Spinal stenosis physical examination: Difference between revisions

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Latest revision as of 04:16, 15 February 2019

,Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mohamadmostafa Jahansouz M.D.[2]

Overview

Patients with spinal stenosis usually appear normal. Patients with spinal stenosis usually have a normal vital signs.Physical examination of patients with spinal stenosis may be remarkable for: Neck pain and tenderness, Lower back pain and tenderness, Scrotal and perianal claudication, Hyperreflexia, positive Romberg test, decrease in upper extremity sensation, weak knee and ankle reflexes, leg muscle weakness bilaterally, positive straight leg raise test, abnormal gait, bilateral calf muscle atrophy, weak knee and ankle reflexes and muscle atrophy.

Physical Examination

Physical examination of patients with spinal stenosis may be remarkable for: Neck pain and tenderness, Lower back pain and tenderness, Scrotal and perianal claudication, Hyperreflexia, positive Romberg test, decrease in upper extremity sensation, weak knee and ankle reflexes, leg muscle weakness bilaterally, positive straight leg raise test, abnormal gait, bilateral calf muscle atrophy, weak knee and ankle reflexes and muscle atrophy.

Spinal stenosis is more likely when^[1]:

Age over 60 years
Positive 30-second extension test
Negative straight leg test
Pain in both legs
Leg pain relieved by sitting
Leg pain decreased by leaning forward or flexing the spine

Appearance of the Patient

Patients with spinal stenosis usually appear normal.

Vital Signs

Patients with spinal stenosis usually have a normal vital signs.

Skin

Skin examination of patients with spinal stenosis is usually normal.

HEENT

HEENT examination of patients with spinal stenosis is usually normal.

Neck

In patients with cervical spinal stenosis, neck physical examination may be positive for:
- Neck pain and tenderness^[2]^[3]

Lungs

Pulmonary examination of patients with spinal stenosis is usually normal.

Heart

Cardiovascular examination of patients with spinal stenosis is usually normal.

Abdomen

Abdominal examination of patients with spinal stenosis is usually normal.

Back

Back examination of patients with spinal stenosis is usually positive for:
- Lower back pain and tenderness^[4]^[5]

Genitourinary

Genitourinary examination of patients with spinal stenosis is usually positive for:
- Scrotal and perianal claudication^[6]

Neuromuscular

Neuromuscular examination of patients with spinal stenosis is usually positive for:
- Hyperreflexia^[7]^[8]^[9]
- positive Romberg test
- Decrease in upper extremity sensation^[8]^[9]
- Weak knee and ankle reflexes^[9]
- Leg muscle weakness bilaterally^[9]
- Positive straight leg raise test^[10]
- Abnormal gait^[11]

Extremities

Extremities examination of patients with spinal stenosis is usually positive for:
- Bilateral calf muscle atrophy^[12]
- Weak knee and ankle reflexes^[12]
Muscle atrophy

