The Rational Clinical Examination
David L. Simel, Drummond Rennie
Low Back Pain
Ben Stern, Richard A. Deyo, James Rainville, Richard S. Bedlack
Clinical Scenario
Topics Discussed:
back pain, low back pain, lower back
Excerpt:
"A physically active 61-year-old man presents with complaints
of low back pain and occasional pain in his left buttock and upper
thigh. His symptoms began approximately 3 weeks ago. In addition,
increasing pain in his lower extremities is preventing him from
participating in his hobbies and socializing with his usual group
of friends. He has no history of weight loss and no changes in bowel
or bladder habits. During the physical examination, the patient
reports thigh and back pain at 50 degrees during the straight leg
raise (SLR) test on the left but no radiation below the knee. He
has slight pain in the back of his right leg with SLR testing to
75 degrees. When you test his quadriceps strength, his left side
seems a little weaker than the right, but the testing is limited
by his discomfort. His single-leg sit-to-stand test result is normal.
The ankle reflexes are absent bilaterally. Given the results of
this brief history and physical examination, are there other maneuvers
you could perform? What diagnosis can you provide for this patient?..."
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