DOI: 2/10/1987. Patient is a 70-year-old male truck driver who sustained injury when he lost footing and twisted his back. Per OMNI, he is status post fusion at L4-S1 in 1989, with hardware removal in 1996.
Based on the medical report dated 11/07/16 by Dr. Moelleken, the patient reports an intermittent stabbing pain, at the midline. At time of evaluation he rates the pain a 9/10 on the pain scale. He reports radiation of pain and weakness to the bilateral lower extremities following standing or walking for longer than 15 minutes.
He notes sitting, standing, and walking for 15 minutes exacerbates the low back pain. History of treatment includes 12 acupuncture sessions, 4 chiropractic sessions, multiple PT sessions, 3 epidurals of the back and medications. It was noted that the patient has had MRI’s in 1990’s, with no reports available.
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Range of motion (ROM) shows flexion of 30 degrees and extension and bilateral lateral bend of 10 degrees. Motor strength testing shows 4-/5 with bilateral psoas and quadriceps. Reflexes are hyporeflexic to the lower extremities.
Current medications include Ketoprofen, Flexeril cream, and over-the-counter Aleve.
Of note, Xrays of the lumbar spine obtained on 03/10/15 showed L4-S1 fusion and L2-L3 severe disc space narrowing with retrolisthesis.
IW was diagnosed with failed back surgery syndrome, lumbago and lumbar degenerative disc disease. Plan is for an MRI of the lumbar spine. The patient wants to consider his interventional treatment options and his previous studies are outdated from an interventional standpoint.
Patient was dispensed #60 naproxen 500mg and Flexeril cream. He will likely require a CT scan of the lumbar spine after the
Pain was significantly increased with flexion and extension. Sensation is decreased in the bilateral upper extremities. Strength is decreased in the bilateral upper extremities.
The patient is a 45 year old male who was in a car accident that
Saris, S. (2011). Patient Guide to Minimally Invasive Lumbar Microdiscectomy. Retrieved 10 19, 2011, from Neurosurgery Associates: Rhode Island and Southeastern Massachusetts: http://neurosurgery-associated.com/min.htm
L. H. a 22-year-old female who came into the clinic as a new patient complaining of lower back pain. Vital signs include: height 62 inches, weight 108 lbs., and 16 respirations. The patient stated that her back pain has gone on for quite sometime now (about 2 years total). She works as a nursing assistant in a nursing home in Wahoo. The physician stated that he wanted to taper her off tramadol (she takes 150 mg a day). He also wants to taper her off Effexor as well. The doctor noticed that the painful region was in the patient’s upper left side of her back. He recommended to the patient that L1 to L2 and L2 to L3 facets would benefit from steroid injections. The patient and her mother wanted to make sure they met their
In 1993, Will, a 49-year-old pipeline welder started experiencing back pain. At first he believed the pain was due to normal muscle strain after working hard on the job, but many years later the pain still hadn't subsided, and had become increasingly worse. In 2002, Will was experiencing higher levels of pain in his lower back, and pain traveling down the back of his left leg. Over the course of a year this pain grew into a stabbing sensation in his thigh, that would come and go in electric shock like bursts. Will was having a difficut time working with sudden onsets of debilitating pain so he decided to take some time off from work and consult his doctor.
On admission, a complete physical assessment was performed along with a blood and metabolic panel. The assessment revealed many positive and negative findings. J.P. was positive for dyspnea and a productive cough. She also was positive for dysuria and hematuria, but negative for flank pain. After close examination of her integumentary and musculoskeletal system, the examiner discovered a shiny firm shin on the right lower extremity with +2 edema complemented by severe pain. A set of baseline vitals were also performed revealing a blood pressure of 124/80, pulse of 87 beats per minute, oxygen saturation of 99%, temperature of 97.3 degrees Fahrenheit, and respiration of 12 breaths per minute. The blood and metabolic panel exposed several abnormal labs. A red blood cell count of 3.99, white blood cell count of 22.5, hemoglobin of 10.9, hematocrit of 33.7%, sodium level of 13, potassium level of 3.1, carbon dioxide level of 10, creatinine level of 3.24, glucose level of 200, and a BUN level of 33 were the abnormal labs.
