lumbar disc
TRANSCRIPT
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Pathology and TCM Treatmentof the Herniated Lumbar Disc
East West Healing Center
By Dr. Leon Chenwww.eastwesthealingcenter.net
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Definition in Western Medicine
Lumbar intervertebral disc injury leads to
• partial damage to or tears of the annulus
fibrosus• protrusion of the nucleus pulposus
• compression of the spinal nerve roots
• lower back pain, leg pain (including shootingpain)
This is called Lumbar Disc Herniation Syndrome.
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Definition in Traditional
Chinese Medicine (TCM)
• Lumbar Disc Herniation Syndrome is called
―BiZheng痹症” in Traditional Chinese Medicine(TCM).
• The HuangDiNeiJin in 475-221 B.C.(The Yellow
Emperor ’s Internal Classic) discussed the
syndrome of pain in the low back and leg.
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Local anatomy
The Structure of Vertebral Column
The vertebral column in an adult typicallyconsists of 33 vertebrae arranged in five
regions: 7 cervical, 12 thoracic, 5 lumbar,and 5 sacral, and 4 coccygeal. Thevertebral column is considered to have 26vertebrae, because 5 vertebrae are fusedin adults to form the sacrum and 4vertebrae are fused to form the coccyx.
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Curvatures of the Vertebral Column:
The vertebral column appears straight from the
anterior and posterior position. Laterally, it has
three natural curves to balance the body:
cervical, thoracic, and lumbar curves. A straight
line from head to foot should run through the
crossing point of each curvature.
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Physical Purposes of the Curvatures of
the Vertebral Column:
1) To increase the ability of vertebral column to support
weight; and balance the body.
2) To decrease the concussion to protect the head.
3) To strengthen the stability of the standing posture.
4) To spread body weight evenly throughout the
vertebrae and discs.
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41° A
B
C
L3
Measurement of lumbarsacral
angle can be found by drawing a
line along the sacral base (B) and
making a horizontal line (A).Normal values lie between 26-57°
with a mean of 41°.
The lumbar gravity line: the C linefrom center of L3 body by drawing a
vertical line which pass through the
anterior lip of the sacral base (S1), if
this C line does not surpass 10 mm
that is all normal.
lumbarsacral angle
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Structure of Lumbar Vertebrae:
1) Lumbar vertebrae have massive and flat
bodies, because this shape helps to support
more body weight.
2) Each vertebrae includes the vertebral body
(centrum), vertebral foramen, pedicle, lamina,
articular facet, articular process, transverseprocess and spinous process.
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椎体Centrum
椎弓根Pedicle
椎弓板Lamina
横突Transverse process
棘突
Spinous process
椎孔
Vertebral foramen
上关节突Superior articular
process
下关节突 Inferior
articular facet
棘突Spinous process
上关节突Superior
articular process
横突Transverse
process椎体
Centrum
椎弓根
Pedicle
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Intervertebral Disc
椎体 Centrum透明软骨板
Hyaline Cartilage
纤维环 Annulus Fibrosus
纤维环
纤维环
髓核
Nucleus
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Thickness of Intervertebral Discs
The Thickness of IV Disc: total: 139mm.
Cervical IV disc, 3.85 mm.
Thoracic IV disc, 4.03 mm.
Lumbar IV disc, 12.7 mm.
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Function of Intervertebral Discs:
The function of lumbar IV discs is verysimilar to the intervertebral (IV) discs ofthe cervical and thoracic vertebra:
• To bear the weight of the trunk• To connect to the limbs
• To perform normal physical posture and
movement.Lumbar IV discs are the most important in
the vertebral column.
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Structure of the Spinal Canal
1) The spinal canal is a passage, formed by
successive openings in the articulated
vertebrae through which the spinal cord
and its membranes (epidural space) pass. Also called vertebral canal .
2) The spinal canal is made up of the
vertebral foramen, and ligamentum flavum,and posterior longitudinal ligament.
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Biomechanics of the
vertebral column
• The vertebral column has inner balance and
outer balance which helps the body to move in
a balanced way. Normally, both inner and
outer balance of the vertebral column keepsthe body in perfect balance.
1) Inner balance is formed by discs and facet
joints (zygapophysial joints) of vertebrae.
2) Outer balance is formed by dorsal and ventral
muscles.
