Template:Lower Limb Pain Neurogenic and Referred DDX: Difference between revisions
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***Diabetes Mellitus of other subtypes - proximal diabetes, truncal, cranial, median and ulnar neuropathies | ***Diabetes Mellitus of other subtypes - proximal diabetes, truncal, cranial, median and ulnar neuropathies | ||
***Diabetes Mellitus with autonomic neuropathy | ***Diabetes Mellitus with autonomic neuropathy | ||
***Diabetic amyotrophy | ***Diabetic amyotrophy - Probably a vasculitis aetiology with ischaemia followed by axonal degeneration and demyelination. Characterised by unilateral weakness, wasting, and pain, commonly in the quadriceps, then spreading later to the contralateral side asymmetrically. | ||
**Vasculitic Neuropathy | **Vasculitic Neuropathy - vasculitis of the small and medium-sized vessels in the peripheral nervous system. | ||
***Primary vasculitides: Churg-Strauss syndrome, microscopic polyangiitis, classic polyarteritis nodosa and Wegener granulomatosis | ***Primary vasculitides: Churg-Strauss syndrome, microscopic polyangiitis, classic polyarteritis nodosa and Wegener granulomatosis | ||
***Secondary vasculitides: A complication of connective tissue disease (systemic lupus erythematosus, rheumatoid arthritis and Sjรถgren syndrome), infection (hepatitis B and C, human immunodeficiency virus, Lyme disease, cytomegalovirus, Herpes zoster virus and various bacterial infections), medication (sulphonamides, other antibiotics and anti-viral agents) and paraneoplastic vasculitis | ***Secondary vasculitides: A complication of connective tissue disease (systemic lupus erythematosus, rheumatoid arthritis and Sjรถgren syndrome), infection (hepatitis B and C, human immunodeficiency virus, Lyme disease, cytomegalovirus, Herpes zoster virus and various bacterial infections), medication (sulphonamides, other antibiotics and anti-viral agents) and paraneoplastic vasculitis | ||
**Paraneoplastic peripheral neuropathy | **Paraneoplastic peripheral neuropathy - In addition to local effects and paraneoplastic vasculitis, can also get sensorimotor paraneoplastic neuropathy. May have anti-neuronal antibodies and EMG findings. | ||
*Brain | *Brain | ||
**Multiple sclerosis | **Multiple sclerosis | ||
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**Syringomyelia | **Syringomyelia | ||
**Transverse myelitis | **Transverse myelitis | ||
**Posterior or anterolateral situated space-occupying lesion (e.g. tumour, abscess, haematoma) | **Posterior or anterolateral situated space-occupying lesion (e.g. disc herniation, tumour, abscess, haematoma) | ||
*Cervical and Thoracic Spinal Canal | *Cervical and Thoracic Spinal Canal | ||
**Any posterior or anterolateral space-occupying lesion (e.g. abscess, tumour, haematoma) | **Any posterior or anterolateral space-occupying lesion (e.g. abscess, tumour, haematoma) | ||
*Conus Medullaris | *Conus Medullaris | ||
**Disc pathology | **Disc pathology - parasagittal, as nerve roots are lateral to spinal cord | ||
**Tumours (soft tissue, intradural, extradural, bone, metastases) | **Tumours (soft tissue, intradural, extradural, bone, metastases) | ||
*Lumbar Spine Canal | *Lumbar Spine Canal | ||
**Interspinous bursa | **Interspinous bursa (kissing spines, Baastrup's disease) | ||
**Facet joint (OA, hypertrophy, cyst, rotational instability) | **Facet joint (OA, hypertrophy, cyst, rotational instability) | ||
** | **Degenerative spondylolisthesis - the vertebral body and inferior facet joints displace anteriorly, compressing the dural sac and nerve roots against the posterior aspect of the caudal vertebral body - May only be appreciated on flexion/extension radiographs | ||
**Space-occupying lesion (disc pathology, haematoma, tumours) | **Space-occupying lesion (disc pathology, haematoma, tumours) | ||
*Lumbar Nerve Root Canal | *Lumbar Nerve Root Canal | ||
**Intervertebral disc herniation | |||
**Facet joint - superior articular process moves upwards and forwards impinging nerve root against pedicle or posterior vertebral body in presence of loss of disc height. | |||
**Osteophytes from superior facet joint or posterior inferior vertebral endplate impinging nerve root | |||
**Anterior subluxation of vertebra in degenerative spondylolisthesis with hypertrophy of superior facet joint extending into canal. | |||
**Any nerve root lesion (e.g. cyst, tumour) | |||
**Isthmic spondylolisthesis, with nerve root narrowing due to combination of disc bulging and pars interarticularis hypertrophy | |||
**Pedicle moving down compressing nerve root in complete loss of disc height in combination with spondylolisthesis and degenerative scoliosis. | |||
*Lumbar Extraforaminal Area | *Lumbar Extraforaminal Area | ||
