Author: Erek Latzka, MD
Co Author #1: Neelwant S. Sandhu MD
Editor: Shaun Spielman, MD
A 24 year old male, former swimmer and soccer player, was referred by his primary care physician with 3 weeks of bilateral, right greater than left, radicular low back pain, which began acutely with a "pop" while deadlifting 450 lbs. The low back pain was constant, 6/10, throbbing, aching, and radiated to his right anterolateral thigh, lateral calf, and foot, and to his left lateral thigh and knee. The pain increased with sitting, but improved with standing and walking. He denied saddle anesthesia and bowel or bladder changes. His symptoms remained stable for 3 weeks, except for minimally increasing right lower extremity (RLE) weakness. Despite symptoms, he continued working as a waiter.
No significant past medical history.
General: Average height, muscular build
ROM: Neutral lumbar alignment with decreased range of motion (ROM) limited by pain. Hip ROM normal.
Strength: Left lower extremity (LLE) full strength. RLE strength decreased, with 4/5 hip abduction, 4-/5 big toe extension, and 4-/5 dorsiflexion.
Functional testing: Difficulty performing 5 heel raises on right. Right foot slap when heel walking.
Special tests: Straight leg raise producing pain down posterior thighs bilaterally at 45 degrees.
Sensation: intact to light touch and pin prick in L1-S2 dermatomes.
Reflexes: Patella and Achilles 1+ bilaterally. Negative Babinski. No clonus.
Click here to continue. Challenge yourself by writing down a broad differential diagnosis before moving to the next slide.