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身体平衡示意图 Balance of body 颈部 neck
上肢Upper limbs
胸腔thorax
腹腔abdominal cavity
骨盆腔pelvis
下肢 Low limbs
脊柱Vertebral
column
横膈midriff
Upper limb: Balance
Low limb: SupportVertebral Column: Axis
Pelvis: Pivot
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Muscles in the Outer- Balance of
Vertebral Column
1) Dorsal muscles:
• Psoas Major
• Quadratus Lunborum• Sacrospinalis
• Latissimus Dorsi
• Trapezius
• Rhomboideus
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2) Ventral muscles:
• Serratus posterior inferior
• Rectus Abdominis
• Transversus Abdominis
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腰大肌 Psoas Major 腰方肌 Quadratus Lunborum
Iliac crest
T12
L5
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骶棘肌 Sacrospinalis斜方肌 Trapezius
T6
T12
L5Thoracolumbar fascia
背阔肌 Latissimusdorsi
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腹直肌 Rectus abdominis 腹横肌 Transversus abdominis
5
7
Xiphoid
process
pubis
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Psoas Major
Rectus abdominis
Quadratus Lunborum
Latissimus dorsi
Transversus
abdominis
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坐骨神经
Sciatic N
髂腹下神经
Iliohypogastric N
闭孔神经
髂腹沟神经
Ilioinguinal N
生殖股神经
Genitofemoral N
股外侧皮神经
阴部神经
Pudendal N
股神经
Figure of Lumbosacral Plexus
Obturator N
Femoral N
Lateral femoral
cutaneous N
Inguinal
ligament
腹股沟韧带
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Femoral Nerves
• The femoral nerve involves the ventralrami of the spinal nerves of L2-L4.
• Distribution: Skin of anterior and medial
surfaces of thigh, leg, and foot.• Supplies: the anterior muscles of the thigh
(Quadriceps femoris, Sartorius).
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Femoral nerve
Anterior branches Posterior branches
Intermediate
cutaneous nerveSaphenous nerveMedial cutaneous
nerve
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Sensory area of
Femoral N
股神经
Femoral N
股外皮神经
Lateral femoral
cutaneous N
Saphenous
nerve
Intermediate cutaneous
nerve
Medial cutaneous nerve
Sensory area of
Lateral femoral
cutaneous N
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Lateral femoral cutaneous nerve
• The lateral femoral cutaneous nerve
arises from the spinal nerves of L2 and L3,
and travels to innervate the lateral thigh.
It supplies the skin on the lateral aspect ofthe thigh.
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L2
L3
L4
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坐骨神经
坐骨大孔 Greater sciatic notch
闭孔 Obturator foramen
闭孔神经 Obturator N
股骨小结节 Lesser trochanter
Greater trochanter
Tuberosity of ischium
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Sensory area of
Sciatic N
坐骨神经
Sciatic N
腓总神经
Common
Peroneal N胫神经
Tibial N
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Common Peroneal Nerve
• It has branches called the superficial and
deep peroneal nerves.
• The superficial peroneal supplies the
muscles of the lateral compartment of the
leg.
• The deep peroneal supplies the muscles
of the anterior compartment of the leg.
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腓浅N感觉支配区
腓总神经 Common
Peroneal N
腓浅神经
Superficial
nerve
腓深神经
Deep nerve
腓深N感觉支配区
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Tibial Nerve
• The tibial nerve supplies the muscles and
skin on the posterior surface of the leg and
the sole of the foot.
• The tibial nerve gives rise to the sural
nerve (which supplies the skin on the back
of the leg) and ends on the sole of the foot
as the medial and lateral plantar nerves.
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感觉支配区
胫神经
Tibial N
腓总神经
Common Peroneal N
胫神经
Tibial N
足底外侧神经
Lateral plantar N
足底内侧神经
Medial plantar N
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Location of vertebrae in relation to the
conus medullaris
• Cervical: Cervical vertebrae: the number of the vertebra plus onecorresponds to the number of cervical conus medullaris.
• Thoracic:Upper thoracic vertebrae: the number plus two corresponds to thenumber of the thoracic conus medullaris.
Lower thoracic vertebrae: the number plus three corresponds to thenumber of the thoracic conus medullaris.
• Lumbar vertebrae: correspond to the number 1~5 of sacral conus
medullaris.
