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?

Answer 1

Acute low back pain is most often caused by a sudden injury to the muscles and ligaments supporting the back. The pain may be caused by muscle spasms or a strain or tear in the muscles and ligaments. Sciatic nerve involve

Sciatica is a shooting pain that begins in the lower back, radiates into the buttock and down the back of one leg.

Tests for lower Barack pain

• X-ray. These images show the alignment of your bones and whether you have arthritis or broken bones.   
• MRI or CT scans.
• Blood tests.
• Bone scan.
• Nerve studies.

Other Symptoms of back pain can include:

• Persistent aching or stiffness anywhere along your spine, from the base of the neck to the tail bone
• Sharp, localized pain in the neck, upper back, or lower back especially after lifting heavy objects or engaging in other strenuous activity
• Chronic ache in the middle or lower back, especially after sitting or standing for extended periods
• Back pain that radiates from the low back to the buttock, down the back of the thigh, and into the calf and toes
• Inability to stand straight without having pain or muscle spasms in the lower back

Differential Diagnosis of Acute Back pain

1) Intrinsic Spine

• compression fracture
• herniated nucleus pulposus
• lumbar strain/sprain
• spinal stenosis
• spondylolithesis
• spondylolysis

2) Systemic

• connective tissue disease
• inflammatory spondyloarthropathy
• malignancy
• osteomyelitis

Physical examination

The doctor may test your reflexes using a reflex hammer. This is usually done at the knee and behind the ankle.

As you lie flat on your back, you'll be asked to elevate one leg at a time, both with and without the doctor's assistance.

This is done to test nerves and muscle strength and to assess the presence of tension on the sciatic nerve.

The doctor may test sensation using a pin, paper clip, broken tongue depressor, or other sharp object to assess any loss of sensation in your legs.

Doctor examine Abdominal, Pelvic and rectal to find cause of pain

special maneuvers of lower back pain

Certain sleeping positions can help ease your back pain, so find one that is most comfortable for you. If you sleep on your side, put the pillow between your knees and draw them up slightly toward your chest. If you like to sleep on your back, try the pillow under your knees, or roll up a small towel and place it under the small of your back.

The type of mattress you need depends on your body type. A soft mattress can be good if your hips are wider than your waist because it will let your spinestay straight while you sleep.