References

↑ Genevay S, Courvoisier DS, Konstantinou K, Kovacs FM, Marty M, Rainville J; et al. (2018). "Clinical classification criteria for neurogenic claudication caused by lumbar spinal stenosis. The N-CLASS criteria". Spine J. 18 (6): 941–947. doi:10.1016/j.spinee.2017.10.003. PMID 29031994.
↑ Meyer F, Börm W, Thomé C (2008). "Degenerative cervical spinal stenosis: current strategies in diagnosis and treatment". Dtsch Arztebl Int. 105 (20): 366–72. doi:10.3238/arztebl.2008.0366. PMC 2696878. PMID 19626174.
↑ Kukurin GW (2004). "The amelioration of symptoms in cervical spinal stenosis with spinal cord deformation through specific chiropractic manipulation: a case report with long-term follow-up". J Manipulative Physiol Ther. 27 (5): e7. doi:10.1016/j.jmpt.2004.04.009. PMID 15195045.
↑ Kuramoto A, Chang L, Graham J, Holmes S (2011). "Lumbar spinal stenosis with exacerbation of back pain with extension: a potential contraindication for supine MRI with sedation". J Neuroimaging. 21 (1): 92–4. doi:10.1111/j.1552-6569.2009.00382.x. PMC 3157482. PMID 19490371.
↑ Genevay S, Atlas SJ (2010). "Lumbar spinal stenosis". Best Pract Res Clin Rheumatol. 24 (2): 253–65. doi:10.1016/j.berh.2009.11.001. PMC 2841052. PMID 20227646.
↑ Oh JY, Tan JH, Teo TW, Hee HT (2015). "Spinal stenosis presenting with scrotal and perianal claudication". Asian Spine J. 9 (1): 103–5. doi:10.4184/asj.2015.9.1.103. PMC 4330204. PMID 25705342.
↑ Park MS, Moon SH, Kim TH, Oh JK, Lyu HD, Lee JH; et al. (2015). "Asymptomatic Stenosis in the Cervical and Thoracic Spines of Patients with Symptomatic Lumbar Stenosis". Global Spine J. 5 (5): 366–71. doi:10.1055/s-0035-1549031. PMC 4577327. PMID 26430589.
↑ ^8.0 ^8.1 Akhavan-Sigari R, Rohde V, Alaid A (2013). "Cervical spinal canal stenosis and central disc herniation c3/4 in a man with primary complaint of thigh pain". J Neurol Surg Rep. 74 (2): 101–4. doi:10.1055/s-0033-1349202. PMC 3836946. PMID 24303344.
↑ ^9.0 ^9.1 ^9.2 ^9.3 Kim KT, Ahn SW, Kwon JT, Kim YB (2011). "Leg weakness in a patient with lumbar stenosis and adrenal insufficiency". J Korean Neurosurg Soc. 49 (4): 234–6. doi:10.3340/jkns.2011.49.4.234. PMC 3098429. PMID 21607184.
↑ Tabesh H, Tabesh A, Fakharian E, Fazel M, Abrishamkar S (2015). "The effect of age on result of straight leg raising test in patients suffering lumbar disc herniation and sciatica". J Res Med Sci. 20 (2): 150–3. PMC 4400709. PMID 25983767.
↑ Kim YS, Park SJ, Oh IS, Kwan JY (2009). "The clinical effect of gait load test in two level lumbar spinal stenosis". Asian Spine J. 3 (2): 96–100. doi:10.4184/asj.2009.3.2.96. PMC 2852081. PMID 20404954.
↑ ^12.0 ^12.1 Kim KT, Ahn SW, Kwon JT, Kim YB (2011). "Leg weakness in a patient with lumbar stenosis and adrenal insufficiency". J Korean Neurosurg Soc. 49 (4): 234–6. doi:10.3340/jkns.2011.49.4.234. PMC 3098429. PMID 21607184.

Template:WH Template:WS

[pmid29031994-1] Genevay S, Courvoisier DS, Konstantinou K, Kovacs FM, Marty M, Rainville J; et al. (2018). "Clinical classification criteria for neurogenic claudication caused by lumbar spinal stenosis. The N-CLASS criteria". Spine J. 18 (6): 941–947. doi:10.1016/j.spinee.2017.10.003. PMID 29031994.

[pmid196261742-2] Meyer F, Börm W, Thomé C (2008). "Degenerative cervical spinal stenosis: current strategies in diagnosis and treatment". Dtsch Arztebl Int. 105 (20): 366–72. doi:10.3238/arztebl.2008.0366. PMC 2696878. PMID 19626174.

[pmid151950452-3] Kukurin GW (2004). "The amelioration of symptoms in cervical spinal stenosis with spinal cord deformation through specific chiropractic manipulation: a case report with long-term follow-up". J Manipulative Physiol Ther. 27 (5): e7. doi:10.1016/j.jmpt.2004.04.009. PMID 15195045.

[pmid194903712-4] Kuramoto A, Chang L, Graham J, Holmes S (2011). "Lumbar spinal stenosis with exacerbation of back pain with extension: a potential contraindication for supine MRI with sedation". J Neuroimaging. 21 (1): 92–4. doi:10.1111/j.1552-6569.2009.00382.x. PMC 3157482. PMID 19490371.

[pmid202276462-5] Genevay S, Atlas SJ (2010). "Lumbar spinal stenosis". Best Pract Res Clin Rheumatol. 24 (2): 253–65. doi:10.1016/j.berh.2009.11.001. PMC 2841052. PMID 20227646.

[pmid257053422-6] Oh JY, Tan JH, Teo TW, Hee HT (2015). "Spinal stenosis presenting with scrotal and perianal claudication". Asian Spine J. 9 (1): 103–5. doi:10.4184/asj.2015.9.1.103. PMC 4330204. PMID 25705342.

[pmid264305892-7] Park MS, Moon SH, Kim TH, Oh JK, Lyu HD, Lee JH; et al. (2015). "Asymptomatic Stenosis in the Cervical and Thoracic Spines of Patients with Symptomatic Lumbar Stenosis". Global Spine J. 5 (5): 366–71. doi:10.1055/s-0035-1549031. PMC 4577327. PMID 26430589.

