Case:Low Back Pain 001: Difference between revisions
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= | =PC= | ||
A 52 year old man with right low back pain, and mild radiation into the right groin. | A 52 year old man with right low back pain, and mild radiation into the right groin. | ||
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[[File:52M CLBP pain chart.PNG|300px]] | [[File:52M CLBP pain chart.PNG|300px]] | ||
= | =HxPC= | ||
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. | 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. | ||
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No pertinent contributing psychosocial factors were identified. | No pertinent contributing psychosocial factors were identified. | ||
= | =PMHx= | ||
*Psoriasis | *Psoriasis | ||
*Celiac disease. | *Celiac disease. | ||
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*No regular medications. | *No regular medications. | ||
= | =Bloods= | ||
FBC, CRP, ANA, anti-CCP, RF, HLA-B27, TFTs, LFTs, HbA1c, and creatinine are all normal. | FBC, CRP, ANA, anti-CCP, RF, HLA-B27, TFTs, LFTs, HbA1c, and creatinine are all normal. | ||
Celiac antibodies are undetectable consistent with a compliant gluten free diet. | Celiac antibodies are undetectable consistent with a compliant gluten free diet. | ||
= | =Imaging= | ||
Investigations done 10 months ago | Investigations done 10 months ago | ||
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*Neurological examination is normal | *Neurological examination is normal | ||
= | =More Tests no.1= | ||
;Diagnosis hip injection | ;Diagnosis hip injection | ||
*Ultrasound guided diagnostic right hip injection with 5mL 1% lidocaine done. | *Ultrasound guided diagnostic right hip injection with 5mL 1% lidocaine done. | ||
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*That night the hip joint was 5/10, and low back 7/10 | *That night the hip joint was 5/10, and low back 7/10 | ||
= | =More Tests no.2= | ||
;First medial branch block | ;First medial branch block | ||
*fluoroscopically guided bupivacaine injections to the right L2, L3, L4 medial branches, and the L5 dorsal root. | *fluoroscopically guided bupivacaine injections to the right L2, L3, L4 medial branches, and the L5 dorsal root. |