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Intervertebral Disc and Nerve Roots
LV5
SV1
LV4
LV3
SN1
LN5
LN4
LN3
LV2
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S2
S1
45
C3
4
5 67
8
3
45
C
S2
L1
L2
L3
L4
L5
S1
T1
T1 23
12
4 56
78
910
11
C5
C6C8
C7
C8
C7
C6
S2
L5
L4
L5
L4
L5L4
3
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Patterns of Disc Herniation
• Three patterns differentiated by thecondition of nucleus pulposus herniation
• Five patterns differentiated by the location
and direction of nucleus pulposusherniation
• Two patterns differentiated by ligamentdamage
• Three patterns differentiated bypathological stages of nucleus pulposus
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椎间盘退化
膨隆型
破裂型
游离型
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髓核
纤维环
脊髓
神经根
椎间盘膨隆
protrusion or bulging
破裂椎间盘
游离椎间盘 sequestration
正常椎间盘 Normal disc
破裂型 extrusion
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Five patterns differentiated by the location
and direction of nucleus pulposus herniation
• Herniation of the nucleus pulposus can happenin the anterior , posterior , or lateral direction or in all four directons. Also there is a form ofherniation called herniation inside of thevertebral body.
• Posterior herniation is divided into two patterns:posteriolateral herniation and posteriocentralherniation.
P t i h i ti
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Posterior herniation
Posterolateral Herniation Posterocentral Herniation
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Distribution of Disc Herniations and Their Frequency
The picture is in the
frontal plane
额状面(切掉椎体)
Spinal cord compression
Pedicle section
椎弓根截面
Ligamentum flavum
Disc compression at
medial side below
nerve rootDisc compression at
lateral side above of
nerve root
Side of spinal cord
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Disc herniation inside vertebral body
Nucleus of disc
Schmorl’s
Node
The nucleus of disc
drills through the
hyaline cartilage into
vertebral body
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Two patterns differentiated by damage to
the posterior longitudinal ligament
• Subligamentous extrusion: the posterior
longitudinal ligament has not been torn,
but there is disc protrusion.• Transligamentous extrusion: the disc has
torn through the posterior longitudinal
ligament pressing on the nerve root orspinal cord, and there is disc extrusion.
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Spinal cord
Nerve root
Posterior longitudinal
ligament
nucleus
pulposus
The posterior longitudinal ligament is intact
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The posterior longitudinal ligament is torn
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The posterior longitudinal ligament is torn
and the nucleus pulposus is fragmented
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后纵韧带 Posterior
longitudinal
Ligament前纵韧带
Anterior
Longitudinal
Ligament
受压的神经根
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Three characteristic pathological
evolutionary stages of the nucleuspulposus
1) Pre-herniation.
2) Herniation.
3) Post-herniation.
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IV Etiology
1) Age and sex: Mostly it affects people in
middle age(30-50),males more than
females.
2) Location: Mainly occurs at L4-5 and atL5-S1, and secondarily at L3-L4 or L2-L3.
3) Causes: 1)Degeneration of the disc.
2)Injury
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Disc
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Ⅴ Diagnosis
Symptoms:
1) Low back pain: The pain is mainly
located in the lower back area; the back
pain results from pressure on the
posterior longitudinal ligaments and
periphery of the annulus fibrosus. The
painful area is deep, and it is usually dullpain or severe, acute pain.
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2) Shooting pain in the legs:
Lumbar disc herniation often occurs at the L4-5or L5-S1 level, causing lower back and and hip
pain radiating down the thigh on the lateral and
posterior sides, down the lateral side of the
lower leg, and to the medial and or lateral sideof the foot, and toes. Coughing or sneezing
can aggravate the pain, causing shooting pain
down the lower limbs.
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S2
S1
45
C3
45
6 78
3
45
C
S2
L1
L2
L3
L4
L5
S1
T1
T1 23
12
4 56
78
910
11
C5
C6C8
C7
C8
C7
C6
S2
L5
L4
L5
L4
L5L4
3
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4) Abnormal spinal curvature:
• After the lumbar disc herniation, 64% patientshave abnormal spinal curvature. The curve of the
vertebral column is the body’s way of protecting
against low back pain and leg pain. Lateral
curvature can relax the nerve root and relieve
pain.
• Clinically, disc protrusion is generally at thelateral side above the nerve root (45%) A few
disc protrusions are at the medial side below the
nerve root (7%)
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Distribution of Disc Herniations and Their Frequency
The picture is in the
frontal plane
额状面(切掉椎体)
Spinal cord compression
Pedicle section
椎弓根截面
Ligamentum flavum
Disc compression of
medial side below
the nerve rootThe disc presses at
lateral side above
nerve root
Side of spinal cord
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How to measure the curve
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How to measure the curve
of the vertebral column
• To measure the curvature of the spinal
column, first find the centers of the two
areas of greatest curvature. Draw a
straight line throught these centers; from
these lines, create a perpendicular (90°)
line; cross both perpendicular lines and
you will get the measure of the curve.
