Your case analysis of the case study of the 42 year-old male patient presenting with lower back pain is quite comprehensive. It has followed the episodic SOAP note notation as it is supposed to be. Your patient presents with lower back pain for the past one month. He also states that his pain radiates to his left leg. You have done subjective evaluation of the patient in the form of the chief complaint, the history of presenting illness, current medications, allergies, past medical history, social and family history, and the review of systems (Ball et al., 2019). However, it is in your objective assessment that you have performed tests and manoeuvers that are aimed at coming up with the correct diagnosis for the patient. Response to Brooke Menefee Post on Ankle Pain Case Study. It is clear that you focused more on the musculoskeletal system and the neurological system. From your narration, you gave prominence to physical examination and stated that diagnostics are not necessary in this case. I agree with you about the statement that diagnostics may not be necessary. However, I wish to point out that this statement must be qualified by another statement that states that the physical examination in this case must not leave anything to chance. Te nerves supplying the skeletal muscles of the lower limbs must be assessed, as well as the muscles themselves.
You note that you checked for the presence of the so-called “red flags”. I agree with you on that. Clinical red flags can be helpful in coming up with the correct diagnosis and ruing out others that were promising but misleading. Some of the red flags that you have checked for include progressive sensory and motor loss, urinary retention and bladder incontinence, and a history of cancer or trauma. During the physical examination, you performed the Faber test to rule out the possibility of a sacroiliac origin of the pain. You also performed fist percussion over the costovertebral angles. From your narration, the rationale for this was to differentiate flank pain caused by kidney disease from pain coming from spinal injury. The differential diagnoses that you came up with after your subjective and objective evaluation that was devoid of diagnostics were:
From my own point of view, I would reject all of these diagnoses because they do not conform entirely to the symptomatology presented by the 42 year-old patient. The other reason for the rejection of these diagnoses is that they do not correspond to sound clinical reasoning that should have taken place before arriving at the differential diagnoses. No proper justification or rationale has also been given for the decision to include these specific differential diagnoses.
According to my assessment, therefore, the most likely musculoskeletal condition that this 42 year-old patient could be suffering from is Acute Back Pain with Sciatica (Fritz et al., 2020; Hall et al., 2019). It is notable that this diagnosis does not appear among the ones that you came up with, even though ‘lumbosacral radiculopathy’ comes close. However, according to this patient’s presentation; this is the most likely primary diagnosis. Sciatica frequently accompanies cases of lower back pain that radiates to the legs. The most common cause is usually compression of one or more of the lumbar discs (Fritz et al., 2020; Hall et al., 2019). According to Hall et al. (2019), sciatica is also referred to as nerve root pain or lumbar spinal radiculopathy. It is one way that lower back pain (LBP) manifests and is defined by pain that frequently radiates to the leg and sometimes into the foot and toes . Response to Brooke Menefee Post on Ankle Pain Case Study.
References
Ball, J., Dains, J.E., Flynn, J.A., Solomon, B.S., & Stewart, R.W. (2019). Seidel’s guide to physical examination: An interprofessional approach, 9th ed. Elsevier.
Fritz, J.M., Lane, E., McFadden, M., Brennan, G., Magel, J.S., Thackeray, A., Minick, K., Meier, W., & Greene, T. (2020). Physical therapy referral from primary care for acute back pain with sciatica: A randomized controlled trial. Annals of Internal Medicine, 1-11. https://doi.org/10.7326/M20-4187
Hall, J.A., Konstantinou, K., Lewis, M., Oppong, R., Ogollah, R., & Jowett, S. (2019). Systematic review of decision analytic modelling in economic evaluations of low back pain and sciatica. Applied Health Economics and Health Policy, 17, 467-491. https://doi.org/10.1007/s40258-019-00471-w
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