Presentation:
Leigh, a 36 year old computer engineer presented with gradually worsening low back pain. This had been going on for approximately 2-3 years.
Symptoms:
Leigh’s pain was described as “a deep, dull, ache”. While largely localised to the lumbo-sacral junction, it had recently begun to spread to the thoraco-lumbar region. There was no peripheralisation, Valsalva was negative and there were no Cauda Equina symptoms.
History:
The symptoms began very gradually over the previous 2-3 years. There was no obvious etiology and he had suffered no trauma. He had no prior history of illness but had been recently experiencing occasional fevers and bouts of photophobia. His GP had assessed this to be due a mild viral infection.
He was on no regular medication.
Examination:
Leigh was slightly overweight, with a stocky build. His cervical ranges of motion were all normal and pain free. His lumbar ranges of motion were slightly reduced by stiffness in the mid-range with a soft end-range restriction due to pain. This was largely around the lumbo-sacral region.
Orthopaedic:
All orthopaedic tests were unremarkable with the exception of the Supported Adam’s Test (Belt Test) which indicated some restriction in the sacro-iliac joints.
Neurological Examination:
All cranial nerves tests were normal and bilaterally equal, as were all peripheral neurological tests.
What Is Your Provisional Diagnosis?
If You Have A Differential Diagnosis or Diagnoses, What Is It (or They)?
What Further Tests (if any) Would You Do?
Is This A Chiropractic Case?