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Ⅵ Special Examination
1) Mobility of Lumbar Vertebral Column:
Normal range of motion
Flexion 90°
Extension 30°
Side bend 20°-30°
Twist 30°
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3) Abnormal tendon reflexes
• If the lumbar disk is herniated, the knee tendon reflex
or Achilles tendon reflex can be weak, absent, orexcessive.
• If the herniation is at L3-L4, the knee tendon reflex
can be weak or absent, and foot extension is weak;
• If herniation is at L4-L5, the knee tendon reflex and
Achilles tendon reflex is normal but toe extension is
weak;
• If herniation is at L5-S1, the Achilles tendon reflexbecomes weak or absent, and foot flexion becomes
weak.
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4) Lasegue’s test: (Supine) If there is pain in the
lumbar area and lateral leg on performing a straight
leg raise up to 70° and dorsiflexing the foot, the test ispositive.
5) Kernig’s test: (Supine) While bending the hip joint
and knee joint to 90° degrees, then extending theknee, if pain is induced, the test is positive.
6) Wasserman’s test: (Prone) The hip joint is over-
extended. If pain presents at the anterior border of the
thigh, the test is positive.
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Lasegue Test
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Lindner Test
Ⅶ I i E i ti
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Ⅶ Imaging Examination
1) X-ray:
• The joint space between vertebrae is
uneven.
• The vertebral foramen is narrowed
• There is bone spurring.
• There is spondylolysis--a defect in the
pars interarticularis of a vertebra.
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L3
L4
S1
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2) CT Scans and MRI’s provide
clear images to examine bone,water, fat, muscle, blood, tendon,
ligament, etc.
CT and MRI have three views: axial
(transverse), sagittal and frontal planes.
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L2
L3
L4
L5
S1
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Ⅷ Differential Diagnosis
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Ⅷ Differential Diagnosis
1 Acute lumbar injury2 Lumbar spinal stenosis
3 Piriformis syndrome
4 Sciatic neuritis
5 Spinal tumors6 Sacroiliac joint injury
7 Third lumbar transverse process syndrome
8 Pelvic inflammatory disease
9 Entrapment syndrome of superior cluneal nerve
10 Entrapment syndrome of lateral femoral cutaneousnerve
11 Greater trochanter bursitis
12 Entrapment syndrome of common peroneal nerve
1 Acute Lumbar Injury
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1. Acute Lumbar Injury
Acute lumbar injury is caused when:
• The waist is flexed
• The waist is rotated
• Lifting too much weight unbalances the
lumbar muscles and creates subluxation of
the lumbar facet joints, or lumbar muscle
sprain.
Diagnosis Points of Acute
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Lumbar Injury
Indications of lumbar injury
1) The pain is mostly in the lower back. Sometimesthe pain affects the leg, but there is no shooting
pain in sciatic nerve distribution.2) Pain is aggravated by movement, alleviated by
rest.
3) An obvious tender area is easy to find.
4) CT or MRI does not show a disc herniation.
2 Lumbar Spinal Stenosis
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2. Lumbar Spinal Stenosis
Lumbar spinal stenosis can be caused by:• Tumors and herniated discs
• Degenerative changes (most common
cause) that occur with aging, e.g. arthritis• Degenerative effects-- Narrowing of spinal
canal causes pressure on the spinal cordor spinal nerve roots. This pressure canlead to many problems that often occurwith long periods of walking or standing.
• Diagnosis points of Lumbar
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Spinal Stenosis
1) Lumbar spinal stenosis occurs with aging.Males are affected slightly more than females.
2) Lumbar spinal stenosis occurs mainly in the
L3 - S1 region.3) Lower back pain or leg pain often occurs when
walking or standing for long periods.
4) Intermittent claudication.
5) X-ray, CT or MRI can locate the areas of
compression of the spinal canal.
Lumbar Spinal Stenosis Figure
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3 Piriformis Syndrome
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3. Piriformis Syndrome
• The piriformis syndrome is a condition inwhich the piriformis muscle irritates the
sciatic nerve, causing pain in the buttocks
and leg, with referred pain, commonlycalled sciatica, along the course of the
sciatic nerve.
Diagnosis points of Piriformis
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Syndrome
1) History of injury to the buttocks.
2) Patients generally complain of pain deep in the
buttocks, which is made worse by sitting,
climbing stairs, or performing squats.3) No low back pain or spinal column curvature.
