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Rock Street, San Francisco

Acute low back pain in
quality inspector

Patient history

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Male patient, 32,
Indian, presented to first aid room in residence camp with severe low back pain
of rapid sudden onset, around 6 hours ago, sharp but tolerable at onset with
gradual progress into intolerable by noon, which drove patient to seek medical
attention. No specific factors provoked pain or triggered onset. Patient cannot
recall factors alleviating or worsening pain. Pain in lumbosacral area without
strict localization is constant and sharp, irradiates into thighs bilaterally.
Walking and sitting are painful, with grimace, gait is slow, painful.

NSAID injection
offered in first aid room and patient transferred for neurologist assessment.

No previous history
of backache; denies recent back injury. General medical history unremarkable.

Family history:
unremarkable.  

Non-smoker, denies
alcohol consumption.

Occupational
history:

Current position:
quality welding inspector, 4 years of employment. Routine requires frequent
climbing ladders to/from excavations, squatting (occasional, not repetitive),
walking long distances (few kilometres per day), but rather occasionally, prolonged
sitting in vehicle travelling between inspection points. No manual handling,
lifting, pulling or pushing of weights are required. Spends 1-2 hours a day at
table in office for reporting and image interpretation. Normal work shift is 10
hours, 6 days a week. No major changes to routine reported within last months. Work
load is of moderate psychological demand with strict time frames of work
completion, requiring reasonable self-pacing. Accuracy and precision of test
interpretation are mandatory. 

For the last year
patient lives in residential camp. He denies hobbies after business, preferring
sedentary life.   

Clinical examination

Alert, completely
oriented, lying on couch because of severe lumbosacral pain. Notable hyperesthesia,
does not allow touching any area of skin, screaming of pain at light touch. Back
pain irradiates to anterior aspects of both thighs. Allowed examination after IM
injected NSAID.     

Weigh 92kg

Height 168cm

BMI32.6

HEENT – unremarkable

Pulse 78BPM

BP 121/75mmHg

SpO2 98% room air

T36.4°C

No respiratory
distress. System examination – unremarkable.

Back examination –
unremarkable except superficial dermal hypersensitivity in lumbar, sacral and
gluteal areas.

Neurological
examination – unremarkable, reflexes normal, muscular strength 5/5, no sensory-motor
deficit.

Positive straight leg
raising test, no signs of cauda equina syndrome, or bladder dysfunctions.

Schober test: flexion

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