I am trying to figure out what to do.

F, 51, 2 yr history of lumbar- and R. glute pain after L5/S1 herniation. 4/5 weakness tibialis anterior and GMed, sens. deficits, complete loss of plantar reflex.

Here is the tricky bit.

She is globally hyper-reflexive, 2 beats clonus on R. biceps when reflex testing, bilateral pos. Hoffman, neg. ankle clonus, and negative Babinski. Also, general R. leg weakness iliopsoas, quadriceps, plantar flexors.

Incidental finding? Of importance?

@Retlouping @adamdobson

@thomasroth91 @Retlouping @adamdobson has he had recent MRI exam, to investigate progression to next level up (L4/5) hernia, that affect up to L4 spinal nerve, from which hip flexors receive part of their nerve supply. How about nerve tension tests, SLR, Braggard, slump test etc, contralateral SLR. Bilateral +ve Hoffmann in hyperreflexive person is normal finding, and only worrying unilaterally.

@ole_dr @Retlouping @adamdobson
Yes, recent MRI only showed reabsorption of herniation. Neg. SLR, SLUMP, and crossed SLR. From Twitter discussion I will investigate inverted supination and gait.

@thomasroth91 @Retlouping @adamdobson yeah, doubtful clinical picture indeed, good luck