**Far lateral disc herniation compression of exiting nerve root | |||
**Corporotransverse ligament nerve entrapment in rotatory subluxation with complete disc space narrowing -ย The corporotransverse ligament extends from the vertebral body to the transverse process of the same vertebra. | |||
**Psoas pathology (abscess, haematoma, tumour) | |||
**Spondylolisthesis with severe disc space narrowing causing impingement of the L5 nerve root between the L5 transverse process and the ala of the sacrum | |||
**Degenerative scoliosis with tilting of L5 and depression of the concave L5 transverse process causing impingement of the L5 nerve root | |||
*Pelvis | *Pelvis | ||
**Pelvic malalignment | |||
**L5 transitional vertebra pseudoarthrosis with a large osteophyte compressing L5 nerve root | |||
**Lumbosacral ligament ossification in combination with inferior L5 vertebral body osteophytes impinging L5 nerve root | |||
**Stress fracture of sacrum or pubic rami | |||
**Degenerative sacroiliitis with an osteophyte extending anteriorly compressing a nerve root | |||
**Sacroiliitis of any type | |||
**Tumours of bone and soft tissue | |||
**Lumbosacral radiculoplexus neuropathy - presents with asymmetrical lower limb pain, weakness, atrophy and paraesthesia. It can be caused by diabetic lumbosacral radiculoplexus neuropathy, non-diabetic lumbosacral radiculoplexus neuropathy, chronic inflammatory demyelinating polyneuropathy, connective tissue disease, Lyme disease, sarcoidosis, HIV and cytomegalovirusrelated polyradiculopathy. | |||
**Piriformis muscle syndrome with compression of sciatic nerve | |||
**Superior gluteal nerve entrapment syndrome - The clinical diagnosis triad of buttock pain, weakness of hip, abduction and marked tenderness on deep palpation in the region just lateral to the greater schiadic notch | |||
*Lower Extremity | *Lower Extremity | ||
**Greater trochanteric pain syndrome (Greater trochanteric bursitis and gluteus medius tendinopathy) | |||
**Stress fracture of femoral neck, intertrochanteric area, and proximal femur | |||
**Iliopsoas and iliopectineal bursitis and synovitis | |||
**Non-traumatic focal mononeuropathies | |||
**Myositis and myopathy | |||
**Sports related leg pain | |||
***Medial tibial stress syndrome | |||
***Chronic exertional compartment syndrome | |||
***Tendinopathies | |||
***Nerve entrapment syndromes | |||
***Vascular syndromes | |||
***Myopathies | |||
**CRPS | |||
**Restless legs syndrome | |||
**Painful legs and moving toes syndrome | |||
**Nerve entrapment syndromes | |||
***Iliohypogastric (T12, L1), Ilioinguinal (T12, L1), Genitofemoral (L1, L2) - Usually after lower abdominal surgery | |||
***Lateral femoral cutaneous nerve (L2-4) | |||
***Femoral nerve (L2-4) entrapment below the inguinal ligament | |||
***Pelvic procedures with acutely flexed, abducted, and externally rotated positioning | |||
***Saphenous nerve (L3-4) entrapment as it pierces the roof of the adductor canal, by femoral vessels, pes anserine bursitis, varicose vein operations, and medial knee surgery | |||
***Common peroneal neuropathy | |||
***Deep peroneal nerve | |||
***Superficial peroneal nerve | |||
***Proximal tibial entrapment neuropathy | |||
***Distal tibial entrapment | |||
***Sural nerve | |||
***Medial plantar nerve neuropathy | |||
***Inferior calcaneal nerve | |||
***Interdigital neuropathy | |||
***Medial plantar proper digital neuropathy (Joplin's neuroma) |
Latest revision as of 18:55, 18 August 2021
- Systemic Conditions
- Metabolic Neuropathy
- Diabetes Mellitus with distal symmetrical polyneuropathy
- Diabetes Mellitus of other subtypes - proximal diabetes, truncal, cranial, median and ulnar neuropathies
- Diabetes Mellitus with autonomic neuropathy
- Diabetic amyotrophy - Probably a vasculitis aetiology with ischaemia followed by axonal degeneration and demyelination. Characterised by unilateral weakness, wasting, and pain, commonly in the quadriceps, then spreading later to the contralateral side asymmetrically.
- Vasculitic Neuropathy - vasculitis of the small and medium-sized vessels in the peripheral nervous system.
- Primary vasculitides: Churg-Strauss syndrome, microscopic polyangiitis, classic polyarteritis nodosa and Wegener granulomatosis
- Secondary vasculitides: A complication of connective tissue disease (systemic lupus erythematosus, rheumatoid arthritis and Sjรถgren syndrome), infection (hepatitis B and C, human immunodeficiency virus, Lyme disease, cytomegalovirus, Herpes zoster virus and various bacterial infections), medication (sulphonamides, other antibiotics and anti-viral agents) and paraneoplastic vasculitis
- Paraneoplastic peripheral neuropathy - In addition to local effects and paraneoplastic vasculitis, can also get sensorimotor paraneoplastic neuropathy. May have anti-neuronal antibodies and EMG findings.
- Metabolic Neuropathy
- Brain
- Multiple sclerosis
- Parkinsonโs disease
- Motor neurone disease
- Post-stroke pain in lenticulo-capsular haemorrhages
- Space-occupying lesions.
