- Joined
- Mar 30, 2006
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Ah the all dreaded back pain. Something that seems so simple, yet so far, far from it. How do you guys differentiate the serious pathology from the benign ones? Yes we all know the red flag symptoms - bowel/bladder incontinence, neuro deficits, IVDA + fever, saddle anesthesia, poor rectal tone, etc etc, but how do you REALLY tell the difference; say someone can't lift their left leg up - is it because they have a neuro deficit in that left leg or is it because of the immense pain they're having in that lumbar region that they're unwilling to lift that leg up?
Let me present a case to you guys:
I had a 58 year old female come in the other week for back pain. Started 3 days prior to arrival in the ED, complaining mainly of left lower paraspinal pain, shot down to the back of her leg. States it was mainly pain, didn't feel any weakness/numbness/tingling. States was moving boxes around and thinks might have hurt her back that way. Was having increased difficulty walking because of the pain, had taken some ibuprofen/tylenol which helped her pain and was able to ambulate more readily after meds. She had no PMH, took no meds, no red flag symptoms. Physical exam - tenderness over left and right paraspinal lumbar muscles, no midline spinal tenderness, straight leg test negative but did elicit pain in the left lower paraspinal region, had difficulty lifting her left leg up against gravity but kept saying it was because of the pain in the back and not because she felt weak, was able to stand and ambulate, had full strength and sensation in her ankle and toes. Gave her pain relief meds in the ER, shot xray's of her back, everything checked out, she felt a lot better, could walk without difficulty, and d/c home.
She came back a week later, MR showed cord compression on the left side.
I keep going over the case in my head and I don't see how I would have done anything differently everytime. Unless my entire approach is incorrect. What would you guys have done?
Let me present a case to you guys:
I had a 58 year old female come in the other week for back pain. Started 3 days prior to arrival in the ED, complaining mainly of left lower paraspinal pain, shot down to the back of her leg. States it was mainly pain, didn't feel any weakness/numbness/tingling. States was moving boxes around and thinks might have hurt her back that way. Was having increased difficulty walking because of the pain, had taken some ibuprofen/tylenol which helped her pain and was able to ambulate more readily after meds. She had no PMH, took no meds, no red flag symptoms. Physical exam - tenderness over left and right paraspinal lumbar muscles, no midline spinal tenderness, straight leg test negative but did elicit pain in the left lower paraspinal region, had difficulty lifting her left leg up against gravity but kept saying it was because of the pain in the back and not because she felt weak, was able to stand and ambulate, had full strength and sensation in her ankle and toes. Gave her pain relief meds in the ER, shot xray's of her back, everything checked out, she felt a lot better, could walk without difficulty, and d/c home.
She came back a week later, MR showed cord compression on the left side.
I keep going over the case in my head and I don't see how I would have done anything differently everytime. Unless my entire approach is incorrect. What would you guys have done?