT - negative. • Ankle normal with palpable DP, & PT vessels.• EHL gr 5 power, • ankle jerks are normal on both sides.• Unable to walk on toes and heels.
Clinical examination
• There was no wasting of any muscle. • The history was only 7 days. • Active quadriceps was ok but not against
resistance (could be attributed due to pain). • Quadriceps weakness gr 3 ?• Left knee jerk was present.• Right knee jerk was absent.
Clinical examination
• Testing of knee reflex and comparing with deep reflexes of other limb, click the possibility of neurological involvement.
• Hence I asked for MRI. My patient had doubt in mind. His pain/discomfort was in/around knee and I am asking for MRI of spine!
Treatment
• Conservative– Pain was getting less.– Mono-radiculopathy.– Minimal neurological deficit.– Least possibility of progression/or deterioration of neurology.
comments
• L3 –L4 extruded disc can be missed.• Knee pain can come from spine and hip.• High degree of suspicion.• Through neurological examination.• Comparison on two sides.
comments
• When Patient’s narration of symptoms does not match with the clinical examination, it is better to over investigate the patient.
• When differentiating between an L3 radiculopathy versus a femoral neuropathy, weakness in the hip adductors in addition to the quadriceps group would indicate an L3 radiculopathy.
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