- Spinal Cord
- Multiple sclerosis
- Motor neurone disease
- Syringomyelia
- Transverse myelitis
- Posterior or anterolateral situated space-occupying lesion (e.g. disc herniation, tumour, abscess, haematoma)
- Cervical and Thoracic Spinal Canal
- Any posterior or anterolateral space-occupying lesion (e.g. abscess, tumour, haematoma)
- Conus Medullaris
- Disc pathology - parasagittal, as nerve roots are lateral to spinal cord
- Tumours (soft tissue, intradural, extradural, bone, metastases)
- Lumbar Spine Canal
- Interspinous bursa (kissing spines, Baastrup's disease)
- Facet joint (OA, hypertrophy, cyst, rotational instability)
- Degenerative spondylolisthesis - the vertebral body and inferior facet joints displace anteriorly, compressing the dural sac and nerve roots against the posterior aspect of the caudal vertebral body - May only be appreciated on flexion/extension radiographs
- Space-occupying lesion (disc pathology, haematoma, tumours)
- Lumbar Nerve Root Canal
- Intervertebral disc herniation
- Facet joint - superior articular process moves upwards and forwards impinging nerve root against pedicle or posterior vertebral body in presence of loss of disc height.
- Osteophytes from superior facet joint or posterior inferior vertebral endplate impinging nerve root
- Anterior subluxation of vertebra in degenerative spondylolisthesis with hypertrophy of superior facet joint extending into canal.
- Any nerve root lesion (e.g. cyst, tumour)
- Isthmic spondylolisthesis, with nerve root narrowing due to combination of disc bulging and pars interarticularis hypertrophy
- Pedicle moving down compressing nerve root in complete loss of disc height in combination with spondylolisthesis and degenerative scoliosis.
- Lumbar Extraforaminal Area
- Far lateral disc herniation compression of exiting nerve root
- Corporotransverse ligament nerve entrapment in rotatory subluxation with complete disc space narrowing - The corporotransverse ligament extends from the vertebral body to the transverse process of the same vertebra.
- Psoas pathology (abscess, haematoma, tumour)
- Spondylolisthesis with severe disc space narrowing causing impingement of the L5 nerve root between the L5 transverse process and the ala of the sacrum
- Degenerative scoliosis with tilting of L5 and depression of the concave L5 transverse process causing impingement of the L5 nerve root
- Pelvis
- Pelvic malalignment
- L5 transitional vertebra pseudoarthrosis with a large osteophyte compressing L5 nerve root
- Lumbosacral ligament ossification in combination with inferior L5 vertebral body osteophytes impinging L5 nerve root
- Stress fracture of sacrum or pubic rami
- Degenerative sacroiliitis with an osteophyte extending anteriorly compressing a nerve root
- Sacroiliitis of any type
- Tumours of bone and soft tissue
- Lumbosacral radiculoplexus neuropathy - presents with asymmetrical lower limb pain, weakness, atrophy and paraesthesia. It can be caused by diabetic lumbosacral radiculoplexus neuropathy, non-diabetic lumbosacral radiculoplexus neuropathy, chronic inflammatory demyelinating polyneuropathy, connective tissue disease, Lyme disease, sarcoidosis, HIV and cytomegalovirusrelated polyradiculopathy.
- Piriformis muscle syndrome with compression of sciatic nerve
- Superior gluteal nerve entrapment syndrome - The clinical diagnosis triad of buttock pain, weakness of hip, abduction and marked tenderness on deep palpation in the region just lateral to the greater schiadic notch
- Lower Extremity
- Greater trochanteric pain syndrome (Greater trochanteric bursitis and gluteus medius tendinopathy)
- Stress fracture of femoral neck, intertrochanteric area, and proximal femur
- Iliopsoas and iliopectineal bursitis and synovitis
- Non-traumatic focal mononeuropathies
- Myositis and myopathy
- Sports related leg pain
- Medial tibial stress syndrome
- Chronic exertional compartment syndrome
- Tendinopathies
- Nerve entrapment syndromes
- Vascular syndromes
- Myopathies
- CRPS
- Restless legs syndrome
- Painful legs and moving toes syndrome
- Nerve entrapment syndromes
- Iliohypogastric (T12, L1), Ilioinguinal (T12, L1), Genitofemoral (L1, L2) - Usually after lower abdominal surgery
- Lateral femoral cutaneous nerve (L2-4)
- Femoral nerve (L2-4) entrapment below the inguinal ligament
- Pelvic procedures with acutely flexed, abducted, and externally rotated positioning
- Saphenous nerve (L3-4) entrapment as it pierces the roof of the adductor canal, by femoral vessels, pes anserine bursitis, varicose vein operations, and medial knee surgery
- Common peroneal neuropathy
- Deep peroneal nerve
- Superficial peroneal nerve
- Proximal tibial entrapment neuropathy
- Distal tibial entrapment
- Sural nerve
- Medial plantar nerve neuropathy
- Inferior calcaneal nerve
- Interdigital neuropathy
- Medial plantar proper digital neuropathy (Joplin's neuroma)