A Pain In The Butt (and Back)

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A Pain In The Butt (and Back) - Page #1

Author: Kiyomi Goto, DO Co Author #1: Jeanne M. Doperak, DO Patient Presentation: 71-year-old seasoned male equestrian with history of prior T1 compression fracture presents with back pain after being thrown from a horse 5 days prior. History: He was riding on a trail when he and the horse moved in opposite directions, causing him to fall directly onto his left buttock. He felt immediate pain radiating into his leg and lower back. Pain worsened with forward flexion and diminished in the supine position. He was evaluated at an urgent care center for his back pain following the initial injury where plain film x-rays were done. Denied any bowel or bladder incontinence/retention, saddle anesthesia, paresthesias or weakness of the lower extremities. Past Medical/Surgical Hx: non-contributory Allergies: None Medications: ASA, simvastatin Social Hx: No IV drug or ETOH use Physical Exam: He is able to ambulate without difficulty and to sit comfortably. He has minimal pain upon palpation to the midline lumbar spine. He has full active flexion of the lumbar spine albeit with some discomfort. He is able to extend and twist his trunk without pain. Patellar and Achilles reflexes are 2+ bilaterally. He has a negative straight leg raise. He has full strength and sensation in the bilateral lower extremities. Pain and radiation are reproducible with palpation over the left gluteal muscle. He is neurovascularly intact. Click here to continue. Challenge yourself by writing down a broad differential diagnosis before moving to the next slide.		Back
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