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Test
Your Knowledge #4-What is your diagnosis in this patient with mid-back pain? by Alan Matsumoto, M.D. |
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| A 56 year old woman is referred to rheumatology for complaints of severe back pain for the past 3 months. There is no clear history of antecedent trauma or injury. She otherwise feels well without systemic complaints. Specifically there is no history of fever, chill, night sweats or weight loss. The pain is localized to the back without radiation to the legs. There is no history of leg weakness, paresthesias or lower extremity claudication. The pain does not improve with recumbancy and often keeps her up at night. Her referral states that she has had unremarkable lumbar spine x-rays with the exception of scoliosis. Her past medical history is significant only for mild hypertension treated with a diuretic.
On examination, her vital signs are normal. Her general exam is unremarkable. There is adenopathy. Her abdomen is soft without masses or bruits. Peripheral joints show no signs of inflammation. Peripheral pulses are full and symmetric. Strength and sensation in her lower extremities is intact. Tendon reflexes are normal. Straight leg raising test is negative. She has marked tenderness to percussion over her mid-back.
1. Based upon her history and examination you consider the following diagnostic possibilities: b. Soft tissue/non-specific back pain d. Tumor d. Compression Fracture d. Spondyloarthropathy d. Abdominal aortic aneurysm |
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