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FA, 42-year-old Caucasian male “Lowest back pain for the past month” FA is a 42-year-old Caucasian male who presents to the clinic due to lower back pain that c has been ongoing for the past one month. FA stated that his pain started after attempting to lift a heavy table in his home from one part of the house to another one month ago. Patient reports that resting and taking Ibuprofen to reduce the pain, while his pain increases with activity. FA rates his pain at 5 on the 0-10 pain scale, as aching/dull that radiates to her left leg intermittently. Denies any allergy. Up to date to immunization. Last influenza and pneumonia vaccine was November 2019. No past medical history noted. No previous hospitalization or blood transfusion. FA owns a local car repair shop. He is married with 2 young kids 10 and 8 years old. Patient is deeply involved in the local catholic church and is a choir master. Denies use of illicit drug and tobacco. States he is a social drink and consumes 2-3 beer weekly. Exercises regularly. Father, Alive 72, HTN. Mother, Alive 68 Diabetes. Paternal Grandfather: HTN, deceased at age 78 from stroke. Paternal Grandmother: Alive, 95, Anxiety. Maternal Grandfather: Alive, 93 HTN, Hyperlipidemia. Paternal Grandmother: Alive, 88 Type 11 diabetes (controlled with diet). Daughter: No medical history, age 10. Son: No medical history, age 8. Pt denies fever and fatigue. Denies weight loss. Pt headache, dizziness, syncope, paralysis, ataxia, numbness or tingling in the extremities. No change in bowel or bladder control. : Eyes: T denies visual changes. Ears: denies hearing loss. Nose: Denies rhinorrhea. No hearing loss. Sneezing, runny nose or sore throat. : Denies sore throat. Pt denies rash, abrasions, or bruising denies rash. Pt denies chest pain, chest pressure or chest discomfort. palpitation, and tachycardia. Pt denies SOB, Cough congestion or congestion. Respiratory: Reports aching/dull lower back pain. Reports a limited range of motion with bending. Pain occasionally radiated to left leg. Vitals: T: 98.0, HR: 78, RR: 18, BP: 128/70, O2sat: 98% on RA. Pain 5/10 Pt is AAOx4. Well-groomed male calm and cooperative Able to communicate fluently, with a good eye contact. Appears in no acute distress. No signs of dizziness, no problems with gait or posture noted. 4/5 strength with dorsiflexion and toe extension in LLE. 5/5 strength with dorsiflexion and toe extension in RLE. No decreased sensation to BUE and BLE. EOMI, PERRLA, pupil round and reactive to light, moist mucus membrane noted. No head injury noted, oral mucosa dry. No edema noted on extremities No abrasions, and cyanosis. Skin taut, non-tenting, and atraumatic. S1, S2 noted with a regular rhythm. No murmur, gallops, or extra heart sounds. : Lungs sound clear on auscultation. No adventitious breath sounds noted. No scoliosis noted.  Negative Sciatic Nerve, Negative Mackiewicz sign in bilateral lower extremifies. Negative Lasegue’s sign in left lower extremity. Pain noted on palpation of L5. Patellar reflex 2+ bi

laterally. Full range of motion in torso extension and lateral flexion. Limited range of motion with flexion and lateral rotation of torso related to pain. Lumbosacral Radiculopathy According to the scenario presented, the probable nerve that are involved are L4-S1. The cause could also be from lumbar two, three, and four (L2,3,4) (Ball, Dains, Flynn, Solomon, & Stewart, 2019). The straight leg test is used to test for L4-S1 abnormalities (Standford Medicine 25, n.d.). The femoral stretch test is used to test for L2,3,4 abnormalities (Mackiewicz sign). Also, using the patient’s history, such as pain onset, location, duration, character, aggravating and relieving factors could help in diagnoses (Ball et al., 2019). I chose these 5-differential diagnosis, disc herniation, vertebral osteomyelitis, lumbar stenosis, paraspinal muscle strain, and piriformis syndrome. The assessment and diagnosis of the lower back pain should involve examination of gait, posture, range of motion, inspection, and palpation of the painful location (Bratton, 1999). Assessment should include asking the patient to bend forward in flexion, extension, lateral flexion, and lateral rotation to evaluate the range of motion and limitation (Bratton, 1999). References American Association of Neurological Surgeons. (n.d.). Lumbar spinal stenosis. Retrieved January 13, 2020, from Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). (9th ed.). St. Louis, MO: Elsevier Mosby. Boyajian-O’Neill, L. A., McClain, R. L., Coleman, M. K., & Thomas, P. P. (2008). Diagnosis and management of Piriformis Syndrome: An osteopathic approach. , , 657-664. Retrieved from Bratton, R. L. (1999). Assessment and management of acute low back pain. , (8), 2299-2306. Retrieved from Cooper, R. G. (1993). Understanding paraspinal muscle dysfunction in low back pain: A way forward? , (6), 413. https://doi.org/10.1136/ard.52.6.413 Crowley, K. (n.d.). Patient education: Muscle strain (The Basics). Retrieved January 12, 2020, from Engle, A. M., Chen, Y., Marascalchi, B., Wilkinson, I., Abrams, W. B., He, C., Yao, A. L., Adekoya, P., Cohen, Z. O., & Cohen, S. P. (2019). Lumbosacral Radiculopathy: Inciting Events and Their Association with Epidural Steroid Injection Outcomes. , (12), 2360–2370. https://doi-org.ezp.waldenulibrary.org/10.1093/pm/pnz097 Hsu, P. S., Armon, C., & Levin, K. (2019). Acute lumbosacral radiculopathy: Pathophysiology, clinical features, and diagnosis. Retrieved January 12, 2020, from McDonald, M., & Peel, T. (2019). Vertebral osteomyelitis and discitis in adults. Retrieved January 12, 2020, from Patricios, J. (2019). Adductor muscle and tendon injury. Retrieved January 12, 2020, from Roblot, F., Besnier, J. M., Juhel, L., Vidal, C., Ragot, S., Bastidies, F., … Godet, C. (2007). Optimal duration of antibiotic therapy in vertebral osteomyelitis. , (5), 269-277. https://doi.org/10.1016/j.semarthrit.2006.09.004 Standford Medicine 25. (n.d.). Approach to the low back exam. Retrieved January 12, 2020, from