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Sclerotome sidedness

Exit forum ID Forum Discussion Sclerotome sidedness

This topic contains 12 replies, has 3 voices, and was last updated by   Carl Nottoli, DC May 21, 2020 at 2:28 pm.

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  • #9231

    Andrew Wengert
    Participant

      I currently have a patient with an L5-S1 annular fissure to the left of midline.
      Her first order hx matches up perfectly except symptoms are on her right side.
      My question is, Does the side of the damage have to match up with the side of the scleratome’s referral?

      #9232

      Seth Schultz, DC
      Participant

        The sinuvertebral nerve innervates the annulus as a whole to my understanding. If there is damage to the annular fibers that nerve would be stimulated.

        What is the sx quality?

        #9234

        Andrew Wengert
        Participant

          Thank you for helping Seth. Dull, achy, deep, tension

          #9235

          Seth Schultz, DC
          Participant

            So now the question would be why the right side? What other pathology could be present to cause the right side to be symptomatic and not the left.

            #9236

            Carl Nottoli, DC
            Participant

              Great problem solving so far!

              Andrew, what’s to say the annular tears haven’t also migrated to the right as well? How recent are the images from when you had your consultation?

              Can you give the rest of the 7 first order history answers?

              #9237

              Andrew Wengert
              Participant

                63 year old female
                Location ant RIGHT hip and into thigh (near perfect match for S1 sclerotome).
                Quality: dull achy tension on initial
                Now shooting burning
                Intensity: currently 7/10
                Average 7/10
                Worst 8-9/10
                Provocative:
                Laying down in any position (not mentioned on initial but is now worst provocative
                Bending forward
                Sitting
                Coughing/sneezing

                Palliative:
                Laying on side with pillows between legs (slight lessening of symptoms)
                Walking

                All lumbar and hip tests were 100% from a ROM perspective.
                With the exception of
                QLF: 80% 2.5 inches flat L4-S1
                SLPF 4” from floor with reproduced CC
                R SLR and SHF mild reproduction of CC at end ROM

                Palpation: Despite the relatively good function there was 2+ adhesion in both the right and left erectors.

                With such good function I was definitely thinking structure so ordered the MRI right off the bat.

                FASTMAP 100% STRUCTURE + FUNCTION
                MRI 4/29/20:
                L5-S1 Bulge with annular fissure left of midline
                L4-5 minimal bulge Left facet effusion
                L2 small schmorl’s node sup endplate

                Patient did a 5-6 day steroid pack. 1st 3 days felt almost no pain but since then pain returned. 2 Aleve will take edge off now

                #9238

                Carl Nottoli, DC
                Participant

                  Thanks for the information and great job getting the MRI first.

                  While there is clearly multiple disc issues happening, consider looking for unusual things with unusual presentations. The quality of symptoms may also represent a nerve problem. Now instead of only looking at location as a sclerotome, which peripheral nerve supplies that region? I have included a screen shot for you to cross reference.

                  If a nerve is entrapped at the psoas for example, it could potentially follow the similar provocatives and the other ones can be explained from the annular tear. The psoas is active with bending, sitting, coughing/sneezing.

                  I have seen on rare occasions, and discussed in some instructor settings, the possibility of a nerve entrapment along the psoas that doesn’t block KHE. It’s rare.

                  Let us know what you find.

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                  #9242

                  Seth Schultz, DC
                  Participant

                    I’m curious Andy, did you palpate local tissue?

                    #9251

                    Andrew Wengert
                    Participant

                      Carl thank you for your help with this. That chart is really helpful with this and some of my other cases. I would say it closely matches the anterior femoral cutaneous nerve distribution but would also be the lumboinguinal branch of genitofemoral.

                      Seth I’m ashamed to say no. At the time it seemed to match up so well with the sclerotome referral, so I didn’t. I will check psoas and the anterior hip next time the patient comes in.

                      #9254

                      Seth Schultz, DC
                      Participant

                        Awesome, let us know what you find. Looking forward to it.

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