TINA WILLIAM "LOW BACK PAIN" IHUMAN CASE LATEST UPDATES 2023 .

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TINA WILLIAM "LOW BACK PAIN" IHUMAN CASE LATEST UPDATES 2023 . 3 Patient Profile: tina is a 52-year-old male who presents to the primary care clinic with complaints of low back pain. ... He reports that the pain started a few weeks ago and has been gradually worsening. He describes the pain as a constant ache that is present in his lower back and sometimes radiates down his right leg. The pain is worse with standing and walking and is relieved when he lies down. The patient reports no history of trauma or injury to the back, and he denies any weakness or numbness in his legs. He has tried over-the-counter pain medication, which provides some relief, but the pain persists. Initial Assessment: Upon examination, the patient is alert and oriented, with a heart rate of 80 beats per minute, a blood pressure of 130/80 mmHg, and a respiratory rate of 16 breaths per minute. His lower back is tender to palpation, and he has limited range of motion. Straight leg raise test is positive on the right side, which reproduces the pain in the leg. Neurological examination of the lower extremities is normal, with no weakness or sensory deficits. Case Questions with solutions: 1. What additional questions would you ask the patient to gather more information about his low back pain? • You could ask about the timing and onset of the pain, as well as any exacerbating or relieving factors. • You could ask about the patient's occupation and physical activities, as well as any recent changes in his work or exercise routine. • You could ask about the presence of any previous back pain or injuries. • You could ask about the patient's medical history, including any chronic medical conditions or medications that may be contributing to the pain. 2. What physical exam maneuvers would you perform to further assess the patient's low back pain? To further assess the patient's low back pain, several physical exam maneuvers could be performed, including: • Thorough Musculoskeletal Exam: This exam includes palpation, range of motion, and other maneuvers that evaluate the patient's posture, alignment, and musculoskeletal structure. It is important to assess the patient's back muscles and ligaments for tenderness, swelling, or signs of inflammation. • Straight Leg Raise Test: This test involves lifting the patient's leg while keeping the knee straight. A positive test reproduces the patient's pain, which suggests nerve root irritation. • Neurological Assessment: The examiner should evaluate for any signs of neurological deficits, such as weakness or sensory loss in the legs. Sensory loss may include decreased sensation to light touch, pinprick, or temperature. • Muscle Spasms or Trigger Points Evaluation: The examiner should evaluate for any muscle spasms or trigger points that may be contributing to the pain. This may include assessing the patient's muscle strength, as well as the presence of any tender points or knots. • Gait Assessment: The examiner should observe the patient's gait for any abnormalities, such as limping or antalgic gait. Overall, a thorough physical examination is crucial to accurately diagnose and manage low back pain. It helps to identify the underlying cause of the pain, as well as to rule out other potential causes. 3. What are your top three differential diagnoses for this patient's low back pain? 5 Low back pain can have various causes, and a differential diagnosis involves considering different possible conditions that can cause similar symptoms. The top three differential diagnoses for this patient's low back pain are: • Lumbar disc herniation: A herniated disc occurs when the soft inner material of a spinal disc bulges out and puts pressure on surrounding nerves. The patient's positive straight leg raise test and radiating pain down the right leg suggest that a herniated disc is a likely cause of his symptoms. [Show More]

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