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CASE REPORT
A 41-year-old man gave a 1-week history of very intense lower back pain, which radiated down the right posterolateral thigh, to the anterior tibia and the dorsum of the foot. He had previously undergone a renal transplantation. On examination, Lasègue’s sign was positive on the right. The medial hamstring reflex was absent on the right but normal on the left (figure 1 and online supplemental video). MR scan of lumbar spine showed a voluminous extruded disc herniation with compression of the descending right L5 nerve root (figure 2). Electromyography showed decreased recruitment of motor unit action potentials in the tibialis anterior and gluteus medius muscles (L5 myotomal pattern).
Medial hamstring reflex elicited with the patient prone: The index finger, placed on the medial hamstring tendon above the knee joint, should be struck with a tendon hammer, looking for contraction of the medial hamstring muscles (semitendinosus and semimembranosus).
MR scan of lumbar spine T2-weighted images: (A) sagittal and (B) axial, showing a …
Footnotes
Contributors EGdCN—acquisition of data and literature review. MFG—acquisition of data and literature review. MM—acquisition of data and literature review. BMDC—acquisition of data and literature review. AMH—critical revision of manuscript for intellectual content and study supervision. FTR—critical revision of manuscript for intellectual content and study supervision.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient consent for publication Consent obtained directly from patient(s).
Provenance and peer review Not commissioned. Externally peer reviewed by Robert Hadden, London, UK.
Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.
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