Low Back Pain Case
Here is a quiz on a case of low back pain.
Define the following terms and discuss their clinical significance.
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A patient presents with low back pain and bilateral radicular sciatica with bilateral tingling in the legs on neck flexion; offer three differential diagnosis
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What other signs and symptoms might be present with each diagnosis?
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How would you recognize urinary retention from the patient's history?
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What conditions may cause urinary incontinence or retention with or without back pain?
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What condition is likely to cause low back pain with signs and symptoms in one leg and signs only in the other?
A patient presents with low back pain and bilateral radicular sciatica with bilateral tingling in the legs on neck flexion; offer three differential diagnosis.
- Cauda equina syndrome
- Multiple sclerosis
- Bilateral disc herniation with bilateral spinal nerve compression
- Spinal cord compression (unlikely due to presence of radicular sciatica)
What other signs and symptoms might be present with each diagnosis?
Cauda equina syndrome
- severe articular signs
- urinary incontinence or retention depending on the severity of the compression
- multisegmental hyporeflexia
- multisegmental paresis
- multisegmental hypoesthesia
- absence of clonus or Babinski response
Multiple sclerosis
- moderate, mild or absent articular signs
- urinary retention (neurogenic bladder) if affected
- extra-segmental hyperreflexia
- extra-segmental paresis or paralysis
- extrasegmental hypoesthsia or anesthesia
- Babinski response and clonus
Bilateral disc herniation with bilateral compression spinal nerve syndromes
- Extremely rare and perhaps the least likely explanation. There would be hyporeflexia, motor and sensory segmental palsies
Spinal cord compression
- Extrasegmental hyperreflexia, clonus, Babinski responses, hypertonicity, urinary retention
How would you recognize urinary retention from the patient's history?
- Stress incontinence due to pelvic floor weakness
- Cauda equina syndrome with S4 palsy
- Bladder infections
- Pregnancy
- Prostatism
- Pelvic cancers
What condition is likely to cause low back pain with signs and symptoms in one leg and signs only in the other?
References:
Any good anatomy text book (not an atlas)
Clinical anatomy of the lumbar spine. 2nd Edition (or 1st if that's what you have). Bogduk, N. Twomey, LT. Churchill Livingston, Edinburgh
Disclaimer:
The assessment and treatment techniques depicted or described in this site are not intended to replace formal instruction in orthopedic manual or any other type of physical therapy. They are intended to review, augment and facilitate the knowledge and skills previously gained on manual therapy or other course and to stimulate the untrained or trainee physical therapist to increase the bounds of his or her knowledge and skill base.
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