Differential Diagnosis for Lower Back Pain
The patient presents with lower back pain localized to the left SI joint, accompanied by spasmodic moments, tender back mice, and iron deficiency. The following differential diagnoses are considered:
- Single Most Likely Diagnosis + Sacroiliac Joint Dysfunction: The patient's symptoms of lower back pain localized to the SI joint, tenderness, and pain radiating to the buttock are consistent with SI joint dysfunction. The presence of back mice and spasmodic moments in the lumbar and mid back also support this diagnosis.
- Other Likely Diagnoses + Musculoskeletal Strain: The patient's history of lower back pain and spasmodic moments could be indicative of a musculoskeletal strain, particularly given the presence of tender back mice. + Lumbar Radiculopathy: The patient's pain radiating to the buttock and positive SLR test at 30-40° suggest possible lumbar radiculopathy, which could be contributing to the lower back pain. + Iron Deficiency-Related Myalgia: Iron deficiency can cause muscle pain and weakness, which may be contributing to the patient's lower back pain and spasmodic moments.
- Do Not Miss Diagnoses + Cauda Equina Syndrome: Although less likely, cauda equina syndrome is a serious condition that requires prompt attention. The patient's symptoms of lower back pain, radiating pain, and positive SLR test warrant consideration of this diagnosis. + Spinal Infection or Abscess: Infection or abscess in the spine can cause severe back pain, muscle spasms, and tenderness. Although rare, this diagnosis should not be missed due to its potential severity. + Ovarian Cyst or Torsion: In a female patient, ovarian cyst or torsion can cause lower back pain and should be considered, especially if the pain is severe and accompanied by other symptoms such as nausea or vomiting.
- Rare Diagnoses + Spondyloarthritis: Conditions like ankylosing spondylitis or psoriatic arthritis can cause lower back pain, stiffness, and sacroiliac joint dysfunction. Although rare, these conditions should be considered in patients with persistent or severe symptoms. + Spinal Tumor: A spinal tumor can cause lower back pain, muscle weakness, and spasms. Although rare, this diagnosis should be considered if the patient's symptoms are severe, progressive, or accompanied by other red flags such as weight loss or neurological deficits.