Question

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?

• Consider what history would be necessary to collect from the patient in the case study you were assigned.
• Consider what physical exams and diagnostic tests would be appropriate to gather more information about the patient's condition. How would the results be used to make a diagnosis?
• Identify at least five possible conditions that may be considered in a differential diagnosis for the patient.

Answer 1

LOWER BACK PAIN

1. Determining causes;

• Sciatica ;- Is a form of pain that radiates along the sciatic nerv
• Lumbar herniated disc;- Ruptured disc put pressure on spinal nerv that van cause severe pain.
• Pirifformis syndrome;- is a neurological disorder that occurs when piriformis muscle compress the sciatic nerv
• Arachnoiditis;- Arachnoid is a membrane that protect the spinalcord nervs.Inflammation and irritation of arachnoid can causepain in the lower back and legs.

2.What nerv roots involved

sciatic nerv ;- sciatic nerv arise from sacral plexes from the roots of L4 to S3 and run through the buttock and down to lower lumb.sciatic nerv pain commonly ovvurs in herniated disc and,spinal stenosis.

3,Diagnosis

Review the history and physical examination

plain x ray,CAT scanning,bone scanning to identify disc abnormalities.

Eletromyograms,nerv conduction velocities for sciatica

MRIscanning for disc abnormalities

OTHER SYPTOMS NEED TO BE EXPLORED

• Numbness and tingling of lower extrimities
• incontinance of urine
• lower extrimity weakness
• atrophy of lower extrimity muscle
• Rash,fever ,chills, weight loss, burning on urination
• Diziness jointpain and fatigue

physiacal examination

• complete neurological assessment
• vital signs
• rectal,pelvic examinations

​​​​​​​special maneuvers

• Straight leg raise test-cup the heel of foot and gently raise leg,if there is nerv root irritation,patient will experiance the typical pain
• achillus tendon reflex-which is a function ofs1 root.
• Gently internally and externally rotate the hip.In pyriformis syndrome internal rotation will stretch the externalrotator muscle causing further compression and cause pain

​​​​​​​history collection;

• history of fall or strain injuries
• hisory of any musculoskelital illnss such as arthritis
• History of treatment for specific disease
• working habits
• history of smoking,obesity.

​​​​​​​The differential diagnosis done by radiologicalstudies and blood studies

Neurological assessment help toprovide more information about patient health