Differential Diagnosis for Lower Back Pain
The patient presents with lower back pain that started after lifting a heavy box, limited range of motion, and fever. Here's a differential diagnosis organized into categories:
Single Most Likely Diagnosis
- Musculoskeletal Strain: This is the most likely diagnosis given the onset of pain after lifting a heavy box. The limited range of motion and presence of fever could be indicative of an inflammatory response to the injury. Musculoskeletal strain is a common condition that typically resolves with rest, physical therapy, and pain management.
Other Likely Diagnoses
- Herniated Disc: The patient's symptoms could be consistent with a herniated disc, especially if the lifting caused a disc to bulge or rupture, putting pressure on nearby nerves. Fever might not be a typical symptom but could occur if there's an associated infection or significant inflammation.
- Degenerative Disc Disease: While less directly related to the acute onset after lifting, if the patient has pre-existing degenerative disc disease, the lifting could have exacerbated the condition, leading to increased pain and limited mobility.
- Spondylosis or Spondylolisthesis: These conditions involve defects in the vertebrae or the slipping of one vertebra over another, which could be exacerbated by lifting and result in pain and limited range of motion.
Do Not Miss Diagnoses
- Spinal Epidural Abscess: Although less common, this condition is potentially life-threatening and requires immediate medical attention. Symptoms can include back pain, fever, and limited mobility, making it a critical diagnosis not to miss.
- Osteomyelitis or Discitis: Infections of the bone or disc can present with back pain, fever, and limited range of motion. These conditions require prompt diagnosis and treatment to prevent serious complications.
- Cauda Equina Syndrome: A medical emergency characterized by compression of the nerves in the lower spine, which can result from a herniated disc or other conditions. Symptoms include severe back pain, bowel or bladder dysfunction, and sensory changes in the legs.
Rare Diagnoses
- Spinal Tumors: Both primary and metastatic tumors can cause back pain, but they are less common and might not have such an acute onset directly related to lifting. However, they should be considered, especially if other risk factors are present.
- Inflammatory Spondyloarthropathies: Conditions like ankylosing spondylitis could present with back pain and stiffness, but the acute onset after lifting and presence of fever would be unusual for these chronic conditions.