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A Young Back, An Old Problem: Rethinking The Usual Suspects - Page #1
 

Author: Karanvir Singh Gill, MD, MBBS
Co Author #1: Mohammad Kazimi, MD
Co Author #2: Taofeek Akinpelu, MD, CAQSM
Senior Editor: Kristine Karlson, MD, FAMSSM
Editor: Jeffrey Feden, MD, FAMSSM

Patient Presentation:
A 21-year-old male presented to the sports medicine clinic with four days of worsening low back pain associated with progressive left lower extremity weakness, paresthesia, and difficulty ambulating.

History:
A 21-year-old male with past medical history that included ADHD and migraine headaches developed lower back pain after heavy lifting at work. The pain initially began as a dull, localized discomfort in the lower lumbar region, and it progressively worsened over the next several days. Pain later radiated into the left thigh and calf and was associated with tingling, numbness, and increasing weakness of the left leg. His symptoms were worse with standing and walking and improved only slightly with rest.
He denied direct trauma, fever, chills, recent infection, bowel or bladder dysfunction, saddle anesthesia, prior similar episodes, or known history of thrombosis. He also denied visible leg swelling, redness, warmth, or color change. Over-the-counter analgesics provided minimal relief. By the time of presentation, his weakness had progressed enough to limit normal ambulation.

Physical Exam:
The patient was alert, hemodynamically stable, and in mild distress because of pain. Inspection did not show any spinal deformity, skin changes, or clinically obvious swelling of either leg. Palpation revealed mild tenderness over the lower lumbar paraspinal region without prominent muscle spasm.
A straight leg raise test on the left reproduced his symptoms. Strength testing demonstrated motor strength 3/5 with left hip flexion and left knee extension. Sensation was decreased in the distribution of L4 and L5. Deep tendon reflexes were symmetric. There was no saddle anesthesia and no loss of sphincter tone. His gait was antalgic and limited by left leg weakness.

Click here to continue. Challenge yourself by writing down a broad differential diagnosis before moving to the next slide.

NOTE: For more information, please contact the AMSSM, 4000 W. 114th Street, Suite 100, Leawood, KS 66211 (913) 327-1415.
 

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4000 W. 114th Street, Suite 100
Leawood, KS 66211
Phone: 913.327.1415


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