Differential Diagnosis — Low Back & Lower Extremity Case: Part 2

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Before reading the objective findings below, make sure you read the subjective history taking in Part 1 here of this differential diagnosis case.

Observation: Slouched posture. Decreased lumbar lordosis.

Gait: Stiff leg, wide-based gait pattern with very little knee flexion and hip extension.

Tenderness: Generalized tenderness in lower lumbar spine and SIJ with no particular one location.  This is the same in weight-bearing (standing/sitting) and non weight-bearing (prone).

Palpation: No warmth to and around the lumbar spine and pelvis.

Lumbar ROM: Painful in all directions but only limited by 25%. No particular DP. Symptoms are generalized in lumbar spine.  No peripherlization or centralization of symptoms with repeated movement exam in standing or prone.

Hip and knee ROM: Normal and unremarkable in all planes.

MMT: 4/5 hip flexion that causes low back pain.  Both knee flexion and knee extension is 4+/5 that also causes low back pain.  No myotomal weakness or remarkable findings distally.

Neurological: 

– Negative SLR and prone femoral neural tensioning test.

3+ B L4, 3+ B S1.

+ Babinski

– Hoffman sign

– Supinator sign

– 2+ B C5-C7

Based on the above information,

What are your top 3 differential diagnoses?

What type of information did you gain from the video above?

What other objective findings would you look for / test?

Would you treat, refer or treat and refer; and why?

Filed under: Differential Diagnosis, Lumbar Spine/SIJ http://intouchpt.wordpress.com/