Differential Diagnosis for Lumbar Facet and SI Joint Pain
Single Most Likely Diagnosis
- Lumbar Facet Syndrome or Sacroiliac Joint Dysfunction: The patient's symptoms of mild to moderate pain on lumbar facets and SI joint, positive Kemp's test (which indicates lumbar facet joint pain), and onset after pregnancy and carrying a 3-month-old baby, suggest a mechanical issue related to these joints. The increased stress and altered biomechanics during pregnancy and postpartum, especially with lifting and carrying a baby, can exacerbate or precipitate facet joint pain and SI joint dysfunction.
Other Likely Diagnoses
- Postpartum Low Back Pain: This is a common condition following pregnancy, often related to the physical demands of childcare, hormonal changes, and residual effects from pregnancy on the musculoskeletal system.
- Musculoskeletal Strain: Lifting and carrying a baby can lead to strain on the back muscles, contributing to pain in the lumbar region and SI joint.
- Pelvic Girdle Pain: This condition, also known as symphysis pubis dysfunction, can occur during or after pregnancy, causing pain in the pelvic area, lower back, and sometimes the SI joints.
Do Not Miss Diagnoses
- Osteoporotic Compression Fracture: Although less likely, it's crucial not to miss this diagnosis, especially in postpartum women with risk factors for osteoporosis. Compression fractures can cause sudden onset of back pain.
- Spinal Infection or Osteomyelitis: Infections of the spine are rare but serious conditions that require prompt diagnosis and treatment. They can present with back pain and may be associated with fever, chills, or other systemic symptoms.
- Cauda Equina Syndrome: A medical emergency characterized by low back pain, sciatica, and signs of nerve root compression, such as bladder or bowel dysfunction. It requires immediate medical attention.
Rare Diagnoses
- Spondylolisthesis: A condition where one of the vertebrae slips forward over the bone below it, which can cause lower back pain and may be exacerbated by the physical stresses of pregnancy and childcare.
- Sacroiliac Joint Infection: A rare condition that can cause pain in the SI joint area, often accompanied by systemic signs of infection.
- Spinal Tumor: Although very rare, spinal tumors can cause back pain and should be considered in the differential diagnosis, especially if there are red flags such as unexplained weight loss, night pain, or a history of cancer.