Analyze the possible conditions from your colleagues’ differential diagnoses: Sciatica Radiculopathy
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Analyze the possible conditions from your colleagues’ differential diagnoses. Determine which of the conditions you would reject and why. Identify the most likely condition, and justify your reasoning.
Case: A 42-year-old male reports pain in his lower back for the past month. The pain sometimes radiates to his left leg.
1) Sciatica Radiculopathy: Pain related to spinal nerve root (L4 through S2) involvement can be caused by strenuous lifting, twisting, and bending (Davis et al., 2021). The burning pain can radiate along the lateral thigh, leg, and foot (Dains et al., 2019). A positive straight leg raise test (SLR) and sitting knee extension test will produce radicular pain that may also be felt in the buttocks or posterior thigh (Dains et al., 2019). The patient’s signs and symptoms, health status, and occupational activities support this diagnosis.
2) Herniated Disk: When the soft, jelly-like center of the intervertebral disk pushes through the disk’s outer rings or causes the ring to bulge, pressure is placed on the spinal cord and nearby nerve roots (AAOS, 2018). The pressure may cause lower back pain that radiates down the buttock to below the knee (Dains et al., 2019). Symptoms typically present in less than one month (AAOS, 2018). A positive straight leg raise test is a strong indicator of a herniated disk (AAOS, 2018). An MRI could confirm which spinal nerves are affected (AAOS, 2018). The patient’s signs and symptoms support this diagnosis.
3) Lumbar muscle strain: When the muscle fibers are abnormally stretched or torn from moving, twisting, twisting, or bending over time or from an injury, lumbar muscle strain can occur (AANS, 2021). Low back strain can cause symptoms of low back pain that may radiate to the buttocks but do not affect the legs (AANS, 2021). Muscle spasms usually are present at rest or with activity (AANS, 2021). An x-ray or MRI could be ordered to rule out other conditions. The case study patient has low back pain that radiates to the buttocks, but he also complains of leg pain. He has no complaint of muscle spasms. This diagnosis is not as probable.
4) Spondylolisthesis: Repetitive stress and overuse of the back can cause a crack or stress fracture in the vertebra (commonly in L5 or L4), causing spondylolysis (AAOS, 2016). Spondylolysis can weaken the vertebra and cause improper positioning of the spine, known as spondylolisthesis (AAOS, 2016). The symptoms can include low back pain, pain that radiates to the buttocks and back of the thighs, pain that worsens with activity and improves with rest, and difficulty standing and walking (AAOS, 2016).
Lumbar x-rays or MRI is needed to confirm a stress fracture (AAOS, 2016). The patient’s signs and symptoms support this diagnosis. However, this condition is more common in younger adults and children (Dains et al., 2019). Therefore, this diagnosis is not as probable.
5) Spinal Stenosis: A thickening of the ligaments in the back, as well as a bulging of the discs that separate the vertebrae, can cause narrowing in the small spinal canal (ACR, 2021). The narrowing causes pinching of the spinal cord and/or nerve roots, resulting in pain (ACR, 2021).
If there is a narrowing in the lower back, there could be pain in the lower back and legs (ACR, 2021). An x-ray or MRI could help confirm the diagnosis. The case study patient does have lower back and leg pain. However, this condition is more common in ages 50 or older. Also, the patient does not have any medical conditions that may cause spinal stenosis, such as osteoarthritis and bony spurs, inflammatory spondyloarthritis, spinal tumors, or Paget’s disease (ACR, 2021). Therefore, this diagnosis is not as probable.
American Academy of Orthopaedic Surgeons. (2016, September). Spondylolysis and spondylolisthesis – OrthoInfo – AAOS. OrthoInfo – Patient Education. https://orthoinfo.aaos.org/en/diseases–conditions/spondylolysis-and- spondylolisthesis/
American Academy of Orthopaedic Surgeons. (2018, June). Herniated disk in the lower back – OrthoInfo – AAOS. OrthoInfo – Patient Education. https://orthoinfo.aaos.org/en/diseases– conditions/herniated-disk-in-the-lower-back/
American Association of Neurological Surgeons. (2021). Low back strain and sprain – Symptoms, diagnosis and treatments. https://www.aans.org/patients/neurosurgical- conditions-and-treatments/low-back-strain-and-sprain
American College of Rheumatology. (2021). Spinal stenosis. https://www.rheumatology.org/I- Am-A/Patient-Caregiver/Diseases-Conditions/Spinal-Stenosis
Dains, J. E., Baumann, L. C., & Scheibel, P. (2019). Advanced health assessment and clinical diagnosis in primary care (6th ed.). St. Louis, MO: Elsevier Mosby.
Davis, D., Maini, K., & Vasudevan, A. (2021, June 21). Sciatica – StatPearls – NCBI bookshelf.