Differential Diagnosis for Back Pain
The patient's history and physical examination reveal a complex presentation of back pain, with various factors contributing to the condition. The following differential diagnosis is organized into categories to facilitate a thorough evaluation.
- Single Most Likely Diagnosis
- Lumbar Disc Degeneration or Herniation: The patient's history of heavy lifting, sudden back snap, and bulge in vertebrae S1, L5, L4, along with the exacerbation of pain during certain yoga positions and activities, suggests a degenerative or herniated disc. The improvement in back pain after long hikes with a supportive backpack may indicate that the condition is responsive to stabilization and support.
- Other Likely Diagnoses
- Lumbar Facet Joint Syndrome: The patient's pain during upward-facing dog, bending, and twisting, as well as the relief during plank and bridging exercises, may indicate facet joint involvement.
- Sacroiliac Joint Dysfunction: The patient's history of heavy lifting, sudden back snap, and pain during certain activities, such as bending and twisting, may suggest sacroiliac joint dysfunction.
- Hamstring Strain or Tightness: The patient's tight hamstrings, limited forward bending, and pain during straight leg raise may indicate a hamstring strain or tightness contributing to the back pain.
- Do Not Miss Diagnoses
- Cauda Equina Syndrome: Although less likely, cauda equina syndrome is a serious condition that requires prompt attention. The patient's history of sudden back snap, bulge in vertebrae, and pain during certain activities may warrant consideration of this diagnosis.
- Spinal Stenosis: The patient's age, history of heavy lifting, and pain during certain activities may suggest spinal stenosis, which can be a progressive condition.
- Infection or Tumor: Although rare, infection or tumor should be considered in the differential diagnosis, especially if the patient presents with systemic symptoms, such as fever, weight loss, or night pain.
- Rare Diagnoses
- Spondylolisthesis: The patient's history of heavy lifting and sudden back snap may suggest spondylolisthesis, although this is a less common condition.
- Spondylosis: The patient's age and history of heavy lifting may suggest spondylosis, although this is a less common condition.
A thorough evaluation, including imaging studies and further physical examination, is necessary to confirm the diagnosis and develop an effective treatment plan.