Differential Diagnosis for 48-year-old Female with Back Pain and Radiating Symptoms
Single Most Likely Diagnosis
- Lumbar Spinal Stenosis: This condition is characterized by narrowing of the spinal canal, which can cause back pain radiating down both legs, positive straight leg raise test, and symptoms in the hands and wrists due to possible cervical spine involvement or referred pain. The patient's age and symptom distribution make this a plausible diagnosis.
Other Likely Diagnoses
- Degenerative Disc Disease: This condition can lead to back pain and radiating symptoms down the legs due to herniated discs compressing nerves. It could also explain hand and wrist symptoms if there's cervical spine involvement.
- Fibromyalgia: Although less likely given the specific neurological signs (positive straight leg raise), fibromyalgia can cause widespread pain, including back pain and pain in the hands and wrists, along with numbness.
- Rheumatoid Arthritis: This autoimmune disorder can cause pain and stiffness in the hands and wrists, and although less common, can also involve the spine, leading to back pain and radiating symptoms.
Do Not Miss Diagnoses
- Cauda Equina Syndrome: A medical emergency where the nerves in the spinal canal are compressed, leading to severe back pain, sciatica, and potentially bladder and bowel dysfunction. The presence of bilateral leg pain and positive straight leg raise tests necessitates consideration of this diagnosis.
- Spinal Epidural Abscess: An infection in the spinal canal that can cause back pain, radiating pain, and neurological deficits. It's a rare but potentially deadly condition if not promptly treated.
- Multiple Myeloma: A type of blood cancer that can cause back pain due to vertebral body fractures or infiltration of the bone marrow. It's less likely but critical to diagnose early due to its severity.
Rare Diagnoses
- Neurosyphilis: A complication of untreated syphilis that can cause a wide range of neurological symptoms, including back pain and radiating symptoms down the legs.
- Sarcoidosis: An autoimmune disease that can affect multiple parts of the body, including the spine, leading to back pain and neurological symptoms.
- Arachnoiditis: Inflammation of the membranes surrounding the spinal cord, which can cause severe back pain, numbness, and tingling in the legs, and less commonly, in the hands and wrists.