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  #1  
Old 07-23-2011
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Question Male urinary incontinence after heavy weight lifting

A 54 yr old male carpenter presents with urinary incontinence and urine leaking. It all began after lifting heavy log of wood and started with backache. Which decrease with rest and increase with activity. Pain radiates down to knee and heel. He also feels tingling and numbness in legs. On examination decreased sensation found in lower leg . Straight leg rising test is positive and decreased lower limb reflex. What could be the likely diagnosis?
1. Spinal stenosis
2. Epidural abscess
3. Lumbar facet syndrome
4. Osteoporotic compression fracture
5. Disc herniation
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  #2  
Old 07-23-2011
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Default A spinal stenosis

A Spinal stenosis
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Old 07-23-2011
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Straight leg test is preety specific to disk herniation so its D

For spinal stenosis if i remember correctly there is a case of pain on leaning forward relived by leaning back ( hence decrease pain on going down hill or such)

Epidura abcess has a hx of tenderness at that point


Lumber facet syndrome pain that is made worse by twisting or leaning

Compression fracture it should be an older person ( usually female) hx of sudden severe pain
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Old 07-23-2011
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E disc herniation
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Old 07-24-2011
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This is probably disc herniation leading to cauda equina syndrome
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Old 07-24-2011
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5. Disc herniation
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Old 07-24-2011
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1. Spinal stenosis
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Old 07-24-2011
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Would go with 5. Disc herniation.
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disc herniation
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Old 07-24-2011
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D disc herniation.....resulting in cauda equina syndrome which needs emergent surgical decompression
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Old 07-24-2011
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Disc herniation.....straight leg+ with urinary incontinence and signs of nerve compression
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Old 07-24-2011
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what is the answer?????
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Old 07-24-2011
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Quote:
Originally Posted by confident View Post
A 54 yr old male carpenter presents with urinary incontinence and urine leaking. It all began after lifting heavy log of wood and started with backache. Which decrease with rest and increase with activity. Pain radiates down to knee and heel. He also feels tingling and numbness in legs. On examination decreased sensation found in lower leg . Straight leg rising test is positive and decreased lower limb reflex. What could be the likely diagnosis?
1. Spinal stenosis
2. Epidural abscess
3. Lumbar facet syndrome
4. Osteoporotic compression fracture
5. Disc herniation
Answer here is 5. Disc herniation: Mainly seen after lifting heavy objects and similar activities, straight leg rise test positive, normally neurological features are not seen but if present it indicates large herniation (mostly nerve root below lesion is effected), pain radiating below knee to heel, pain relief on lying, cauda equina syndrome may be seen, mostly 2-3 months duration but acute can occur, antalgic gait seen.

Negative straight rising test differentiate spinal stenosis and disc herniation

1. Spinal stenosis: Pain relief usually after bending and sitting, straight leg rising test is negative, pain radiates to lateral aspect of leg, stooped posture or gait seen, it is chronic about 1 to 2 and more yrs old, congenital or aquired, neurological feature are not seen(rare).


Pain radiating below knee to heel rules out lumbar facet syn in which pain radiates only up to knee joint. Moreover depending on which facet involved referred pain to that will be seen. In facet h/o trauma, chronic disease, hyperextention injury etc seen.

In epidural abscess: Paravertebral spasm, constitutional features like fever, increase CRP and ESR seen. So it is not the answer here.

In compression fracture: H/o trauma, results in hunchback or kyphosis, pain on lifting wt, pain increases on twisting and bending relief on lying...its not the answer here.
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Old 07-24-2011
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Quote:
Originally Posted by confident View Post
Answer here is 5. Disc herniation: Mainly seen after lifting heavy objects and similar activities, straight leg rise test positive, normally neurological features are not seen but if present it indicates large herniation (mostly nerve root below lesion is effected), pain radiating below knee to heel, pain relief on lying, cauda equina syndrome may be seen, mostly 2-3 months duration but acute can occur, antalgic gait seen.

Negative straight rising test differentiate spinal stenosis and disc herniation

1. Spinal stenosis: Pain relief usually after bending and sitting, straight leg rising test is negative, pain radiates to lateral aspect of leg, stooped posture or gait seen, it is chronic about 1 to 2 and more yrs old, congenital or aquired, neurological feature are not seen(rare).


Pain radiating below knee to heel rules out lumbar facet syn in which pain radiates only up to knee joint. Moreover depending on which facet involved referred pain to that will be seen. In facet h/o trauma, chronic disease, hyperextention injury etc seen.

In epidural abscess: Paravertebral spasm, constitutional features like fever, increase CRP and ESR seen. So it is not the answer here.

In compression fracture: H/o trauma, results in hunchback or kyphosis, pain on lifting wt, pain increases on twisting and bending relief on lying...its not the answer here.
Disc herniation: for young age not old am i right ????
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Quote:
Originally Posted by miss patho View Post
Disc herniation: for young age not old am i right ????
Disc herniation can occur from youn age to 50..when most activity occurs but in old due to degenrative disorder herniation can occur depending on situation it may occur.

Disc herniation is seen in young and stenosis in old...but it is characteristics of that age group i,e mostly seen but variable presentation can be seen.

So if people become old means they are not free of disorder but chances of disease occuring exist.
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