Advanced Nursing Practice

CASE STUDY

This case involves a 40-year-old Asian American male with the main complaints of mid-lumbar pain, right buttock pain, right foot pain, and paresthesias in the right thigh. He had injured his lower back while attempting to lift a heavy weight at work; he thereafter developed immediate back pain just above his waist but it wasn’t intense and he carried on working. However, his indicators worsened steadily and he developed left calf numbness and tingling. The patient went to the hospital 13 days after the injury and he got an MRI and was prescribed pain and anti-inflammatory medications. His MRI revealed a very large disc extrusion at L5/S1, which was measured by the radiologist. The dimensions were 12 mm transverse x 10 mm AP x 16 mm craniocaudal. There was left S1 nerve root impingement and mild indentation of the left anterolateral thecal sac. The patient was referred to a doctor at an occupational medicine clinic and he managed the work injury claim from that point. The occupational medicine doctor prescribed physical therapy and chiropractic treatment. The patient had his first chiropractic appointment 20 days after his injury and began physical therapy 8 days after chiropractic care commenced.

Fig. 1 Pre-spinal decompression T1-weighted sagittal (A) and axial (B) MR images through the L5/S1 level (supine position). Radiologist report states there is a large left disc extrusion that impinges upon the left S1 nerve root and left anterolateral aspect of the thecal sac.

Fig. 1A Fig. 1B

A full orthopedic and neurologic examination was performed on the patient’s first chiropractic appointment. With range of motion testing, the patient showed marked limitations of lumbar flexion but none with extension. Straight leg raise test on the left was limited to 50 degrees and created severe left buttock pain. Well leg raise was normal to 80 degrees. Braggard’s test re-created the same left buttock symptoms. Seated SLR with slump maneuver reproduced similar...