721 Spondylosis and allied disorders
721.3 Lumbosacral spondylosis without myelopathy
721.4 Thoracic or lumbar spondylosis with myelopathy
721.42 Spondylosis with myelopathy, lumbar region
721.9 Spondylosis of unspecified site
721.90 Spondylosis of unspecified site, without myelopathy
721.91 Spondylosis of unspecified site, with myelopathy
M47.16 Other spondylosis with myelopathy, lumbar region
M47.817 Spondylosis without myelopathy or radiculopathy, lumbosacral region
M47.819 Spondylosis without myelopathy or radiculopathy, site unspecified
PREFERRED PRACTICE PATTERNS
4B: Impaired Posture
4D: Impaired Joint Mobility, Motor Function, Muscle Performance, and Format Range of Motion Associated with Connective Tissue Dysfunction
4E: Impaired Joint Mobility, Motor Function, Muscle Performance, and ROM Associated with Localized Inflammation
The patient is a 72-year-old woman with complaints of low back pain that has been increasingly getting worse over the last few years. Patient reports tingling and numbness down her right leg. She is fairly active and has been a walker and a golfer for many years. She has recently noticed that during walking there is a decrease in distance due to her right leg feeling heavy and tired. She has stopped playing golf due to decreased power in her swing and wonders if it is from the weakness in her leg.
She reports that she is very stiff in the morning and loosens up after she gets ready for the day. Patient reports that she has relief with Motrin. The patient says that she does not like driving and cannot sit through watching her television shows at night anymore. She says that the pain is not bad as long as she keeps moving, and standing always seems to help alleviate her pain. She said that she has to get her son to help her carry the groceries now because it hurts too much.
During the evaluation, there was hypomobility at L3/L4 and L4/L5 during passive intervertebral motion testing. She had a positive slump test and had a grade of +1 for right patella tendon reflex. She tested positive for straight leg raise test at 30 degrees.
Patient had imaging done and shows a narrowing of the spinal canal between L3–L4 and L4–L5.
Examination algorithm for the low back. (From Dutton M. Dutton’s Orthopaedic Examination, Evaluation, and Intervention. 3rd ed. http://www.accessphysiotherapy.com. Copyright © The McGraw-Hill Companies, Inc. All rights reserved.)
Osteoarthritis of the lumbar spine
Progressive arthritis of the lumbar spinal joints
As the space between the lumbar vertebrae decreases, there can be compression onto the nerve roots
Arthritis can be central or lateral foramen based
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