Left flank pain. Differential Diagnosis.

Quick case here.

I have a current 31 year old female patient who is seeking my care for shoulder pain following a work injury.  She arrived to our clinic the other day with excruciating left flank pain.

Subjective: She says she started having left low back pain that morning but very mild.  However, when she got to our clinic and used the restroom, her back pain became excruciating (10/10…to the point of tears).  She said it hurt more while using the restroom.

What is your diagnosis so far? 

Upon further questioning, she said she had some painful urination (dysuria) for the last few days but wasn’t as bad as currently in the clinic.

Does this change your diagnosis?

Upon further questioning, I ask the patient what she thinks is her problem.  She says a kidney stone.

Does this change your diagnosis?

She had reproduction of symptoms with percussion sign over involved costovertebral junction of 12th rib.

Should you perform further mechanical testing (i.e. active range, passive physiologicals?) or do you have enough info?

…………

I referred out immediately….

Okay, so this case was quite straight forward to refer out but good to share.

One thing I wanted to highlight is my question of “what do you think is your problem?”.  This is a simple question and we forget it sometimes.  Patients often times know is something is “mechanical or non-mechanical”.

Follow-up: She came back to me a few days later and said CT scan showed kidney stone in ureter (actually on both sides) and she thinks the stone has passed on one side but not the other.  She was put on morphine in the ER and now on Norco at home.  Occassional sharp back pain and is scheduled to see urologist.

Filed under: Differential Diagnosis, Lumbar Spine/SIJ