[pmid243033442-8] 8.0 ^8.1 Akhavan-Sigari R, Rohde V, Alaid A (2013). "Cervical spinal canal stenosis and central disc herniation c3/4 in a man with primary complaint of thigh pain". J Neurol Surg Rep. 74 (2): 101–4. doi:10.1055/s-0033-1349202. PMC 3836946. PMID 24303344.

[pmid216071842-9] 9.0 ^9.1 ^9.2 ^9.3 Kim KT, Ahn SW, Kwon JT, Kim YB (2011). "Leg weakness in a patient with lumbar stenosis and adrenal insufficiency". J Korean Neurosurg Soc. 49 (4): 234–6. doi:10.3340/jkns.2011.49.4.234. PMC 3098429. PMID 21607184.

[pmid259837672-10] Tabesh H, Tabesh A, Fakharian E, Fazel M, Abrishamkar S (2015). "The effect of age on result of straight leg raising test in patients suffering lumbar disc herniation and sciatica". J Res Med Sci. 20 (2): 150–3. PMC 4400709. PMID 25983767.

[pmid204049542-11] Kim YS, Park SJ, Oh IS, Kwan JY (2009). "The clinical effect of gait load test in two level lumbar spinal stenosis". Asian Spine J. 3 (2): 96–100. doi:10.4184/asj.2009.3.2.96. PMC 2852081. PMID 20404954.

[pmid21607184-12] 12.0 ^12.1 Kim KT, Ahn SW, Kwon JT, Kim YB (2011). "Leg weakness in a patient with lumbar stenosis and adrenal insufficiency". J Korean Neurosurg Soc. 49 (4): 234–6. doi:10.3340/jkns.2011.49.4.234. PMC 3098429. PMID 21607184.