4) Special examination will be positive.
5) CT or MRI does not show a herniated disc.
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4 Sciatic Neuritis
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4. Sciatic Neuritis
Sciatic pain mainly is caused by viralinfection, which damages the sciatic
nerve. This is also called sciatic neuritis,
and isn’t commonly seen clinically.
5 Spinal Tumors
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5. Spinal Tumors
• The cause of pain may be a spinal tumor— a cancerous or noncancerous growth
that develops within or near the spinal
cord or in the bones of the spine.• In most areas of the body, noncancerous
tumors aren't particularly worrisome. But
in the vertebrae both kinds of tumors areof concern.
6 Sacroiliac Joint Injury
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6. Sacroiliac Joint Injury
• The sacroiliac joint (SI joint) is a firm, small joint that lies at the junction of the spine
and the pelvis. Most often when we think
of joints, we think of knees, hips, andshoulders--joints that are made to undergo
motion. The sacroiliac joint does not move
much, but it is critical to transferring theload of your upper body to your lower
body.
Diagnosis Points of Sacroiliac
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Joint Injury
1) Indication of lumbar injury2) Pregnancy or delivery may injure the SI
joint
3) Pain on one side lower back, without legpain.
4) Faber’s test (―4‖ character test ) ispositive.
5) Studies (X-Rays, MRIs, CAT Scans,Bone Scans) are often normal
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Diagnosis points of the third lumbar
t d
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transverse process syndrome
1) The pain can be on one or both sides ofthe third lumbar region, and may radiate tothe posteriolateral part of the thigh insevere cases.
2) The patient is unable to sit and stand forlong, with pain aggravated on sitting orstanding and alleviated after rest.
3) A longer or normal transverse process ofthe third lumbar vertebra is shown in theX-ray or MRI film.
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8. Pelvic inflammatory disease
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8. Pelvic inflammatory disease
Pelvic inflammatory disease (PID) is ageneral term that refers to infection of the
uterus, fallopian tubes and bladder.
The inflammation can irritate tissues andmuscle, causing lower back pain.
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Diagnosis points of entrapment syndrome of
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g p p y
superior cluneal nerve
1) Indication of injury to lumbosacral area.
2) The pain occurs in the specific area of the nerve
and radiates to the lateral thigh.
3) Bending the waist and walking causes pain.
Also, changing posture from sitting to standing is
difficult.
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The dorsal cutaneous
rami nerves
Latissimus dorsi
Trapezius
Gluteus maximus
Gluteus medius
Superior cluneal nerve
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Diagnosis points of entrapment syndrome of
the lateral femoral cutaneous nerve
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the lateral femoral cutaneous nerve
1) This syndrome is most commonly seen in individualsaged 20-60 years, but it can occur in people of all ages.
2) Sports injuries such as trauma or muscle tears of thelower abdominal muscles may also result in injury to
the nerve.3) It may also occur during pregnancy due to the rapidlyexpanding abdomen in the third trimester.
4) It may also be caused by injury from surgicalprocedures.
5) There is pain on deep palpation just below the anteriorsuperior iliac spine and from hip extension.
6) The pain is at the lateral thigh or anterolateral thighand down to the knee and also sometimes in theinguinal region.
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Lateral femoral cutaneous N
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Femoral N
Lateral femoral
cutaneous N
Femoral N
11. Greater trochanteric bursitis
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• Greater trochanteric bursitis ischaracterized by painful inflammation of
the bursa located just superficial to the
greater trochanter of the femur.• Patients typically complain of lateral hip
pain, although the hip joint itself is not
involved. Pain may radiate down thelateral aspect of the thigh.
Diagnosis points of greater
trochanter bursitis
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trochanter bursitis
1) With acute trauma, patients may recall specific detailsof the impact.
2) The classic symptom is pain at the greater trochantericregion at the lateral hip.
3) Pain may radiate down the lateral aspect of the
ipsilateral thigh. Pain usually does not radiate all theway into the foot.
4) Typically, symptoms worsen when the patient is lyingon the affected bursa (eg, lying in the lateral decubitusposition).
5) Pain may awaken the patient at night.6) Palpation also may reproduce pain that radiates down
the lateral thigh, but it does not go below the knee.
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Greater trochanter
12. Entrapment Syndrome of
Common Peroneal Nerve
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Common Peroneal Nerve
• The common peroneal nerve courses aroundthe fibular neck and passes through the fibro-osseous opening in the superficial head of theperoneus longus muscle. This opening can be
quite tough and result in the nerve passingthrough it at an acute angle.
