Low back pain

Question 1

45yo F presents with low back pain that radiates to the lateral aspect of her left foot. The straight leg raise is positive. The patient is unable to tiptoe.

Answer 1

DISK HERNIATION
lumbar muscle strain
tumor in the vertebral canal

XR L spine
MRI L spine

Question 2

45yo F presents with low back pain that started after she cleaned her house. The pain does not radiate, and there is no sensory deficit or weakness in her legs. Paraspinal muscle tenderness and spasm are also noted.

Answer 2

LUMBAR MUSCLE STRAIN
disk herniation
vertebral compression fracture

XR L spine
MRI L spine

Question 3

45yo M presents with pain in the lower back and legs during prolonged standing and walking. The pain is relieved by sitting and leaning forward (e.g. pushing a grocery cart)

Answer 3

LUMBAR SPINAL STENOSIS
lumbar muscle strain
tumor in the vertebral canal
peripheral vascular disease

Mri L spine (preferred)
XR L spine
CT L spine
ankle-brachial index

Question 4

17yo M presents with low back pain that radiates to the left leg and began after he fell on his knee during gym class. He also describes areas of loss sensation in his left foot. The pain and sensory loss do not match any known distribution. He insists on requesting a week off from school because of his injury.

Answer 4

MALINGERING
lumbar muscle strain
disk herniation
knee or leg fracture
ankylosing spondylitis

XR L spine/knee
MRI L spine