Weight 195.2 pounds, BP 118/68, pulse rate 63, temperature 97.4, respiration rate 14. The gait once again is not antalgic. He can perform a full squat without difficulty. Single leg squats reveal knee adduction bilaterally, which is mild. Palpation of the lower back shows only mild tenderness at the lower lumbar paraspinals and only at the right sciatic notch, not at the sciatic nerve trunk exit. Motor power in the lower extremities is at the 4+/5 both proximally and distally. Sensation remains diminished in the L5-S1 distribution. Reflexes were present at the knees bilaterally and absent at the right ankle, but now present at the left. Toes were downgoing. The straight leg raising maneuver was negative. The figure-of-four test revealed lower back pain
The term herniated disc refers to an unnatural protrusion of the spinal disc between vertebrae. The disc is an intervertebral piece of cartilage (it lies between the bones of the spine) that is smooth, rubber-like and absorbs shock. It allows slight movement of the vertebrae and acts as a ligament that holds everything in the spine together.
Tests after tests including MRI’s, X-rays, and experimental procedures were performed to show I had five ruptured disks in the lower lumbar section of my back. Tedious Examination done by a group of doctors concluded I had a crippling disease of the spinal column called spinal stenosis. Spinal stenosis is a narrowing of the spinal canal that causes compression of the spinal cord. (Lohr,1) If this disease was ignored any longer, it would lead to many other problems affecting other areas of my back to help support this weakness. It was an extremely rare case for an athlete my age.
Balta, D. M. D. (2009). The TMJ: How can Such a Small Joint Cause so Much Trouble?, [Online]. Available: http://www.drbalta.com/tmj.htm [11/12/14].
Vasconcelos, O., Rodrigues, P., Barreiros, J. & Jacobsohn, L. (2009). Laterality, developmental coordination disorders and posture. In L. P. Rodrigues, L. Saraiva, J. Barreiros & O. Vasconcelos (Eds.) Estudos em desenvolvimento motor da criança II (pp.19-26). Escola Superior de Educação, Instituto Politécnico de Viana do Castelo.
Simple musculoskeletal back pain has symptoms of pain in the lumbrasacral area of the back (Jackson & Simpson, 2006). The upper thighs and knees are also known to be affected (Jackson & Simpson, 2006). This pain is usually described as a dull pain (Jackson & Simpson, 2006). Spinal nerve root pain is localised down the leg, and usually continues below the knee and into the feet (Jackson & Simpson, 2006). It has been d...
Back with no tenderness over her kidney area. She does have a scar in her low back. Scar is surrounded by some blotchy redness, but the patient states this always looks like this. She does have pain to palpation above the scarred area and her low back. She has decreased range of motion of her low back, in general. Flexion however, causes significant pain and she is reluctant to do this. She has no pain when flexing her neck.
This was his second episode since 10 days ago where he develop the same pain at his right flank. He suddenly experienced severe pain 8 hours before admission when the pain shifts to his right lower quadrant of his abdomen. The onset is at 6.30 am before worsening at 10 p.m to 2 p.m. He described the pain as continuous sharp pain and gradually increased in severity. There is no radiation of the pain. The pain was exaggerated on movement and touch. There were no relieving factor and he scale the severity as 7/10. He experienced fever for 1 day prior to admission. It was a mild grade continuous fever. He does not experienced chills and rigor. The patient does not experience any nausea or vomiting, no dysphagia, no pain during micturition and no alteration in bowel habit. He experienced loss of appetite but not notice any weight loss.
The Indian retail industry has emerged as one of the most dynamic and fast-paced industries due to the entry of several new players. It accounts for over 10 per cent of the country’s Gross Domestic Product (GDP) and around 8 per cent of the employment. India is the world’s fifth-largest global destination in the retail space.