Case:Low Back Pain 001: Difference between revisions
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The patient has right low back pain, with mild radiation into the right groin. It causes sudden shocks of pain. He does not get any leg pain apart from the knee pain as above. He gets some groin pain but the back is much worse, but these seem to flare up together. The pain is worse in the mornings causing stiffness which lasts about 1-2 hours. He has found certain pain relieving stretches. He works long hours as a chef which causes discomfort. | The patient has right low back pain, with mild radiation into the right groin. It causes sudden shocks of pain. He does not get any leg pain apart from the knee pain as above. He gets some groin pain but the back is much worse, but these seem to flare up together. The pain is worse in the mornings causing stiffness which lasts about 1-2 hours. He has found certain pain relieving stretches. He works long hours as a chef which causes discomfort. | ||
The patient first hurt his back in his 20s playing rugby. A few years ago he reinjured it while snowboarding. His current flare of pain started after using a foam roller on his hips. In 2015 he injured his right knee running which was diagnosed as caused by a | The patient first hurt his back in his 20s playing rugby. A few years ago he reinjured it while snowboarding. His current flare of pain started after using a foam roller on his hips. In 2015 he injured his right knee running which was diagnosed as being caused by a complex meniscal tear with medial chondral fissuring on MRI. | ||
He saw an Orthopaedic Surgeon who recommended conservative management, but to proceed to anterior discectomy and fusion at L5/S1 if symptoms became unbearable. | He saw an Orthopaedic Surgeon who recommended conservative management, but to proceed to anterior discectomy and fusion at L5/S1 if symptoms became unbearable. | ||
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[[File:52M CLBP pain chart.PNG|300px]] | [[File:52M CLBP pain chart.PNG|300px]] | ||
= | =Past History= | ||
*Psoriasis | |||
*Celiac disease. | |||
*Right knee medial compartment osteoarthritis | |||
*No regular medications. | |||
=Blood Tests= | =Blood Tests= | ||
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=Previous Imaging= | =Previous Imaging= | ||
Investigations done 10 months ago | |||
;MRI Lumbar Spine | |||
*L1/2: right paracentral disc protrusion. | *L1/2: right paracentral disc protrusion. | ||
*L2/3: small left paracentral disc protrusion which contacts the left L3 nerve root at the lateral recess. | *L2/3: small left paracentral disc protrusion which contacts the left L3 nerve root at the lateral recess. | ||
*L3/4 facet joint effusions | *L3/4 facet joint effusions | ||
*L4/5: mild disc bulge with contact of left L4 nerve root. facet joint effusions | *L4/5: mild disc bulge with contact of left L4 nerve root. facet joint effusions | ||
;Xray Pelvis and Lumbar Spine | |||
*CAM deformities of the bilateral hips with mild joint space loss. | |||
*Facet arthrosis L3 down to S1. | |||
=Examination= | =Examination= | ||
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=Further Investigations no.1= | =Further Investigations no.1= | ||
Ultrasound guided diagnostic right hip injection with 5mL 1% lidocaine done. Pre-procedure pain 7/10 on NRS. | ;Diagnosis hip injection | ||
*Ultrasound guided diagnostic right hip injection with 5mL 1% lidocaine done. | |||
*Pre-procedure pain 3/10 in hip, and 7/10 in low back on NRS. | |||
*Post-procedure pain at 30 minutes: 2/10 in hip, and 6/10 in low back | |||
*Post-procedure pain at 60 minutes: 1/10 in hip, and 6/10 in low back | |||
*That night the hip joint was 5/10, and low back 7/10 | |||
=Further Investigations no.2= | =Further Investigations no.2= | ||
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[[Category:Case Histories]] | [[Category:Case Histories]] |