A 42-year-old male reports pain in his lower back for the past month. The pain sometimes radiates to his left leg. In determining the cause of the back pain, based on your knowledge of anatomy, what nerve roots might be involved? How would you test for each of them? What other symptoms need to be explored? What are your differential diagnoses for acute low back pain? Consider the possible origins using the Agency for Healthcare Research and Quality (AHRQ) guidelines as a framework. What physical examination will you perform? What special maneuvers will you perform?
Patient Information:
J.G. Age 42 Caucasian Male
CC: “Lower Back Pain”
HPI: The patient is a 42-year-old white male who complains of lower back pain that started approximately 1 month ago. He states sometimes the pain radiates to his left leg. His lower back pain is increased with sitting or standing for long periods of time. Denies any fever, chills, and sweating.
Current Medications: Multivitamin 1 tab daily, Motrin 800 mg every 4 to 6 hours prn
Allergies: No known drug, food, or environmental allergies.
PMHx: Denies medical history
PSHx: Tonsillectomy 1978
Soc Hx: J.G. is a junior-high school history teacher and a football and baseball coach. J.G. lifts weights at the gym 3-4 days a week. He is happily married and has 1 son (4 yrs) who has no health problems.
Personal/Social History: Patient denies ever smoking cigarettes. Denies any recreational drug use. Drinks alcohol 1 night on the weekends, usually 6 shots of whiskey.
Fam Hx: Mother alive, age 72-years-old-COPD and hypertension. Father alive-COPD, hypertension, and DM
ROS:
GENERAL: Appears well groomed and well nourished. No weight loss. Complaint of lower back pain. No complaint of fever, chills, weakness, fatigue, constipation, bladder or bowel incontinence.
HEENT: Eyes: No visual loss, blurred vision, double vision or yellow sclerae. Ears, Nose, Throat: No hearing loss, sneezing, congestion, runny nose or sore throat.
SKIN: No rash or itching.
CARDIOVASCULAR: No chest pain, chest pressure or chest discomfort. No palpitations or edema.
RESPIRATORY: No complaint of dyspnea, no cough.
GASTROINTESTINAL: No nausea and vomiting. No diarrhea. No abdominal pain. No changes in bowel patterns.
GENITOURINARY: No difficulty with urination, no urinary leakage or incontinence. No hematuria.
NEUROLOGICAL: No headache, no dizziness, no syncope, no paralysis, no ataxia, no numbness or tingling in the extremities. No change in bowel or bladder control.
MUSCULOSKELETAL: complaints of lower back pain x 1month that radiates to left leg. Pain 7/10 sometimes increase pain when sitting or standing for long periods of time. States the pain is intermittent. Denies numbness. Pt states the pain is better after taking motrin. Patient denies any swelling, redness or heat at any of the joint sites.
HEMATOLOGIC: No anemia, bleeding or bruising.
LYMPHATICS: No enlarged nodes in the groin. No history of splenectomy.
PSYCHIATRIC: No history of depression or anxiety.
ENDOCRINOLOGIC: No complaints of fever, chills, and sweating.
ALLERGIES: No history of asthma, hives, eczema or rhinitis.
O.
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