Differential Diagnosis and Treatment for a Patient With Lower Extremity Symptoms

Steven Z. George

The process of differential diagnosis involves the development of working hypotheses concerning dysfunction. These working hypotheses are revised, if necessary, based on the results of a physical examination. Some of the hypotheses to consider for a patient with symptoms involving the posterior thigh include lumbar radiculopathy, hamstring strain or tear, and sciatic nerve irritation. Involvement of the lumbar spine is assessed by evaluating the range and pattern of active lumbar movements. For example, a patient with asymmetrical lumbar sidebending may have facet joint restriction. In addition to range of motion, lumbar movements that centralize or peripheralize lower extremity symptoms are determined. Centralization of symptoms is defined as lumbar spine movements that abolish lower extremity symptoms, or make the symptoms move towards the spine. Peripheralization of symptoms is defined as lumbar spine movements that produce lower extremity symptoms or make the symptoms move farther away from the spine. The purpose of this case problem is to highlight the decision making process involved in determining the treatment of a patient with posterior thigh symptoms. In addition, the method of treatment will be described, and the patient's response to the treatment will be included in this article.

J Orthop Sports Phys Ther. 2000;30(8):468-472.

Key Words: lumbar, posterior thigh symptoms

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