A 60-year-old construction worker presents to your office with a one-week history of back pain. The pain is brief, severe, and radiates along the posterior surface of the right thigh. It is provoked by bending forward and straining, and abates on lying down. His past medical history is insignificant. He has tried several over-the-counter pain relievers without success. Which of the following is most likely to be present in this patient?

Question

Quizplus · Accepted Answer

Explanation: The characteristics of the back pain described in this scenario are typical for nerve root irritation. The pain is frequently brief and shooting, and radiates along the corresponding nerve distribution. It can be provoked by forward bending, coughing, or straining, and it diminishes on lying down. A positive straight-leg raising test at a 60 degree angle or less is characteristic. (Choice E)Spinal stenosis is responsible for neurogenic claudication. In contrast to radiculopathy, the pain in spinal stenosis increases with extension of the spine and decreases with flexion of the spine. (Choice A) Night pain is considered an 'alarm' symptom. Night pain may indicate the presence of malignancy, infection, or vertebral fracture. (Choice B) Morning stiffness is typical for inflammatory diseases. (Choice D) Trigger points are characteristic for fibromyalgia. Educational Objective: Careful history and physical examination are helpful in the differential diagnosis of back pain. Brief and shooting back pain provoked by bending forward and straining is typical for nerve root irritation. A positive straight-leg raising test at 60 or less is usually present.

A 60-Year-Old Construction Worker Presents to Your Office with a One-Week