Differential Diagnosis
- Single most likely diagnosis
- E) Osteoporotic compression fracture: The patient's sudden onset of severe low back pain without radiation to the lower extremities, triggered by lifting a heavy object (her grandson), and her long history of rheumatoid arthritis treated with prednisone (which can lead to osteoporosis due to chronic steroid use), make this diagnosis the most likely. The exquisite tenderness to percussion over the lumbar spine further supports this diagnosis.
- Other Likely diagnoses
- D) Muscle strain: Given the context of lifting a heavy object, muscle strain is a plausible diagnosis, although the severity of the pain and the presence of exquisite tenderness to percussion over the lumbar spine might suggest a more serious condition.
- A) Herniated disc: Although less likely due to the lack of radiating pain and the negative straight-leg raising test, a herniated disc cannot be entirely ruled out without further imaging.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- G) Spinal epidural abscess: This is a medical emergency that requires prompt diagnosis and treatment. Although the patient's temperature is normal, and there's no mention of fever or other systemic symptoms, the severe back pain and history of chronic steroid use (which can suppress the immune system) make it essential not to miss this diagnosis.
- C) Metastatic cancer: Given the patient's age and the sudden onset of severe back pain, metastatic cancer to the spine is a possibility that should be considered, especially if there's a known history of cancer or if initial diagnostic tests do not reveal another cause.
- Rare diagnoses
- F) Sacroiliitis: This condition is less likely given the location of the pain (lumbar spine) and the lack of symptoms suggestive of sacroiliac joint inflammation.
- H) Spondylolisthesis: While possible, this condition would more likely present with a history of gradual onset back pain and possibly neurological symptoms, which are not described in this case.
- B) Lumbar spinal stenosis: Typically presents with neurogenic claudication (pain, weakness, or fatigue in the legs and buttocks brought on by walking or standing), which is not consistent with this patient's symptoms.