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SOAP man with pain in his left leg.
Case 4
A 38-year-old man complains of pain in his left leg. Three weeks earlier, while helping a friend move, he
felt a “pop” in his back. Later that day, he noticed aching in the left hip. The next morning, he
experienced sharp shooting pains from the left buttock and hip region down the posterior aspect of the
leg, and “pins and needles” sensations in the sole of the left foot. The pain was worsened by sitting and
standing. There was no weakness, numbness, or sphincter symptoms. There was no history of back
trauma.
1) Summarize the case briefly, including neuroanatomic localization and pathogenesis.
2) What is the most likely diagnosis? Name 1-2 alternative diagnoses, and discuss briefly why these
are less likely.
3) What additional information (history, exam, laboratory or other studies, consultations) would you
obtain? What laboratory findings would you expect if your most likely diagnosis is correct?
4) Assuming your most likely diagnosis is correct, how would you manage this patient? Include doses
for one medication you might prescribe, along with an estimate of the cost of a month of your
proposed therapy. How would you counsel the patient about his condition and about any proposed
therapy?
SOAP man with pain in his left leg.
Case 4
A 38-year-old man complains of pain in his left leg. Three weeks earlier, while helping a friend move, he
felt a “pop” in his back. Later that day, he noticed aching in the left hip. The next morning, he
experienced sharp shooting pains from the left buttock and hip region down the posterior aspect of the
leg, and “pins and needles” sensations in the sole of the left foot. The pain was worsened by sitting and
standing. There was no weakness, numbness, or sphincter symptoms. There was no history of back
trauma.
1) Summarize the case briefly, including neuroanatomic localization and pathogenesis.
2) What is the most likely diagnosis? Name 1-2 alternative diagnoses, and discuss briefly why these
are less likely.
3) What additional information (history, exam, laboratory or other studies, consultations) would you
obtain? What laboratory findings would you expect if your most likely diagnosis is correct?
4) Assuming your most likely diagnosis is correct, how would you manage this patient? Include doses
for one medication you might prescribe, along with an estimate of the cost of a month of your
proposed therapy. How would you counsel the patient about his condition and about any proposed
therapy?SOAP man with pain in his left leg.