• The common peroneal nerve gives off 2branches: the superficial peroneal nerve (the
lateral cutaneous nerve of the calf ) and deepperoneal nerve (the sural communicatingbranch nerve )
• Diagnosis Points of Entrapment Syndrome
of Common Peroneal Nerve
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of Common Peroneal Nerve
1) Peroneal nerve injuries are most commonperipheral nerve injuries in the lower limb after
multiple traumatic injuries.
2) Chronic compression injury is the cause.
3) The loss of sensation in the cutaneous
distribution of the superficial and deep
peroneal nerves may be noted, but ankle
dorsiflexion weakness is often of most concernto the patients.
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Deep
peroneal N
area
Common
peroneal N
areaSuperficial
peroneal N
area
Deep
peroneal N
Superficialperoneal N
Common
peroneal N
Ⅸ TCM Treatment of Disc
Herniation
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Herniation
TCM treats the herniated lumbar disc withthree methods:
• TuiNa
• Acupuncture
• Herbs.
According to Chinese medical research,
70% of herniated lumbar discs showsgood results with TCM treatments
TuiNa Actions
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1) Reduce the pain.2) Increase blood circulation in specific
areas.
3) Relax the muscles, activate the channels.
4) Reduce muscle spasm.
5) Repair damaged soft tissue.
6) Adjust joints.
Modern Research of TuiNa
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1) Increases content of Beta-endorphin(END) and Catecholamine (CA) in blood to
help reduce pain.
2) Decreases content of 5-hydroxytryptamine (5-HT) in the blood, to
reduce pain.
TuiNa Methods
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1. Single manipulation:1) Tui: pushing.①Finger pushing.②Palm pushing.③
Twin palms pushing.
2) Na: Grasping.① Fingers.② Twin palms.
3) An: pressing.① Finger pressing.② Palm pressing.
③ Elbow pressing.4) Mo: Rubbing.
5) Rou: Kneading.
6) Gun: Rolling.① Side fist.② Fist.
7) Dou: Shaking.8) Da: Patting and pounding.
2 Combined manipulation:
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2. Combined manipulation:
1)GunRou: Rolling and Kneading.
2)NaRou: Grasping and Kneading.
3)Wave: Grasping, Pushing and Rolling.
4)AnRou: Pressing and Kneading.
3 Manipulation of joints:
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3. Manipulation of joints:
1) BaShen: Counter traction.①Jointtraction.②Cervical traction.③ Lumbar
traction.
2) BanFa: Adjustment of joints.3) YaoHuang: Rotating.
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牵引按压法
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俯卧斜扳
法
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侧卧斜扳法
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坐位斜扳法 双人扳法 单人扳法
• Differentiation and Treatment of TCM
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1. Wind-cold-damp pattern:May or may not have history of injury
Lumbar area and legs feel cold, painful and
heavy;If pain is chronic, symptoms are sometimes
severe, sometimes mild, worsened by
cloudy and rainy weather.
Tongue: white and greasy
Pulse: heavy and slow.
• Acupuncture: BL23 YaoYan BL40 GB30
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Acupuncture: BL23 YaoYan BL40 GB30
GB31 GB34 BL55 GB39; evenly
supplement and reducing, needle retaining
20 minutes, with moxibustion or TDP.
• Herbal Treatment: Du Hu Ji Sheng Tang,Xiao Huo Luo Tang etc.
2. Qi and Blood Stagnation Pattern:
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g
• History of injury• Lower back pain occurs right after the
injury, worse with movement,
gradually radiating pain in lower limb;
• Tongue: dark red
• Pulse: hesitant or wiry and rapid.
• Acupuncture Treatment: Yaoyan BL40
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p y
GB30 GB31 GB 32 GB34 BL55 ST36
GB39; reducing technique; no needleretaining; with cold compress.
• Herbal Treatment: Yuan Hu Zhi Tong Tang,
Shen Tong Zhi Tong Tang and so on.
Ⅹ Cautions and Contraindications
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• At the acute stage, don’t use heavy manipulation,better to use rest, traction, acupuncture andherbs .
• Surgery if one of the following happens:
①If the symptoms are very severe, occurrepeatedly in one year, alternative treatment isnot working.
②Central herniation, with compression to caudaequina nerves that cause sphincter dysfunction.
③Nerve root compression with the numbness andfoot drop.
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Thank you
Phone:630-916-0781
E-mail: [email protected]
Web:www.eastwesthealingcenter.net