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@@ Line 1: / Line 1: @@
 __NOTOC__
 {{Spinal stenosis}}
-{{CMG}}
+,{{CMG}}; {{AE}}{{MMJ}}
 ==Overview==
+Patients with spinal stenosis usually appear normal. Patients with spinal stenosis usually have a normal vital signs.Physical examination of patients with spinal stenosis may be remarkable for: Neck pain and tenderness, [[Lower back pain]] and tenderness, [[Scrotal]] and [[perianal]] [[claudication]], [[Hyperreflexia]], positive [[Romberg's test|Romberg test]], decrease in upper extremity [[sensation|sensation,]] weak knee and [[ankle]] reflexes, leg [[muscle]] weakness bilaterally, positive straight [[leg]] raise test, abnormal [[gait|gait,]] bilateral [[Calf muscle|calf muscle atrophy]], weak [[knee]] and [[Ankle reflex|ankle reflexes]] and muscle [[atrophy]].
 ==Physical Examination==
-During the physical exam, the doctor will try to pinpoint the location of the pain and figure out how it affects your movement. You will be asked to:
-* Sit, stand, and walk. While you walk, your doctor may ask you to try walking on your toes and then your heels.
+Physical examination of patients with spinal stenosis may be remarkable for: Neck pain and tenderness, [[Lower back pain]] and tenderness, [[Scrotal]] and [[perianal]] [[claudication]], [[Hyperreflexia]], positive [[Romberg's test|Romberg test]], decrease in upper extremity [[sensation|sensation,]] weak knee and [[ankle]] reflexes, leg [[muscle]] weakness bilaterally, positive straight [[leg]] raise test, abnormal [[gait|gait,]] bilateral [[Calf muscle|calf muscle atrophy]], weak [[knee]] and [[Ankle reflex|ankle reflexes]] and muscle [[atrophy]].
-* Bend forward, backward, and sideways.
-* Lift your legs straight up while lying down. If the pain is worse when you do this, you may have sciatica, especially if you also feel numbness or tingling in one of your legs.
+Spinal stenosis is more likely when<ref name="pmid29031994">{{cite journal| author=Genevay S, Courvoisier DS, Konstantinou K, Kovacs FM, Marty M, Rainville J et al.| title=Clinical classification criteria for neurogenic claudication caused by lumbar spinal stenosis. The N-CLASS criteria. | journal=Spine J | year= 2018 | volume= 18 | issue= 6 | pages= 941-947 | pmid=29031994 | doi=10.1016/j.spinee.2017.10.003 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29031994  }} </ref>:
+* Age over 60 years
+* Positive 30-second extension test
+* Negative straight leg test
+* Pain in both legs
+* Leg pain relieved by sitting
+* Leg pain decreased by leaning forward or flexing the spine
+===Appearance of the Patient===
+*Patients with spinal stenosis usually appear normal.
+===Vital Signs===
+*Patients with spinal stenosis usually have a normal vital signs.
-Your doctor will also move your legs in different positions, including bending and straightening your knees. All the while, the doctor is assessing your strength, as well as your ability to move.
+===Skin===
+* Skin examination of patients with spinal stenosis is usually normal.
-To test nerve function, the doctor will use a rubber hammer to check your reflexes. Touching your legs in many locations with a pin, cotton swab, or feather tests your sensory nervous system (how well you feel). Your doctor will instruct you to speak up if there are areas where the sensation from the pin, cotton, or feather is duller.
+===HEENT===
+*HEENT examination of patients with spinal stenosis is usually normal.
+===Neck===
+*In patients with cervical spinal stenosis, neck physical examination may be positive for:
+**Neck pain and tenderness<ref name="pmid196261742">{{cite journal| author=Meyer F, Börm W, Thomé C| title=Degenerative cervical spinal stenosis: current strategies in diagnosis and treatment. | journal=Dtsch Arztebl Int | year= 2008 | volume= 105 | issue= 20 | pages= 366-72 | pmid=19626174 | doi=10.3238/arztebl.2008.0366 | pmc=2696878 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19626174  }}</ref><ref name="pmid151950452">{{cite journal| author=Kukurin GW| title=The amelioration of symptoms in cervical spinal stenosis with spinal cord deformation through specific chiropractic manipulation: a case report with long-term follow-up. | journal=J Manipulative Physiol Ther | year= 2004 | volume= 27 | issue= 5 | pages= e7 | pmid=15195045 | doi=10.1016/j.jmpt.2004.04.009 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15195045  }}</ref>
+===Lungs===
+*Pulmonary examination of patients with spinal stenosis is usually normal.
+===Heart===
+*Cardiovascular examination of patients with spinal stenosis is usually normal.
+===Abdomen===
+*Abdominal examination of patients with spinal stenosis is usually normal.
+===Back===
+*Back examination of patients with spinal stenosis is usually positive for:
+**[[Lower back pain]] and tenderness<ref name="pmid194903712">{{cite journal| author=Kuramoto A, Chang L, Graham J, Holmes S| title=Lumbar spinal stenosis with exacerbation of back pain with extension: a potential contraindication for supine MRI with sedation. | journal=J Neuroimaging | year= 2011 | volume= 21 | issue= 1 | pages= 92-4 | pmid=19490371 | doi=10.1111/j.1552-6569.2009.00382.x | pmc=3157482 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19490371  }}</ref><ref name="pmid202276462">{{cite journal| author=Genevay S, Atlas SJ| title=Lumbar spinal stenosis. | journal=Best Pract Res Clin Rheumatol | year= 2010 | volume= 24 | issue= 2 | pages= 253-65 | pmid=20227646 | doi=10.1016/j.berh.2009.11.001 | pmc=2841052 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20227646  }}</ref>
+===Genitourinary===
+*[[Genitourinary]] examination of patients with spinal stenosis is usually positive for:
+**[[Scrotal]] and [[perianal]] [[claudication]]<ref name="pmid257053422">{{cite journal| author=Oh JY, Tan JH, Teo TW, Hee HT| title=Spinal stenosis presenting with scrotal and perianal claudication. | journal=Asian Spine J | year= 2015 | volume= 9 | issue= 1 | pages= 103-5 | pmid=25705342 | doi=10.4184/asj.2015.9.1.103 | pmc=4330204 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25705342  }}</ref>
+===Neuromuscular===
+*[[Neuromuscular]] examination of patients with spinal stenosis is usually positive for:
+**[[Hyperreflexia]]<ref name="pmid264305892">{{cite journal| author=Park MS, Moon SH, Kim TH, Oh JK, Lyu HD, Lee JH et al.| title=Asymptomatic Stenosis in the Cervical and Thoracic Spines of Patients with Symptomatic Lumbar Stenosis. | journal=Global Spine J | year= 2015 | volume= 5 | issue= 5 | pages= 366-71 | pmid=26430589 | doi=10.1055/s-0035-1549031 | pmc=4577327 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26430589  }}</ref><ref name="pmid243033442">{{cite journal| author=Akhavan-Sigari R, Rohde V, Alaid A| title=Cervical spinal canal stenosis and central disc herniation c3/4 in a man with primary complaint of thigh pain. | journal=J Neurol Surg Rep | year= 2013 | volume= 74 | issue= 2 | pages= 101-4 | pmid=24303344 | doi=10.1055/s-0033-1349202 | pmc=3836946 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24303344  }}</ref><ref name="pmid216071842">{{cite journal| author=Kim KT, Ahn SW, Kwon JT, Kim YB| title=Leg weakness in a patient with lumbar stenosis and adrenal insufficiency. | journal=J Korean Neurosurg Soc | year= 2011 | volume= 49 | issue= 4 | pages= 234-6 | pmid=21607184 | doi=10.3340/jkns.2011.49.4.234 | pmc=3098429 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21607184  }}</ref>
+**positive Romberg test
+**Decrease in upper extremity [[sensation]]<ref name="pmid243033442">{{cite journal| author=Akhavan-Sigari R, Rohde V, Alaid A| title=Cervical spinal canal stenosis and central disc herniation c3/4 in a man with primary complaint of thigh pain. | journal=J Neurol Surg Rep | year= 2013 | volume= 74 | issue= 2 | pages= 101-4 | pmid=24303344 | doi=10.1055/s-0033-1349202 | pmc=3836946 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24303344  }} </ref><ref name="pmid216071842">{{cite journal| author=Kim KT, Ahn SW, Kwon JT, Kim YB| title=Leg weakness in a patient with lumbar stenosis and adrenal insufficiency. | journal=J Korean Neurosurg Soc | year= 2011 | volume= 49 | issue= 4 | pages= 234-6 | pmid=21607184 | doi=10.3340/jkns.2011.49.4.234 | pmc=3098429 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21607184  }} </ref>
+**Weak knee and [[ankle]] reflexes<ref name="pmid216071842">{{cite journal| author=Kim KT, Ahn SW, Kwon JT, Kim YB| title=Leg weakness in a patient with lumbar stenosis and adrenal insufficiency. | journal=J Korean Neurosurg Soc | year= 2011 | volume= 49 | issue= 4 | pages= 234-6 | pmid=21607184 | doi=10.3340/jkns.2011.49.4.234 | pmc=3098429 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21607184  }} </ref>
+**Leg [[muscle]] weakness bilaterally<ref name="pmid216071842">{{cite journal| author=Kim KT, Ahn SW, Kwon JT, Kim YB| title=Leg weakness in a patient with lumbar stenosis and adrenal insufficiency. | journal=J Korean Neurosurg Soc | year= 2011 | volume= 49 | issue= 4 | pages= 234-6 | pmid=21607184 | doi=10.3340/jkns.2011.49.4.234 | pmc=3098429 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21607184  }} </ref>
+**Positive straight [[leg]] raise test<ref name="pmid259837672">{{cite journal| author=Tabesh H, Tabesh A, Fakharian E, Fazel M, Abrishamkar S| title=The effect of age on result of straight leg raising test in patients suffering lumbar disc herniation and sciatica. | journal=J Res Med Sci | year= 2015 | volume= 20 | issue= 2 | pages= 150-3 | pmid=25983767 | doi= | pmc=4400709 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25983767  }}</ref>
+**Abnormal [[gait]]<ref name="pmid204049542">{{cite journal| author=Kim YS, Park SJ, Oh IS, Kwan JY| title=The clinical effect of gait load test in two level lumbar spinal stenosis. | journal=Asian Spine J | year= 2009 | volume= 3 | issue= 2 | pages= 96-100 | pmid=20404954 | doi=10.4184/asj.2009.3.2.96 | pmc=2852081 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20404954  }}</ref>
+===Extremities===
+*Extremities examination of patients with spinal stenosis is usually positive for:
+**Bilateral [[Calf muscle|calf muscle atrophy]]<ref name="pmid21607184">{{cite journal| author=Kim KT, Ahn SW, Kwon JT, Kim YB| title=Leg weakness in a patient with lumbar stenosis and adrenal insufficiency. | journal=J Korean Neurosurg Soc | year= 2011 | volume= 49 | issue= 4 | pages= 234-6 | pmid=21607184 | doi=10.3340/jkns.2011.49.4.234 | pmc=3098429 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21607184  }} </ref>
+**Weak [[knee]] and [[Ankle reflex|ankle reflexes]]<ref name="pmid21607184">{{cite journal| author=Kim KT, Ahn SW, Kwon JT, Kim YB| title=Leg weakness in a patient with lumbar stenosis and adrenal insufficiency. | journal=J Korean Neurosurg Soc | year= 2011 | volume= 49 | issue= 4 | pages= 234-6 | pmid=21607184 | doi=10.3340/jkns.2011.49.4.234 | pmc=3098429 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21607184  }} </ref>
+*Muscle [[atrophy]]
-A brain/nervous system (neurological) examination can confirm leg weakness and decreased sensation in the legs.
 ==References==
-{{reflist|2}}
+{{Reflist|2}}{{WH}} {{WS}}
-{{WH}}
+[[Category: (name of the system)]]
-{{WS}}
-[[Category:Skeletal disorders]]
-[[Category:Rheumatology]]
-[[Category:Orthopedics]]
-[[Category:Needs Overview]]