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A 45-year-old man had sudden onset of searing low back pain (LBP) with radiation into the right buttock
lateral thigh and calf yesterday while lifting a heavy chair. He has had difficulty dorsiflexing his right
ankle since yesterday, but is now having trouble standing on the toes of his right foot. Currently, there is
numbness in the distribution of the searing pain and also on the rightward half of his genitals. Although
he is bothered by some new bladder difficulties, he is most concerned about a bowel accident this
afternoon.
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? How would you
monitor his condition and its treatment? What is the prognosis?
Case 24:Soap note on low back pain
A 45-year-old man had sudden onset of searing low back pain (LBP) with radiation into the right buttock
lateral thigh and calf yesterday while lifting a heavy chair. He has had difficulty dorsiflexing his right
ankle since yesterday, but is now having trouble standing on the toes of his right foot. Currently, there is
numbness in the distribution of the searing pain and also on the rightward half of his genitals. Although
he is bothered by some new bladder difficulties, he is most concerned about a bowel accident this
afternoon.
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? How would you
monitor his condition and its treatment? What is the prognosis?
Soap note on low back pain