01 THE PHENOTYPE
PAIN ≠ IMPAIRMENT
NEURAL FUNCTION / 001
decoded.
SCIATICA
Radicular pain and impaired root function
can occur independently.
CONCEPTUAL SCULPTURE / NOT A CLINICAL IMAGE
01—08
02 THE PATHWAY
Root.
Plexus.
Nerve.
L4–S3SACRAL PLEXUSSCIATIC NERVE
Connected structures.
Different localisations.
01 / ROOT LEVEL ≠ DISC LEVELCONCEPTUAL NERVE STUDY / PATHWAY SCHEMATIC IN NOTES
03 BEYOND COMPRESSION
Under
pressure.
+MECHANICAL LOAD
Compression and inflammation interact.
Imaging severity is not symptom severity.
more than forceGLASS STUDY / A VISUAL METAPHOR, NOT ANATOMY
04 CONVERGENCE
Read the
overlap.
L4Knee extension
L5Great-toe extension
S1Plantarflexion
Combine sensation, strength and reflexes.
Patterns overlap.
MOTOR CONTRIBUTION TRACES / SCHEMATIC, NOT TO SCALE
05 THE ALTERNATIVES
LOOK
BEYOND.
HIPPERIPHERAL NERVEREFERRED PAIN
Leg pain has more than one origin.
Let discordance widen the examination.
X-RAY-INSPIRED NERVE STUDY / NOT DIAGNOSTIC IMAGING
06 THE QUESTION BEFORE THE TEST
Test for
a reason.
FIG. 06 / ILLUSTRATIVE STUDYMRISelected structural questions
EMG / NCSPhysiology and localisation
Investigate when the result
can change the next decision.
NOT A DIAGNOSTIC IMAGE / NO ROUTINE EARLY MRI FOR UNCOMPLICATED PRESENTATIONS
07 CARE & THE COURSE
a way forwardBack to
function.
Support activity and functional goals.
Recovery varies. Reassess the course.
CARE / REASSESS / SELECTCONCEPTUAL NERVE SCULPTURE / NO RECOVERY PROMISE IMPLIED
08 THE EXCEPTION THAT CANNOT WAIT
recognise. then
ACT.
01New bladder, bowel
or sexual dysfunction
02Altered perineal sensation
03Severe or progressive
bilateral neurological deficits
Immediate assessment for cauda equina syndrome.Activate the local emergency MRI and spinal pathway.
Do not await every sign. Progressive motor loss also needs urgent escalation.
CLINICIAN EDUCATION / APPLY CURRENT LOCAL PATHWAYS
