A 30-year-old female, presents with low back pain, pain at the hip, posterolateral thigh, over the knee, and medial aspect of the leg. There is also presence of numbness over the anteromedial thigh and knee. Weak knee extension along with atrophy of quadriceps is noticed during the physical examination. The knee jerk is also diminished. In this case, what could be the expected level of disc herniation?
Explanation
Answer: A - L3 - L4 could be the expected level of disc herniation if the patient presents with low back pain, pain at hip, posterolateral thigh, over the knee, and medial aspect of the leg and also presence of numbness over the anteromedial thigh and knee along with weak knee extension and atrophy of quadriceps, and diminished knee jerk.
The key points to come to a conclusion in this scenario are the area of pain distribution and the diminished knee jerk.
In L4 - L5 level disc herniation, the pain will be distributed over the sacroiliac region, hip, posterolateral thigh, and anterolateral thigh. Numbness will be present over the lateral leg and first web space. There will be weak dorsiflexion of great toe and also there will be minimal calf muscle atrophy. But no reflex is affected.
In L5 - S1 level disc herniation, the pain will be distributed over the sacroiliac region, hip, posterolateral thigh, and leg. Numbness will be present over the back of the leg, heel, foot, and toe. There will be weak plantarflexion of the great toe and foot. Ankle jerk is diminished or even absent.
