Clinical Case Scenario Analysis: Slipped Disc (Disc Herniation)

This document is a clinical case scenario analysis on slipped disc (disc herniation). It discusses the symptoms, signs, organs and tissues involved, and the processes that explain the homeostatic disturbance in this condition. The document also includes references for further reading.

ASSESSMENT TASK 1 – CLINICAL CASE SCENARIO ANALYSIS
SET 3B Slipped Disc (Disc Herniation)
History: A 30-year-old female presented complaining of a two-month history of
progressive low back pain and severe, radiating pain in the right lower extremity
(sciatica). She reported associated numbness and weakness in her right lower
extremity, particularly in her calf muscle. She had difficulty to ambulate including
moderate limitation in daily activities.
Physical examination: She was found to have a reduced range of motion of her
lumbar spine, positive sciatic nerve stretch testing, and measurable weakness in her
calf muscle on the right side. Her gait was impaired, and she walked with a limp.
Laboratory studies: The lumbar spine radiograph appeared normal. Her MRI
revealed disc herniation at the level of L5-S1.
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SET #, CASE 1 – #Diagnosis#
In the clinical case scenario, which symptoms (experienced by the patient like
chest pain) and signs (observed by another person like swelling or redness)
are consistent with the diagnosis?
Symptoms; the severe low back pain that is progressive, pain in her right lower
extremity that radiates and numbness and weakness in her right lower extremity
associated with her calf muscle.
Signs; the lumbar spinal range of motion reduced, positive sciatic nerve stretching
and impaired gait (Ropper & Zafonte, 2015, pp.1240-1248).
(1) Given the symptoms and signs in the clinical case scenario, which organs,
tissues and/or body parts are involved or affected by the homeostatic
disturbance?
Lumbar vertebra number 5, sacral vertebra number 1, sciatic nerve formed by
the peroneal and tibial nerve, sensory ganglion of the nerve tissue, gluteal
muscles, proximal biceps femoris muscle, middle or lower buttock, thigh and
vertebral disc (Ropper & Zafonte, 2015, pp.1240-1248; Hopayian &
Danielyan, 2018 pp.155-164).
(3) What processes are involved that can explain the homeostatic disturbance/s in
the clinical case scenario?
Sciatica can be caused by disturbances happening anywhere along the course of
the sciatic nerve. The sciatic nerve is formed by the joining of four different nerves.
the fourth lumbar nerve and the fifth lumbar nerve joining with the first sacral nerve
and the second sacral nerve. These four nerves join forming the peroneal and tibial
nerves that leave the pelvis in an ensheathed single trunk called the sciatic nerve.

The most disturbances due to disk rupture or osteoarthritic change happen at the
L4-L5, and L5-S1 levels and L3-L4 levels, though less frequently in the latter area
(Ropper & Zafonte, 2015, pp.1240-1248). Disturbances occur where there is usually
a compression of the sciatic nerve below the corresponding ruptured vertebral disc.
The mechanism of the sciatica is related to the distortion of the nerve root or
distortion of its sensory ganglion. Alternatively, it can be due to the effect of the local
inflammatory cytokines. The compression of the sciatic nerve can begin either
suddenly due to physical activity or slowly. This compression can cause pain. This
pain has aching and sharp components that normally radiates along a broad line,
normally starting from the lower buttock (Park et al.,2016, p.218). The MRI revealed
herniation as the cause of sciatica. A herniation is manifested as a protrusion of the
vertebral disc tissue into the epidural cavity. Herniation can also be presented as
extrusion of the discal tissue into the epidural cavity. This protrusion or extrusion
leads to exposure of the disc tissue and impairment of the nerve root. The
herniation, therefore, causes mechanical compression on the sciatic nerve and
tissue exposure contributing to pain (Winkelstein, Allen & Setton, 2014, pp. 305-
326). The pain is therefore commonly seen in the areas covered by the nerve
compressed and presents as low back pain, radiating leg pain, weakness of the
muscles, numbness on the right lower extremity and gait abnormality. The pain,
therefore, starts at the lower or middle buttock radiating along a broad line. In cases
of L5-S1 compression, the pain proceeds posteriorly along the thigh. When the pain
extends below the knee, it will be located on the superficial distribution of the
affected spinal root. According to (Scorupska et al., 2014, p.620), there is an
argument that intensive short-term vasodilation can also have pain effect in the area
of herniation and disc rupture. It has also been established that in chronic stages
muscle pain as well, for example, active trigger points from the gluteus minimus can
mimic sciatica. The intensity of sciatica symptoms depends on the extent of the disc
herniation. The sciatica pain can be worsened by movements like coughing or
sneezing this is because such kinds of movement increase the intra-abdominal
pressure. The pain can also be aggravated by sitting, bending, rising from a sitting
position or prolonged standing. These increases compression which causes
pressure on the herniated disc. However, the pain can be relieved by the supine
position which decreases pressure exerted on the vertebral disc.
References:
Arya, R.K., 2014. Low Back Pain–Signs, Symptoms and Management. Journal, Indian
Academy of Clinical Medicine, 15(1), pp.30-41.
Hopayian, K. and Danielyan, A., 2018. Four symptoms define the piriformis syndrome: an
updated systematic review of its clinical features. European Journal of Orthopaedic Surgery
& Traumatology, 28(2), pp.155-164.
Park, M.S., Yoon, S.J., Jung, S.Y. and Kim, S.H., 2016. Clinical results of endoscopic sciatic
nerve decompression for the deep gluteal syndrome: mean 2-year follow-up. BMC
musculoskeletal disorders, 17(1), p.218.
Ropper, A.H. and Zafonte, R.D., 2015. Sciatica. New England Journal of Medicine, 372(13),
pp.1240-1248.
Skorupska, E., Rychlik, M., Pawelec, W., Bednarek, A. and Samborski, W., 2014. Intensive
short-term vasodilation effect in the pain area of sciatica patients-case study. BMC Research
Notes, 7(1), p.620.

Winkelstein, B.A., Allen, K.D. and Setton, L.A., 2014. Intervertebral disc herniation:
Pathophysiology and emerging therapies. The Intervertebral Disc (pp. 305-326). Springer,
Vienna.