PRESENCE OF TENDER NQULES - In parasplnal muscles and along iliac crest may be found in sclatica due to inflammation ofmuscular and fascial structures

PRESENCE OF TENDER NQULES - In parasplnal muscles and along iliac crest may be found in sclatica due to inflammation ofmuscular and fascial structures 5 RECTAL EXAMINATION • in older patients. III. lnvesugations - 1 Imaging of spine - (a) Straight X-rays - for deteocting disc narrowing in lumbar spine, or lesion öf sacro-iliac or hip joinl (b) Myelography to localise level of disc pratrusion and to dflferentiate such lesions from tumours (c) Nuclear magnetic resonance imagjng -usetful in assessment öf rool lesion. 2 CSF -may show lncreased protein with normal cellcounl In farge protrude intervertebral disc 3. EMG -may be usad to contirm presence öf denervation in affected muscles 4 Procaine injection test - for diagnosis of fibrositic pain, contaact with needie aggravates local pain and elicits referred pain, procaine suppresses both. and freedom o lag and apina movemenl \s restored Differential Diagnose öl conoBions causing Sciatfca - 1 DQc tesion - Hecunem boufä of Iowar back pain (lumbago) followed by unilateral sciatica, or pain first in calf or thigh or both without any lumbar symptoms SLR limiled Naurological signs absent if small protrusion. present if large displacernent compressing the root severely A huge hemiation may squeeze the root so hard that it becomes anaesthietic from ischemia and tha pain ceases, SLR becomes once again of full ränge al tha same time äs cutaneous analgesiä and loss öl power and rgflexes supervene 2 Spondytolisthesis Signs of disc lesion - together with lumbar deformity When spondylolisthesis causs intrinsic symptoms backache after prolonged standing, or bilateral