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Lumbosacral Discogenic Pain Syndrome Clinical Presentation

  • Author: Robert E Windsor, MD, FAAPMR, FAAEM, FAAPM; Chief Editor: Craig C Young, MD  more...
 
Updated: Aug 19, 2016
 

History

The history and physical examination findings of the athlete and nonathlete with discogenic or radiculopathic pain are similar.

  • Discogenic pain typically increases with sitting, flexion, coughing, sneezing, or activities that increase intradiscal pressure.
  • Common features of radiculopathy are leg pain in a dermatomal distribution, exacerbation of pain with a sitting position, and amelioration of pain during standing or ambulation. It is typically a flexion, rotation, or combined flexion-rotation injury.[6]
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Physical

Physical examination does not yield significant information when dealing with internal disc derangement. Physical examination of the lumbar spine evaluating for discogenic pain should focus on a mechanical and neurologic examination in an attempt to identify the likely source of back pain (ie, mechanical, neurologic, or discogenic).

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Causes

Causes of internal disc derangement (IDD) usually involve a series of traumatic events ranging in significance from minor disc injuries to more severe types of injuries. The accumulation of the injuries is generally believed to yield the degenerative nature of the annulus, and the lack of integrity is believed to allow water and protein molecules to escape the confines of the nucleus.

The difference between an asymptomatic degenerative disc and one that hurts has been in question. The nucleus pulposus has no nerve supply; however, the outer third of the annulus is innervated. It receives supply from both the gray ramus laterally and anteriorly and from the sinuvertebral nerve posterior and posterolaterally. The current model holds that in some manner, these annular sensory nerves become sensitized, and any turbulence, such as that caused by twisting or weight-bearing, provokes pain. One possibility is that the nuclear proteins become exposed to the system circulation, allowing an autoimmune reaction to the protein and an intense inflammatory process inside the disc.

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Contributor Information and Disclosures
Author

Robert E Windsor, MD, FAAPMR, FAAEM, FAAPM President and Director, Georgia Pain Physicians, PC; Clinical Associate Professor, Department of Physical Medicine and Rehabilitation, Emory University School of Medicine

Robert E Windsor, MD, FAAPMR, FAAEM, FAAPM is a member of the following medical societies: American Academy of Pain Medicine, American Academy of Physical Medicine and Rehabilitation, American College of Sports Medicine, American Medical Association, International Association for the Study of Pain, Texas Medical Association

Disclosure: Nothing to disclose.

Coauthor(s)

Kevin P Sullivan, MD Consulting Staff, The Boston Spine Group

Kevin P Sullivan, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, North American Spine Society, International Spine Intervention Society

Disclosure: Nothing to disclose.

Erik D Hiester, DO Fellow in Interventional Pain Management, Georgia Pain Physicians, Emory University School of Medicine

Erik D Hiester, DO is a member of the following medical societies: American Academy of Family Physicians, American Medical Association, American Osteopathic Association, American Pain Society

Disclosure: Nothing to disclose.

R Blake Windsor, MD Resident Physician, Department of Pediatrics, Boston Children's Hospital and Boston Medical Center

R Blake Windsor, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, Massachusetts Medical Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Henry T Goitz, MD Academic Chair and Associate Director, Detroit Medical Center Sports Medicine Institute; Director, Education, Research, and Injury Prevention Center; Co-Director, Orthopaedic Sports Medicine Fellowship

Henry T Goitz, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine

Disclosure: Nothing to disclose.

Chief Editor

Craig C Young, MD Professor, Departments of Orthopedic Surgery and Community and Family Medicine, Medical Director of Sports Medicine, Medical College of Wisconsin

Craig C Young, MD is a member of the following medical societies: American Academy of Family Physicians, American College of Sports Medicine, American Medical Society for Sports Medicine, Phi Beta Kappa

Disclosure: Nothing to disclose.

Additional Contributors

Andrew D Perron, MD Residency Director, Department of Emergency Medicine, Maine Medical Center

Andrew D Perron, MD is a member of the following medical societies: American College of Emergency Physicians, American College of Sports Medicine, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

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