Case #1: 49-year-female assembly worker at automotive manufacturer presents to your clinic complaining of increasing back pain over the last week. Back pain is in the central low back region and radiates into both gluteal regions – no leg pain. Has been off work for the last 6 months with no improvement in pain.
- Create a list of possible differential diagnoses?
- Discuss the evidence you would need to obtain to rule in or rule out each differential?
- What additional aspects of the history and physical examination could provide relevant information to help in the diagnosis?
Answers:
Case#1
1)Diffrential diagnosis of Low back pain.
a)Spinal stenosis-
- b) Sciatica
c)Slipped disc
- d) Kidney stone-Nephrolithiasis
e)Spinal fracture
2)Discuss the evidence to rule in and rule out each differential diagnosis?
a)Spinal stenosis-numbness weakness in lower extremities ,pain radiating to buttock and leg ,-only numbness no pain and only radiate at gluteal ,present on the above case..
b)Sciatica-numbness and weakness only at lower extremities ,pain radiating to buttocks and legs. In scenario above no numbness and weakness no pain and radiate at gluteal region.
- c) slipped disc-pain on one side of the body and pain also affect upper extremities.
d)kidney stone – pain radiate on groin and present of blood in urine ,which not present in case # 1
e)Spinal fracture-present of tenderness on palpation,, case # 1 only pain mentioned that radiate gluteal area .
3) Additional history and physical examination provide additional information about diagnosis.?
-ask for any history of trauma ,did she carry heavy object, is she sitting for long time ,and prolonged walking. She fever recently?
–Physical examination ,
Palpation check for present of stiffness, tenderness ,of the back ,legs and check knee joint flexion , check knee jerk reaction.
Case #1: 49-year-female assembly worker at automotive manufacturer presents to your clinic complaining of increasing back pain over the last week. Back pain is in the central low back region and radiates into both gluteal regions – no leg pain. Has been off work for the last 6 months with no improvement in pain.
- Create a list of possible differential diagnoses?
- Discuss the evidence you would need to obtain to rule in or rule out each differential?
- What additional aspects of the history and physical examination could provide relevant information to help in the diagnosis?
Answers:
Case#1
1)Diffrential diagnosis of Low back pain.
a)Spinal stenosis-
- b) Sciatica
c)Slipped disc
- d) Kidney stone-Nephrolithiasis
e)Spinal fracture
2)Discuss the evidence to rule in and rule out each differential diagnosis?
a)Spinal stenosis-numbness weakness in lower extremities ,pain radiating to buttock and leg ,-only numbness no pain and only radiate at gluteal ,present on the above case..
b)Sciatica-numbness and weakness only at lower extremities ,pain radiating to buttocks and legs. In scenario above no numbness and weakness no pain and radiate at gluteal region.
- c) slipped disc-pain on one side of the body and pain also affect upper extremities.
d)kidney stone – pain radiate on groin and present of blood in urine ,which not present in case # 1
e)Spinal fracture-present of tenderness on palpation,, case # 1 only pain mentioned that radiate gluteal area .
3) Additional history and physical examination provide additional information about diagnosis.?
-ask for any history of trauma ,did she carry heavy object, is she sitting for long time ,and prolonged walking. She fever recently?
–Physical examination ,
Palpation check for present of stiffness, tenderness ,of the back ,legs and check knee joint flexion , check knee jerk reaction.