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Case:Low Back Pain 001: Difference between revisions
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{{Partial case history}} | {{Partial case history}} | ||
{{Case section|PC| | |||
A 52 year old NZ European man with chronic right low back pain, and mild radiation of pain into the right groin. | A 52 year old NZ European man with chronic right low back pain, and mild radiation of pain into the right groin. | ||
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[[File:52M CLBP pain chart.PNG|300px]] | [[File:52M CLBP pain chart.PNG|300px]] | ||
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{{Case section|HxPC| | |||
He 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 two years ago following yet another snowboarding accident. 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 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 two years ago following yet another snowboarding accident. 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. | ||
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No pertinent contributing psychosocial factors were identified. | No pertinent contributing psychosocial factors were identified. | ||
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{{Case section|PMHx| | |||
*Psoriasis | *Psoriasis | ||
*Celiac disease. | *Celiac disease. | ||
*Right knee medial compartment osteoarthritis | *Right knee medial compartment osteoarthritis | ||
*No regular medications. | *No regular medications. | ||
}} | |||
{{Case section|Blood| | |||
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. | ||
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{{Case section|Imaging 1| | |||
Investigations done 10 months ago by the Orthopaedic Surgeon, and so they are presented before the examination. | Investigations done 10 months ago by the Orthopaedic Surgeon, and so they are presented before the examination. | ||
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[[File:52M CLBP MRI.PNG]] | [[File:52M CLBP MRI.PNG]] | ||
|MRI Lumbar Spine Report | |||
| | |*L1/2: right paracentral disc protrusion. | ||
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*L1/2: right paracentral disc protrusion. | |||
*L2/3: A tiny 3 mm left paracentral protrusion contacts the left L3 nerve root within the lateral recess, both foramina are patent. Broad based disc bulge. | *L2/3: A tiny 3 mm left paracentral protrusion contacts the left L3 nerve root within the lateral recess, both foramina are patent. Broad based disc bulge. | ||
*L3/4: facet joint effusions and minor spurring. Minor annular bulging. | *L3/4: facet joint effusions and minor spurring. Minor annular bulging. | ||
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*L5/S1: broad disc bulge. | *L5/S1: broad disc bulge. | ||
}} | }} | ||
{{Case section|Imaging 2| | |||
;Xray Pelvis and Right Hip | |||
[[File:52M CLBP Pelvis XR.jpg]] | [[File:52M CLBP Pelvis XR.jpg]] | ||
|Xray Pelvis and Lumbar Spine Report | |||
| | |*CAM deformities of the bilateral hips with mild joint space loss. | ||
| | |||
*CAM deformities of the bilateral hips with mild joint space loss. | |||
*Facet arthrosis L3 down to S1. | *Facet arthrosis L3 down to S1. | ||
}} | }} | ||
{{Case section|Examination| | |||
*Mildly overweight. | *Mildly overweight. | ||
*Negative straight leg raise and slump tests. | *Negative straight leg raise and slump tests. | ||
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*Sacroiliac joint provocation testing positive sacral thrust, but negative distraction, compression, and thigh thrust tests | *Sacroiliac joint provocation testing positive sacral thrust, but negative distraction, compression, and thigh thrust tests | ||
*Neurological examination is normal | *Neurological examination is normal | ||
}} | |||
{{Case section|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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*Post-procedure pain at 60 minutes: 1/10 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 | *That night the hip joint was 5/10, and low back 7/10 | ||
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{{Case section|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. | ||
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Lumbar-medial-branch-nerve-blocks2.jpg|AP View | Lumbar-medial-branch-nerve-blocks2.jpg|AP View | ||
</gallery> | </gallery> | ||
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{{Case section|Diagnosis| | |||
The diagnosis is confirmed facetogenic pain arising from the right L3/4, L4/5, and L5/S1 facet joints. He also has mild hip joint osteoarthritis which is largely asymptomatic. | The diagnosis is confirmed facetogenic pain arising from the right L3/4, L4/5, and L5/S1 facet joints. He also has mild hip joint osteoarthritis which is largely asymptomatic. | ||
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{{Case section|Management| | |||
*He proceeded to radiofrequency neurotomy of the right L2, L3, L4 medial branches, and the L5 dorsal root. | *He proceeded to radiofrequency neurotomy of the right L2, L3, L4 medial branches, and the L5 dorsal root. | ||
*He had a mild pain flare for two weeks | *He had a mild pain flare for two weeks | ||
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*His hips have not been causing any pain. | *His hips have not been causing any pain. | ||
*Subjectively he feels the procedure was very successful. | *Subjectively he feels the procedure was very successful. | ||
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{{Case section|Related Article| | |||
*[[Lumbar Facet Joint Precision Treatment]] | *[[Lumbar Facet Joint Precision Treatment]] | ||
}} | |||
{{Header tabs}} | {{Header tabs}} | ||
[[Category:Case Histories]] | [[Category:Case Histories]] |
Revision as of 20:30, 6 April 2022
The running commentary in this case history is either absent or has not been checked by a relevant specialist. If you would like to help please contact Jeremy